Achieving Oral Health for All

According to the CDC, tooth decay remains the most chronic condition for children and adults. Up to ten percent of children, 2 to 5 years old have untreated cavities. Many working-age adults continue to experience tooth decay, gum disease, and oral cancers.

Oral health is essential for everyone. A healthy mouth helps people avoid pain from oral infections and tooth decay that can affect a person’s nutrition, speech, and overall health. But for many, it is a challenge to obtain dental care services that are accessible and affordable. In addition, oral health information is not always at a level for individuals to understand to make informed decisions for dental care services. Changes are needed to help prevent dental disease before it starts and reduce untreated dental disease. Reducing barriers to dental care can help children and adults have a healthier smile.

Disparities in oral health

Findings from recent published reports from the National Institute of Health (NIH), National Council on Disability (NCD), and the American Dental Association Health Policy Institute (ADA) indicate the following disparities in obtaining dental care services.

Barriers to oral health in the community.

Access to healthy foods, affordable housing, reliable transportation, good jobs and education opportunities were associated with barriers to dental care. Many adults, especially low income and minorities do not have dental insurance. Dr. Jessica Meeske, D.D.S., chair of the ADA Council on Advocacy for Access and Prevention stated, “It’s difficult to value oral health and making a dental appointment if you are struggling with food, shelter, and housing insecurities”.

In April, the ADA published data looking into racial disparities in oral health. Findings indicated Hispanics and Blacks were the most likely to face cost barriers to dental care utilization for all age groups, among the U.S. population.

Access to dental care for people with intellectual and developmental disabilities (I/DD)

A report published by the NCD in March 2022 indicated of the nearly 7.3 million adults with I/DD in the U.S., nearly 4.5 million rely on Medicaid for health coverage. NCD found that Medicaid does not provide adults with I/DD dental coverage consistently in several states. This often results in adults with I/DD in those states going without preventative and routine dental care. Many adults seek emergency dental care at a much higher cost and/or develop chronic health conditions.

Aging adults and access to dental care benefits

As working-age adults transition into retirement, most lose their employer-provided dental insurance. Some adults have underlying health conditions such as diabetes and lack access to dental care. Less than half of the states provide dental care benefits through Medicare. This puts their oral health at risk. Receiving proper oral care can be a challenge for older adults who are frail, disabled, homebound, mentally impaired, or who reside in long-term care facilities.

Oral health inequities in children

Some progress has been made in reducing tooth decay, but not all children have benefited equally. About half of all American children do not receive regular dental care. Also, nearly 1 in 5 children have special, physical, or health care needs. Poor oral health during pregnancy can affect the health outcome for both mother and baby.

Achieving oral health nationally

It is clear, access to dental services are needed to ensure everyone can enjoy the benefits of good oral health. Below are recommendations to achieve equity in oral health from the NIH, ADA, and NCD.

Nearly 24 million people, or about half of all Medicare recipients (47%), did not have any form of dental coverage in 2019. Policymakers are now discussing options to expand dental coverage for the uninsured and make dental care more affordable by increasing dental coverage for people on Medicare (KPP.org). Additional recommendations:

Integrate a system of health care and oral health:

Increase integration of dental care within family and pediatric medical care settings to improve children’s oral health.
Encourage a public health approach among dental and medical providers. Increase coordinated efforts to integrate health care and oral health among adults to prevent new diseases and manage existing health conditions.

Fund state programs to obtain oral health care through Medicaid:

Incentivize the dental workforce to attract providers with expertise in treating children and adults with I/DD.
Implement programs that improve daily oral care provided by caregivers in long-term care facilities.

Develop an oral health literacy campaign:

Create health literacy programs to improve people’s understanding of oral health. The Oral Health Literacy and Awareness Act of 2021 (HLAA) is currently moving through the legislative process. The HLAA would provide evidence-based oral disease prevention information among underserved communities.

Addressing oral health equity locally

The Orange County Local Oral Health Program is working with community partners, organizations, and agencies to increase equity in oral health across the county:

The use of data maps to identify areas that need dental services will help develop a strategic plan to increase dental care in those communities.
Provide mobile dental services in underserved communities.
Create oral health literacy resources such as oral care tip sheets, oral care videos in English, Spanish, and Vietnamese. Distribute the resources to medical and dental providers, and organizations to share with their patients and the community.
Provide trainings to medical and dental providers on the integration of dental and health care services among pregnant patients. This can help families get an early start on their baby’s dental care.

The Medi-Cal Dental Program has made changes to increase access to dental services for recipients of the program:

As of May 1, 2022, adults 50 years of age or older who are currently enrolled in restricted scope Medi-Cal (often called Emergency Medi-Cal) are eligible for full scope Medi-Cal benefits. With full scope Medi-Cal, adults are now eligible to receive all dental treatments covered by the Medi-Cal Dental Program. Immigration status does not matter, but all other Medi-Cal eligibility rules still apply.
On April 1, 2022, dental coverage during pregnancy was expanded from 60 days to 12 months post-partum.
The 2022 Medi-Cal Dental Member and Provider Outreach plan was released. The plan is designed to help:
- Increase the number of Medi-Cal Dental providers accepting new patients and referrals.
- Improve the health of Medi-Cal members by increasing their utilization of the Medi-Cal Dental Program benefits.
- Develop informative materials that are easy to understand and motivate Californians to adopt healthy oral health habits.

Achieving oral health for all is a collective effort from policymakers, medical and dental providers, local and state health departments, community partners, and health insurance programs.