Having reviewed the document, I applaud the AGD for further opening discussions and making recommendations for the underserved, access to care, and utilization of care issues. I felt the white paper took a curious and limited belief in the value of "mid-level" providers and the perceived negative outcomes on the populations to be served, the dental team concept and the prevention model.
It reminded me of the premise in the following paragraph:
"Change creates loss. Even if change is very positive, there is always something to let go of. Fear of change is fear of loss and fear that we may not be able to adapt to the changing environment. There seems to be a little voice inside all of us that shouts 'Status quo!' and fights change with tooth and nail. The more a person lives in fear the smaller they make the world. These people reduce their options and choices are reduced or eliminated in order to stay safe. They pass judgments on others to eliminate having to deal with them and possibly encounter the forces of change. We often fear failure and we fear success."
— Wellness Coaching for a Lasting Lifestyle Change.
To comment on the white paper, send an e-mail to [email protected]. I look forward to reading your feedback. Below is the Exectuive Summary and a link to the document.
Kristine A. Hodsdon RDH, BS
Director, RDH eVillage
Academy of General Dentistry (AGD)
White Paper on Increasing Access to and Utilization of Oral Health Care Services
While patients who have availed themselves of dental services in the United States have enjoyed the highest quality dental care in the world, many patients are underserved presently, thereby raising the need to address both access to care and utilization of care. Access to care refers to the availability of quality care, and utilization of care refers to the behavior and understanding necessary by patients to seek care that is accessible.
Illnesses related to oral health result in 6.1 million days of bed disability, 12.7 million days of restricted activity, and 20.5 million days of lost workdays each year.(1) However, unlike medical treatments, the vast majority of oral health treatments are preventable through the prevention model of oral health literacy, sound hygiene, and preventive care available through the dental team concept.
However, present efforts to institute independent mid-level providers — lesser educated providers who are not dentists — to provide unsupervised care to underserved patients are not only economically unfeasible but also work against the prevention model. Because underserved patients often exhibit a greater degree of complication and other systemic health conditions, the use of lesser-educated providers risks jeopardizing the patients' health and safety. This approach will provide lesser quality care to the poor.
Instead, solving the access to and utilization of care issues, thereby bridging the gap between the 'haves' and the 'have-nots,' requires collaboration among professional organizations, local, state, and federal governments, community organizations, and other private entities. This collaboration must strive toward a multi-faceted approach that focuses on oral health literacy, incentives to promote dentistry and dental teams in underserved areas (including through increased Medicaid and Title VII funding), provision of volunteer services through programs, such as Donated Dental Services (DDS), and bridging the divide between patients' access and utilization through the use of community services like transportation to indigent populations.
Specifically, the AGD's proposed solutions to the access to and the utilization of oral health care issues include, but are not limited to:
1. Extend the period over which student loans are forgiven to 10 years without tax liabilities for the amount forgiven in any year;
2. Provide tax credits for establishing and operating a dental practice in an underserved area;(2)
3. Offer scholarships to dental students in exchange for committing to serve in an underserved area;
4. Increase funding of and statutory support for expanded loan repayment programs (LRPs);
5. Provide federal loan guarantees and/or grants for the purchase of dental equipment and materials;
6. Increase appropriations for funding an increase in the number of dentists serving in the National Health Service Corps and other federal programs, such as IHS, programs serving other disadvantaged populations and U.S. Department of Health and Human Services (HHS)-wide loan repayment authorities;
7. Actively recruit applicants for dental schools from underserved areas;
8. Assure funding for Title VII general practice residency (GPR) and pediatric dentistry residencies;
9. Take steps to facilitate effective compliance with government-funded dental care programs to achieve optimum oral health outcomes for indigent populations:
a. Raise Medicaid fees to at least the 75th percentile of dentists' actual fees
b. Eliminate extraneous paperwork
c. Facilitate e-filing
d. Simplify Medicaid rules
e. Mandate prompt reimbursement
f. Educate Medicaid officials regarding the unique nature of dentistry
g. Provide block federal grants to states for innovative programs
h. Require mandatory annual dental examinations for children entering school (analogous to immunizations) to determine their oral health status
i. Encourage culturally competent education of patients in proper oral hygiene and in the importance of keeping scheduled appointments
j. Utilize case management to ensure that the patients are brought to the dental office
k. Increase general dentists' understanding of the benefits of treating indigent populations;
10. Establish alternative oral health care delivery service units:
a. Provide exams for one-year-old children as part of the recommendations for new mothers to facilitate early screening
b. Provide oral health care, education, and preventive programs in schools
c. Arrange for transportation to and from care centers
d. Solicit volunteer participation from the private sector to staff the centers;
11. Encourage private organizations, such as Donated Dental Services (DDS), fraternal organizations, and religious groups to establish and provide service;
12. Provide mobile and portable dental units to service the underserved and indigent of all age groups;
13. Identify educational resources for dentists on how to provide care to pediatric and special needs patients and increase AGD dentist participation;
14. Provide information to dentists and their staffs on cultural diversity issues, which will help them reduce or eliminate barriers to clear communication and enhance understanding of treatment and treatment options;
15. Pursue development of a comprehensive oral health education component for public schools' health curriculum in addition to providing editorial and consultative services to primary and secondary school textbook publishers;
16. Increase supply of dental assistants and dental hygienists to engage in prevention efforts within the dental team;
17. Expand the role of auxiliaries within the dental team, including a dentist or under the direct supervision of a dentist;
18. Eliminate barriers and expand the role that retired dentists can play in providing service to indigent populations;
19. Strengthen alliances with American Dental Education Association (ADEA) and other professional organizations like the Association of State and Territorial Health Officials (ASTHO), Association of State and Territorial Dental Directors (ASTDD), National Association of Local Boards of Health (NALBOH), National Association of County & City Health Officials (NACCHO), and so forth;
20. Lobby for and support efforts at building the public health infrastructure by using and leveraging funds that are available for uses other than oral health; and
21. Increase funding for fluoride monitoring and surveillance programs, as well as for the development and promotion of new fluoride infrastructure.
1. U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research, 2000. NIH publication 00-4713. Available from www.surgeongeneral.gov/library/oralhealth
2. "The Maine Dental Association's own bill, called 'An Act to Increase Access to Dental Care,' has become law. Starting next year, dentists will be eligible to receive up to $15,000 in income tax credit annually—for up to five years as long as they practice in underserved areas. The law currently limits participation in the program to five dentists, but the legislature will review its effectiveness in two years, and may then amend it to increase the number of allowed participants." American Dental Association (ADA) Update, June 10, 2008 (Retrievable from www.ada.org).
Access to Care? Access the White Paper
The AGD White Paper on Increasing Access to and Utilization of Oral Health Care Services is available online in its entirety at