Giving Voice to a Silent Epidemic in Oral Health

Robert J. Collins, DMD, MPH


September 11, 2012

In This Article
Join the Discussion: Dentists and oral health professionals - please join the discussion on this topic.

Dental Care Access in the Spotlight

In the decade following the first US Surgeon General's report on oral health,[1] the lack of access to dental care in the United States has received considerable attention from the media and decision-makers. Driving the increased focus on the shortcomings of the dental care system was the case of Deamonte Driver, a boy in Maryland who was unable to obtain treatment for an infected tooth that led to a brain abscess and his eventual death.[2]

The media frequently report on the never-ending lines that form for volunteer-staffed clinics that periodically offer free dental care to Americans with acute needs and no resources with which to pay.[3,4] Concomitantly, persons in dental pain who have no other treatment options seek relief from nondentists[5] or from hospital emergency departments in the form of pain medication and antibiotics, a course of action that is extremely expensive and provides only temporary respite.[6,7] The access problem is most severe for low socioeconomic and minority populations and those living in rural areas. Dentists favor establishing their practices in urban and suburban areas, where more social amenities exist and patients are better able to afford their services.[8]

The public's recognition and understanding of the problem of lack of access to dental care is a good thing if it proves to be the first step in the development of a solution to a heretofore "silent epidemic."[1] The access problem has existed for a long time, and yet somehow has remained "under the radar" and unresolved by either the profession or government.

The problem is clear, and the public's attention is focused; how should we address the lack of access? Thus far, we have offered treatment-based solutions, an approach that seems reasonable on the surface. After all, the problem is one of toothaches, infection -- even death -- so, for goodness sake, get some treatment for these folks! How do we do that?

Some say, produce more dentists. Many communities would build additional dental schools, perhaps encouraged by such institutions as the Arizona School of Dentistry and Oral Health (ASDOH), which has had some success in getting a larger portion of their graduates into practices that serve the poor and near-poor.[9]

The profession argues that we need to increase reimbursement rates so that more dentists will participate in such programs as Medicaid and the Children's Health Insurance Program (CHIP).

Still others propose making better use of current professionals, and introducing new dental auxiliaries who have the skills to extract teeth and provide restorative care with or without a dentist in immediate attendance. Let's take a brief look at each of these proposed solutions.