Oral Health: How the Dental System Fails to Deliver
If you arrived at an emergency room or urgent care clinic with a painful infection of your finger that is causing you to miss work and otherwise interfere with daily living – would they give you pain relievers and send you on your way? Often, that is exactly want happens for toothaches.
Oral health is vital to overall health, yet too many people are not getting the care they need. In her new book, Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America, journalist Mary Otto chronicles the fragments of oral health care. The settings vary: the shadows of Baltimore MD’s own iconoclastic University of Maryland School of Dentistry, the first academic institution to award a dental degree, to far-flung Appalachian outposts. The muckraking journalism drives the text – following the “who, what, when, where, and why” behind the stories of a budding beauty queen and a despondent mom with young sons who need a tooth pulled. While the national conversation on affordable, accessible and equitable health care spurts forward, Otto’s point of entry – the medical neglect of a young man who suffers a deadly toothache – remains unreconciled.
Oral health issues are ubiquitous. Dentists are not. In fact, “dental deserts,” areas with no oral health services, permeate every state. Adding to the problem is that no one can tell private dentists who they have to treat, or what they can charge for procedures. This contributes to an excess of practices that do not accept Medicaid while simultaneously promoting revenue-generating “cosmetic dentistry,” or “perfect smile” treatments for patients who can afford them (often through payment plans arranged through the office directly, as Otto points out).
This is why health care advocates keep pushing for licensed mid-level providers – “dental therapists” – who could increase access to care to the numerous dental deserts across the country. Analogous to physician assistants, dental therapists are trained in specific dental prevention and treatment procedures – like cleaning teeth or pulling an abscessed tooth. In 2000, then Surgeon General David Satcher MD, PhD issued the first-ever oral health report for the U.S., calling out the urgent need for mid-level dental providers. Since then, state-based legislation to carve out a “dental therapist” professional category has crawled up the health care reform docket. There are now four states that allow dentists to hire dental therapists – Alaska, Minnesota, Vermont and Washington, which recently approved dental therapist utilization on tribal lands of American Indians (who see the societal and economic impact of the lack of dental care). Twelve more are actively pursuing the creation of a dental therapist licensure category. But in many states, legislation has been blocked or watered down by the professional dental societies.
The Forsyth Institute joins with Community Catalyst and other advocates pushing for dental therapist legislation across the country and in our home state of Massachusetts, to reach children and their adult caretakers, for whom an ounce of prevention would relieve a lifetime of pain and chronic disease. Each year, more than 13 million school hours are lost due to dental disease. The burden of dental decay is heaviest among children of minorities and those living in poverty. Chronic pain that dental therapists could help.
It’s time to stop allowing the dental industry to practice in their own best interest instead of the best interest of their patients. We need to push to ensure that we are addressing the vast inequities the vulnerable and underserved face when attempting to access oral health care. Dental therapists are one of the answers.
Diane MacDonald is the chief operating officer and interim president and CEO at the Forsyth Institute. She is also a member of the Community Catalyst Board of Directors.