Improving Access to Oral Health Care for Vulnerable and Underserved Populations
Good health requires good oral health, yet millions of Americans lack access to basic oral health care. In 2008, 4.6 million children—1 out of every 16 children in the United States—did not receive needed dental care because their families could not afford it. Children are just one of the many vulnerable and underserved populations that face persistent, systemic barriers to accessing oral health care. While the majority of the U.S. population routinely obtains oral health care in traditional dental practice settings, oral health care eludes many vulnerable and underserved individuals—including racial and ethnic minorities, people with special health care needs, older adults, pregnant women, populations of lower socioeconomic status, and rural populations, among others. Lack of access to oral health care contributes to profound and enduring oral health disparities in the United States. Access is hampered by a variety of social, cultural, economic, structural, and geographic factors, but fortunately, opportunities exist in both the public and private sectors to reduce barriers to care.
In 2009, the Health Resources and Services Administration (HRSA) and the California HealthCare Foundation asked the Institute of Medicine (IOM) and the National Research Council (NRC) to convene a committee of experts to address access to oral health care in America for vulnerable and undeserved populations. The committee was charged to assess the current oral health care system, to develop a vision to improve oral health care for vulnerable and underserved populations, and to recommend strategies to achieve the vision.
Vision for Oral Health Care
The committee envisions oral health care in the United States in which everyone has access to quality oral health care across the life cycle. To be successful, an evidence-based oral health system will:
- Eliminate barriers that contribute to oral health disparities;
- Prioritize disease prevention and health promotion;
- Provide oral health services in a variety of settings;
- Rely on a diverse and expanded array of providers who are competent, compensated, and authorized to provide evidence-based care;
- Include collaborative and multidisciplinary teams working across the health care system; and
- Foster continuous improvement and innovation.
In addition, the committee established two principles to guide its deliberations:
- Oral health is an integral part of overall health, and therefore, oral health care is an essential component of comprehensive health care.
- Oral health promotion and disease prevention are essential to any strategies aimed at improving access to care.
Integrating Oral Health Care into Overall Health Care
The committee concludes that the separation of oral health care from overall health care is a factor in limiting access to oral health care for many Americans. With proper training, nondental healthcare professionals, such as nurses, pharmacists, physician assistants, and physicians, could screen for oral diseases and deliver preventive care services. While several nondental health care education programs have made great strides in improving the oral health education and training of their students, these efforts have not spread widely through the professions. Instead of having each profession develop its own set of competencies, the committee recommends that HRSA convene key stakeholders to develop a core set of competencies that could apply to many nondental health professions. Over time, these competencies should be incorporated into certification testing and accreditation requirements to ensure adoption by health professional schools.
Creating Optimal Laws and Regulations
A variety of regulations and policies—such as scope of practice laws—determine who may provide oral health care, how it may be provided, and where. While education and training standards for accreditation are set nationally, regulations defining supervision and scope of practice parameters vary widely among states and even by procedure. Therefore, the committee recommends that state legislatures amend existing state laws to maximize access to oral health care. Changes would allow professionals to practice to the full extent of their education and training in a variety of settings and facilitate technology-based collaboration and supervision.