Oral Health in America: Implications for Dental Practice

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Oral Health is a very significant aspect of our overall well-being as an individual. But unbeknownst to us, it also has the potential to impact even the economy of a country. According to a May 25 article from The Journal of American Dental Association (JADA), poor dental health lowers the economic output of American Society by limiting employment opportunities and raising medical expenses.

The JADA article offers a thorough analysis of changes in the state of oral health over more than 20 years since the 2000 report on oral health from the US surgeon general. The insight gathered by the said analysis is crucial in identifying existing challenges with oral disease burden and provision of health care access in the United States and viable solutions to address the existing problems. In this article, we will highlight the study’s important findings about how oral health in America impacts the future of dental practices.

Introduction

The Oral Health In America study from the 2000 surgeon general exposed significant discrepancies and inequities in the prevalence of oral diseases and access to healthcare in the country. Adults without private or public dental insurance, older adults with complex medical needs, members of the LGBTQ community, people living in areas with a shortage of health professionals, and people residing in long-term care facilities are some groups with insufficient access to oral health care. Additionally, the US dental care system is stuck in a state of limited equilibrium where the supply of oral health care services matches the effective demand for services given current service prices and available community income and financing.

A call for action to address these challenges has been made in response to the prevalent issues in oral health. Measures to enhance access to care, broaden cooperation between dental and medical providers, increase the skills and inclusivity of the oral health care workforce, and advance dental science and technology have been developed by numerous federal and state government programs, professional associations, and private practices. The 2021 National Institutes of Health report, Oral Health in America: Advances and Challenges, outlined 10 key themes for oral health care practice, significant oral health and care access advancements, and unsolved barriers. 

The JADA article highlights the report’s most important findings, from improving the financing and provision of oral health care to building a stronger insurance foundation, diversifying the dental workforce, and the ongoing difficulties in obtaining oral health care.

Oral Health In America

Since 2000, there has been a little improvement in oral health overall. Some important facts regarding the improvements in dental health are as follows:

  • The average number of permanent teeth missing has decreased from nearly 6 to less than 3.6, and the edentulous rate has decreased to 2 percent for working-age persons and 17 percent for those between the ages of 65 and 74.
  • The frequency of cavities varies across socioeconomic and racial/ethnic groups.
  • The prevalence of cavities and those untreated remain unchanged.
  • More than 40 percent of people in low-income groups have untreated cavities, 36 percent among Black people, 23 percent among Hispanic people, and 18 percent among non-Hispanic White people.
  • The prevalence of any form of periodontitis is higher in low-income and racial or ethnic minorities.
  • Medical comorbidities that influence oral health, such as hypertension, heart disease, and dementia, are more common in older Americans than younger ones.

Access And Provision of Oral Care 

Many Americans frequently visit hospital emergency rooms, which are ill-equipped to offer complete or conclusive oral health care to treat nontraumatic dental disorders. Most people who go to the emergency room for care are either uninsured, eligible for Medicaid, or unable to find a dentist who can work around their schedule. The high deductibles and co-payments associated with private dental insurance plans are just out of reach for some people. One of the main issues facing the oral health care system and a major contributor to oral health care inequalities is access to complete dental health care. 

During the initial year of the COVID-19 epidemic, dentistry was not seen as a necessary medical service. In response, the leadership of the American Dental Association assured the public that dentistry is a necessary medical service due to its role in assessing, diagnosing, preventing, or treating oral problems that may impact overall health.

Practice Setting

Ninety-one percent of dentists still practicing as of 2018 remained to work in private practice settings. The remaining worked at hospitals, community clinics, military and Veterans Administration clinics, and dentistry schools.

Data regarding the dental practice in different settings show that;

  • Less than 40 percent of dentists in private settings accept Medicaid or Children’s Health Insurance Program; hence, patients in private offices can mainly afford to cover the costs.
  • Private practices are typically found in densely populated, wealthy areas.
  • Rural communities have greater racial or ethnic differences in dental outcomes.
  • Millions of adults and children who are uninsured or enrolled in public insurance access dental care through safety net clinics.
  • The number of people obtaining oral health care at federally qualified health centers increased from 1.4 million to 5.2 million from 2001 to 2020.
  • Dental support organizations are a substantial contributor to the dental safety net.
  • School-based oral health programs, whether stand-alone or integrated with other health services, improve students’ access to oral health care, deliver preventive services, improve oral health literacy, and connect students and families to a dental home.

