July 13, 2011 -- Fewer than half of Americans see a dentist each year and millions live in areas where access to dental care is severely limited, a new analysis from the health policy group Institute of Medicine (IOM) finds.
A severe shortage of dentists, especially those serving rural and minority groups, is contributing to the "persistent and systemic" barriers to oral health care, the report noted.
According to the report:
- 33 million Americans live in areas that are underserved by dental health professionals.
- 4.6 million children went without dental checkups in 2008 because their families could not afford them.
- In 2006, almost two-thirds of retirees (62%) did not have adequate dental coverage.
The IOM committee concluded that around 9,600 additional dentists would be needed to meet the needs of underserved populations in the United States.
"We have the lowest ratio of dentists to population that we have had in 100 years," says Shelly Gehshan, who directs the Pew Children's Dental Campaign. "This is a serious problem that leaves 40 to 50 million people out of reach of a dentist at any given moment."
Dental Care Lacking for Children, Elderly, and Poor
Gehshan tells WebMD that millions of Americans lack dental coverage or the ability to pay for dental care.
She served on the IOM committee that issued the report.
Committee chairman Frederick P. Rivara, MD, tells WebMD that barriers to dental services disproportionately affect children, the elderly, and minorities.
Rivara is a professor of pediatrics at the University of Washington School of Medicine in Seattle.
"As the nation struggles to address the larger systemic issues of access to health care, we need to ensure that oral health is recognized as a basic component of overall health," he says in a news release.
The IOM report included recommendations to federal and state policy makers to improve access to dental care.
Boosting Access to Dental Care
To address the shortage of dentists in underserved inner city and rural areas, the report calls for dental professional education programs aimed at increasing enrollment of African-Americans, Latinos, and people from rural areas into dental schools.
"Most dentists are white men," Gehshan says. "Research shows that dental students from rural or underserved areas are more likely to go back to these areas to practice."
The committee also called on the Health Resources and Services Administration to expand opportunities for dental residencies in underserved areas.
The IOM also addressed major limitations in oral care among economically disadvantaged people receiving Medicaid. States must provide dental benefits for children enrolled in the Children's Health Insurance Program (CHIP), they are not required to provide benefits to adults.
Gehshan says while the committee members agreed that dental benefits should be available to all Medicaid recipients, the group recognized that this is not likely to happen in the current economic climate.
The committee called on federal officials to fund state-based "demonstration projects" aimed at providing dental care to adult Medicaid recipients.
In addition, the committee recommended increasing Medicaid and CHIP reimbursements and simplifying administrative practices.
"A growing number of dental professionals will not take people on these programs because reimbursements are just too low," Rivara says.
The committee called on state officials to update their dental practice regulations with the goal of doing away with restrictions that limit access to dental services.
One example cited by Gehshan involved the application of fluoride sealants that help prevent cavities.
She says 22 states still require a dentist to examine a child before a dental hygienist is allowed to apply a sealant.
New Ways to Deliver Dental Care
Gehshan says innovative ways of delivering dental services will be needed to address the shortage of dentists.
The report called for more research into new approaches to care, including the use of mobile dental vans staffed by dental hygienists or practitioners who have several years of dental training but are not dentists.
Known as dental therapists, these practitioners are the oral health equivalent of nurse practitioners.
Only two states -- Alaska and Minnesota -- license dental therapists, but at least 50 other countries allow them to practice, Gehshan says.
The American Dental Association (ADA) has come out strongly against allowing non-dentists to perform surgery.
In a statement, ADA President Raymond F. Gist, DDS, praises the IOM report for highlighting the dental care access issue.
Gist notes that the ADA continues to support exploring new ways to expand access to dental care, but he adds, "We must, however, restate our opposition to allowing so-called 'midlevel providers' to diagnose disease or perform such surgical, irreversible procedures as extractions. Everyone deserves a dentist."