Americans Have Access to Dental Care

By Katherine Hobson


We don’t typically consider oral health as part of overall health, and that’s a mistake, according to a new report from the Institute of Medicine.

Because the diseases of the mouth are inextricably linked to overall health, “the unmet oral health needs of millions of Americans cannot be neglected,” the report says.

“Almost one third of the population reports some difficulty in accessing dental care,” Caswell Evans, Jr., an author of the report and associate dean of prevention and public health sciences at the University of Illinois at Chicago College of Dentistry, tells the Health Blog.

Some people lack dental insurance even though they have private health insurance.  (The CDC reported last year that of the 172 million Americans under age 65 with private health insurance, about 27% don’t have dental coverage.)

Others who lack coverage are retired — Medicare doesn’t cover dental care, with some exceptions when it’s in connection with covered procedures, like a jaw reconstruction. Some are poor; states aren’t required to provide dental coverage to adults under Medicaid. And while kids are covered by Medicaid and the Children’s Health Insurance Program, payment rates are so low many have trouble finding a dentist who will treat them.

The report calls for a host of systemic changes intended to improve access to care, including training non-dental health pros such as pediatricians and nurses to play a bigger role in oral care, a reassessment of state practice laws to be sure they promote access to care, establishing CMS-funded state demonstration projects to include essential health benefits in adult Medicaid coverage and increasing Medicaid and CHIP reimbursement rates. (A study appearing in this week’s edition of the Journal of the American Medical Association found that higher Medicaid reimbursement rates were associated with more kids and teens getting dental care.)

In a statement, the American Dental Association praises the focus on oral health access but reaffirms its opposition to allowing non-dentists to perform functions like extractions. “Everyone deserves a dentist,” the ADA says. State laws vary greatly in what they permit non-dentists to do without supervision — seven states require a dentist to be present when a hygienist applies sealants, the report says. Specially-trained dental therapists in Alaska, meantime, can drill and fill cavities — but only in Alaska Natives.

The authors said they were cognizant of the financial pressures facing the federal and state governments. Evans says marginal increases in Medicaid reimbursement rates wouldn’t be terribly burdensome, though. And the authors said they hope that providing access to basic care might save money in the long run by preventing patients from showing up in the ER with more advanced complaints.

More than a decade ago, a U.S. Surgeon General’s report also called for a “national effort to improve oral health among all Americans.”