Policymakers Taking a Look at Lack of Dental Care

The bad news is a lot of people across the country can’t get access to appropriate and timely dental care. The good news is state policymakers can help improve the situation.
That was the message delivered by speakers at a recent CSG eCademy, “How Does the ACA Change the Oral Health Landscape?” Shelly Gehshan, director of children’s dental health at The Pew Charitable Trusts, said states have been “falling down on the job” when it comes to ensuring children on public assistance programs receive the dental care they need.
“Dental care is the biggest unmet health need in the country,” Gehshan said. It’s “not health care, it’s dental care, both for adults and children.”
She said more than 47 million Americans—one out of seven—live in an area of the country where there’s a shortage of dental care.
“Dental caries (also known as cavities) are the number one chronic disease among children and yet over half of children enrolled in Medicaid didn’t get any service at all in 2013,” she said.
Gehshan said the Affordable Care Act is providing more dental coverage for children, as it is considered an essential benefit for children under the law. For adults, however, dental coverage is not considered part of the essential benefits package.
But even if children and adults have coverage, it doesn’t do much good if there are no dentists to provide that service. Gehshan said access to dental care is limited in many states because very few dentists will take new Medicaid patients and dentists are not distributed evenly across any given state.
“Coverage only matters if you actually can use it to receive services,” she said. “Coverage does not mean access. … We need to make sure there are enough providers out there that are willing, able and ready and located where the children are.”
Maine Rep. Heather Sirocki said her state this year took an innovative approach to try to increase dental health care staff by passing a bill that outlines a new category of professional called a dental hygiene therapist. Therapists must have a bachelor’s degree in dental hygiene and take an additional four semesters of coursework.
Sirocki said dental hygiene therapists will provide limited services under the direct supervision of a licensed dentist.
“A mid-level provider could really help with a lot of these practices,” she said. “Their schedules are so tight that they (a dental hygiene therapist) could ease up the dentist’s time. I was convinced that this would be a really fantastic addition to a dental team.”
In order to strengthen access and stress early intervention and prevention strategies, the American Dental Association last year rolled out an initiative called Action for Dental Health, which encourages dentists to get involved in their state.
Dr. Charles Norman, president of the American Dental Association and a North Carolina dentist in private practice since 1977, said in an interview with The Council of State Governments that it’s important for policymakers to know what is causing the lack of access to dental care. There is no one-size-fits-all solution to this problem, he said
“I don’t think you necessarily address a transportation barrier by trying to attract a private practice to an area,” Norman said. “That’s probably not going to happen. What could happen is you could have mobile dental facilities. … We have a growing population of adults living in nursing facilities. Most of those facilities don’t have an in-house dental facility. How do you get them to an office? Well, maybe the office is going to have to go to them.”
Legislators also need to look at their state infrastructure, whether through Medicaid or public health centers, and “make sure they’re adequately staffed, there’s a dentist at those facilities, that they have a dental director in their state who can oversee the public health program as well as the Medicaid program,” Norman said.
“Make sure that there’s a robust benefit under Medicaid. When I started practicing in 1977, the dental component of health care, and conversely of Medicaid, was about 5 percent of the budget. It’s now 2 percent of the budget for Medicaid.”
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