Access to oral health care in the United States has seen notable improvements since the release of the US surgeon general's report on oral health in 2000. However, despite these gains, there is still a considerable gap in meeting the oral health care needs of all individuals equitably. The National Institutes of Health report, "Oral Health in America: Advances and Challenges," examines the current state of the US oral health care system, the progress made since 2000, and the persistent challenges that remain. In this article, we will explore the vital role that dental clinics play in promoting oral health and addressing these challenges.

Over the years, there have been significant advancements in oral health care, including increased access for children and young adults. The expansion of the oral health care workforce, with new dental specialties and allied professional models, has facilitated greater availability of health promotion and preventive services. However, certain populations, such as low-income individuals, minorities, and older adults, still face limited public insurance coverage, hindering their access to necessary care.

Efforts towards integrating oral and systemic health have shown promise in improving access to patient-centered care for vulnerable populations. Dental clinics have played a crucial role in implementing these integration models and expanding their services to cater to the diverse needs of patients. Nonetheless, practice gains made by women and Asian Americans have not extended uniformly across all minority demographic groups, highlighting the existing disparities in oral health care.

To achieve equitable oral health care for all, coordinated policies and additional resources are essential. There is a need to further enhance access to care, develop dental insurance programs that reduce out-of-pocket costs for lower-income adults, and improve the integration of oral and medical health care delivery. Dental care professionals must actively participate in meaningful and system-wide changes to meet the population's needs equitably.

The overall oral health status in America has shown some improvement since 2000. The average number of missing permanent teeth has decreased significantly, and the prevalence of edentulism among working-age adults and older adults has declined. However, there has been no improvement in the prevalence of caries and untreated caries, and racial disparities in oral health persist even after considering income levels.

Periodontal disease remains a significant concern, particularly among low-income and racial or ethnic minority populations, as well as older individuals who often have comorbidities affecting oral health. Additionally, the prevalence of oropharyngeal cancer is increasing due to the rising incidence of human papillomavirus infection.

Access to oral health care has shown improvement, with increased annual visits among children and older adults. However, disparities persist across racial or ethnic and income groups, with older adults below 200% of the federal poverty guideline having lower visit rates. Many Americans seek nontraumatic dental care in hospital emergency departments, which are ill-equipped to provide comprehensive oral health care. Lack of insurance coverage, high deductibles, and limited availability of dental offices accommodating diverse schedules contribute to inadequate access.

The COVID-19 pandemic highlighted the essential nature of dentistry in evaluating, diagnosing, and treating oral diseases. The majority of oral health care services are diagnostic or preventive in nature. Private practice settings dominate the dental landscape, with solo practice being the most common. However, group and corporate practices, as well as dental support organizations (DSOs), are becoming more prevalent and contribute significantly to the dental safety net, particularly for Medicaid and CHIP beneficiaries.

Safety net clinics, including dental schools and federally qualified health centers (FQHCs), play a crucial role in providing care for uninsured or publicly insured individuals. Integration of oral health and primary care practice has been pursued to improve access and provide comprehensive care, with notable success in interprofessional practice collaborations and clinic colocation. However, barriers such as scope-of-practice restrictions, limited training, and technical challenges hinder widespread integration efforts.

Insurance coverage has increased due to Medicaid and CHIP expansion and benefits extension for young adults. However, underserved populations still face challenges in accessing dental care, including low rates of Medicaid acceptance and poor oral health literacy. Improvements in rates of delayed or nonreceipt of needed oral health care have been observed for children and young adults, but not for adults overall, and older adults have experienced a doubling of such rates.

Cost continues to be a significant barrier to accessing oral health care in the United States. Unlike medical insurance, dental insurance often covers a lower percentage of costs, resulting in high out-of-pocket expenses for insured patients. Financial barriers play a larger role in oral health care access than any other type of health care, with a considerable number of adults deferring needed oral health care due to cost. Disparities are evident in dental coverage, with Medicare beneficiaries and Medicaid-eligible adults lacking dental insurance. The stark difference in spending between medical care and dental care underscores the inadequate attention given to the oral health care needs of vulnerable populations.

The dental workforce landscape comprises a diverse range of professionals, including dentists, dental hygienists, dental assistants, and dental laboratory technicians. Efforts to increase diversity in the dental workforce have been successful in terms of gender, with more women entering the profession. However, racial and ethnic diversity remains a challenge, with underrepresentation of Black and Hispanic dentists. Dental therapists and allied dental care professionals can help address access barriers, but scope-of-practice laws restrict their ability to provide care in accessible settings.

To advance dental practice and meet the oral health care needs of the population equitably, three strategies have been highlighted. Firstly, making dental care services an essential benefit for private and public insurance is crucial. Including oral health care in comprehensive health coverage can enhance access and reduce overall health costs. Secondly, incorporating the demand for oral health care services into workforce planning is essential. Policy makers and dental education administrators must align the capabilities and demographic characteristics of the dental workforce with future care demand. Lastly, increasing the integration of oral and medical care delivery is key to improving access, quality, and outcomes. Interprofessional partnerships, addressing system-level barriers, and promoting common diagnostic coding systems and electronic record interoperability are necessary steps toward achieving this integration.

Access to oral health care in the United States is not only influenced by the healthcare system but is also shaped by laws and health policies. Healthy People 2020, a national health initiative, identified several key objectives related to oral health. One of the goals was to increase the proportion of children, adolescents, and adults who have access to preventive dental services. This objective aimed to address the disparities in oral health care access and promote early intervention and preventive care.

To achieve this objective, various laws and policies have been implemented at the federal and state levels. The Patient Protection and Affordable Care Act (ACA) included provisions to expand dental coverage for children, particularly through the Children's Health Insurance Program (CHIP) and Medicaid. These efforts have contributed to increased dental visits among children and improved access to preventive services.

Another important aspect is the integration of oral health into primary care. The ACA encouraged the establishment of accountable care organizations (ACOs) and medical homes that provide comprehensive and coordinated care, including oral health services. This integration is crucial for addressing the connection between oral health and overall health and improving health outcomes for individuals.

Additionally, workforce development has been a focus area to address the shortage of oral health care providers, particularly in underserved areas. Initiatives such as loan repayment programs, scholarships, and grants have been implemented to incentivize oral health professionals to practice in underserved communities. Dental health aide therapists and community dental health coordinators are examples of innovative workforce models that aim to expand access to care in areas with limited resources.

Furthermore, community-based interventions and public health campaigns have been effective in promoting oral health and raising awareness about the importance of preventive care. These initiatives target populations at higher risk of oral diseases and aim to reduce oral health disparities.

So yes, substantial changes are needed to transform the US oral health care system and ensure equitable access to care, reduced costs, and improved oral health outcomes for all Americans. Coordination among public and private stakeholders is critical in eliminating barriers, reducing disparities, and creating a comprehensive and inclusive oral health care system.

Information source: sciencedirect.com