Five members of the health-care community testified before the U.S. Senate's subcommittee on primary health and aging on Feb. 29, 2012, in a hearing titled "Dental Crisis in America: The Need to Expand Access."
A professor of health policy from Columbia University, the director of the Pew Center on the States' dental campaign, a general dentist, an executive director of Vermont-based community health centers, and a Minnesota advanced dental therapist testified before the Senate subcommittee, which consists of eight Democrats and six Republicans. The subcommittee is part of the U.S. Senate Committee on Health, Education, Labor, & Pensions.
Christy Fogarty, a dental hygienist who graduated from Minnesota's oral health practitioner program to earn the credentials to practice as an advanced dental therapist, informed the subcommittee that her occupation is "not a replacement for a dentist but is intended to extend the reach of the oral health care delivery system so that it will be easier and more affordable for underserved populations, including children and the elderly, to obtain high quality oral health services."
Fogarty cited statistics regarding emergency room treatment of dental conditions, public dental health care facilities in Minnesota, and observed that 60% of Minnesota dentists "may retire" during the next 15 to 20 years.
The advanced dental therapist reported, "I will have the ability to work in schools, community centers, nursing homes, virtually anywhere that dental needs are going unmet."
She told the subcommittee, "Despite the challenges in becoming and working as a mid-level dental provider, I am proud to be persevering and so gratified to see the result of our work with patients suffering from the pain of untreated dental decay and look forward to continuing to serve those who would likely not have had access to needed dental care without me."
Dr. Gregory Folse, a Louisiana dentist, said his dental practice provides portable dental services in 24 nursing facilities. He said his model of developing "dental directors" in the facilities delivered care "at the same standards as in-office care can be, and are, achieved."
Dr. Folse said, "I'm a dentist with a traditional staff who has made a viable go of treating wonderful and needy vulnerable patients - the patients we are all here today to serve ... As you will see not all the patients I serve have access to funding for care. I find it rewarding to donate services to them."
The Louisiana dentist, however, said many of his contemporaries could not afford the time or resources to be as charitable to underserved populations. He asked the subcommittee to consider reimbursement programs that would increase access to care, and referred to the Special Care Dentistry Act.
"The bill ensures age appropriate procedures as well as deeming that oral health services are medically necessary," Folse said. "Fiscally it makes sense too. The bill doesn't require coverage for the entire adult Medicaid population, a costly proposition, only the most vulnerable citizens within it."
Shelly Gehshan, the director of Pew Children's Dental Campaign, testified on recent Pew reports indicating socio-economic barriers to dental care.
"This access problem has serious consequences," she said. "For example, research from California and North Carolina shows a clear link between poor oral health and students’ ability to attend school and perform well. In California alone, more than 500,000 children were absent at least one school day in 2007 due to a toothache or other dental problem."
Gehshan reported on progress in states that work with federal agencies such as the Centers for Disease Control and Prevention in developing infrastructure for dental prevention programs. But she pointed out that only 20 states receive CDC infrastructure grants, for example.
"These relatively small, cost-effective investments have the potential to improve the dental health of communities, improve access to care, and reduce decay — and therefore, costs," Gehshan said, adding, "These grants are needed in all 50 states."
Pew also recommends that training on "oral health competencies" be introduced to non-dental health-care professionals, as well as initiate improvements to the dental workforce, including foreign variations of dental therapist occupations.
Dr. Burton Edelstein, a Columbia professor and the president of the Children's Dental Health Project in Washington, D.C., testified on oral health disparities based on age, ethnic factors, income, insurance coverage, and rural or remote areas.
"... people with characteristics associated with these disparities ... also have higher rates of oral diseases and that oral diseases are impactful on people’s ability to, in the words of Healthy People 2020, 'speak, smile, smell, taste, touch, chew, swallow, and make facial expressions to show feelings and emotions.'"
Dr. Edelstein argued that dental benefits be more equitable, monitored by a more intense level of accountability.
His testimony stated, "We encourage federal and state policymakers to adopt best practices in coverage and care as suggested by the American Academy of Pediatric Dentistry. AAPD calls for risk-based care that provides the most intensive clinical care to children with the greatest level of disease and risk for ongoing disease.
"A pediatric-only dental benefit should follow AAPD’s guidance and thereby promote allocation of care according to individual children’s needs. By preventing dental disease at an early age and managing the disease as a chronic condition when it does occur, we can significantly reduce the cost of care and improve the quality of life for our children while setting them on a path toward lifetime oral health."
Grant Whitmer, who oversees Community Health Centers of the Rutland Region in Vermont, said 71% of the dentists in his area do no accept Medicaid patients.
"It became clear to CHCRR that we needed to expand dental access within our community," Whitmer said. "We believe it keeps our patients and communities healthier, makes good sense for the health center medical home, and ultimately saves money by reducing overall healthcare expenditures. Several studies suggest that every dollar spent on oral health returns overall healthcare savings on the order of three to 10 times greater."
He said his centers perceive "a critical need for increased access to comprehensive preventive and restorative dental services in our service area and we are fully committed to doing what we can to positively impact this situation."
To view the entire testimony of the dental health care panel, click here.