Oral Health Integration

Commercial insurers and health institutions have utilized integration to deliver patient-centered care, enhance patient health, and lower costs. Insurance companies have used integration to offer dental exam treatment to children, adults, and pregnant women with comorbidities. Clinic data center shared workflows and fully combined electronic health records have been used by health systems that merge care delivery and coverage to facilitate care integration and improve quality standards; seamlessly engaged dental offices were found to close the care gap for older adults twice to non-integrated offices.

Despite advancements, roadblocks exist at many levels that prevent oral and medical healthcare delivery from being more widely integrated. Clinical constraints include:

  • Perceived boundaries on the range of services that dental and medical professionals can deliver.
  • Lack of cross-discipline training, patient acceptance issues, and a lack of clinical effectiveness data.
  • Technical limitations include lack of time, insufficient facility space, and incompatibility of the electronic records system.
  • Exclusion of comprehensive adult dental benefits in most Medicaid programs and the absence of a universal, comprehensive Medicare dental benefit.

Insurance Coverage and Financing of Dental Services

Compared to other types of health care, financial barriers to accessing oral health care are more significant; in 2014 and 2015, about 25 percent of individuals with earnings below the federal poverty level put off getting the necessary dental health treatment because of expense. The barrier of costs in access to dental health care calls for action to improve the coverage or funding for dental services.

Over the years, some important insights in insurance coverage and financing of dental services are as follows;

  • In the United States, the proportion of people with dental insurance increased from 55 percent in 2009 to 80 percent in 2019.
  • Most higher-income adults have benefitted from increased dental care and coverage access.
  • Lack of dental insurance has been demonstrated to cause individuals to use emergency and urgent care services more frequently, which transfers unmet oral care expenses to the healthcare system.
  • Dental out-of-pocket costs for insured individuals might exceed 40 percent, in contrast to medical insurance, which covers 89 percent of costs and preventive procedures completely.
  • Between 2011 and 2014, 33 percent of those with public insurance, 26 percent without insurance, and 56 percent with private insurance saw a dentist in the previous year.
  • Most yearly dental visits in 2010 were attributed to the expansion of benefits to young individuals aged 19 to 25.

The significant discrepancies in insurance coverage for dental care show that present services are not meeting many vulnerable communities’ oral care needs.

The Dental Workforce

There will be roughly 200,000 active dentists in the United States in 2022. There are about 194,000 dental hygienists, 312,000 dental assistants, and 30,000 dental laboratory technicians, in addition to the 104 dentists per 100,000 residents in the District of Columbia and 41 dentists per 100,000 residents in Alabama. The majority of dentists (80%) work in general practice, with the remaining dentists divided among 12 dental specialties, including new specialties of Dental medicine (2020), dental anesthesia (2019), and orofacial pain (2020). To better reflect the demographics of dental patients, the 2003 surgeon general’s call to action called for initiatives to promote the diversity of the dental workforce.

Women presently make up almost half of dental school graduates and are projected to make up the same percentage of practicing dentists by 2040 due to a major increase in the number of women enrolling in dental schools. The diversity of the dental workforce has been attempted, albeit with less success. More dentists currently in practice are White or Asian, while Black and Hispanic dentists remain underrepresented. Since 2000, there have been small improvements in the number of Hispanic students enrolling in dentistry schools. For low-income and populations of racial or ethnic minorities, increased access to primary oral health care was indicated as being necessary. Dental therapists are now allowed to work in 13 states, but only 5 of them do so.

Into The Future

The 2021 Oral Health in America report revealed that despite significant improvements in workforce development, provision of services, and funding made over the previous 20 years, these improvements have not been sufficient to address the issues with cost and accessibility to oral health care services. Hence, the report emphasized three main tactics to enhance oral healthcare in the US:

  • Making dental services a mandatory perk for both private and government insurance.
  • Considering the demand for dental or oral health care services while planning the workforce.
  • A growing convergence of oral and medical treatment.

According to the research, solutions involving public and private stakeholders should be implemented to remove obstacles and disparities in access to oral health care, lower expenses, and enhance patient-centered treatment and oral health outcomes.

The ADA calls on all medical professionals and decision-makers to campaign for health care laws that will improve oral health care in the United States by increasing public knowledge of the significance of oral disease prevention.

Key Takeaway

To satisfy the requirements of the people, the oral healthcare system in the US needs to undergo significant change equitably. The possibilities outlined above and in the Oral Health in America report are interdependent. Public and private stakeholders must coordinate a significant and systemwide effort to remove barriers and disparities in access to oral health care, lower costs, and improve oral health outcomes for Americans.

Journal Reference

Fellows, J. L., Atchison, K. A., Chaffin, J., Chávez, E. M., & Tinanoff, N. (2022). Oral Health in America. The Journal of the American Dental Association, 153(7), 601–609. https://doi.org/10.1016/j.adaj.2022.04.002 

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