Dental Public Health Programs At The United States

Oral health has a direct impact on the general health, hence, it is important that all Canadians have adequate access to dental care services. Over the years successive Governments have reduced financial support to programs delivering dental care to most vulnerable populations. As a result, many low income families and other vulnerable groups have been unable to access dental care. There is further escalation in the disparities in oral health care among Canadians, as the number of Canadians losing dental care benefits continues to increase. Also, higher oral health care costs can be expected in the near future due to shortage of health care professionals.

Grants have a great value in providing dental care in community health centers particularly dental clinics that represent a large public investment to address the dental health needs of a diverse underserved rural and urban communities, and uninsured populations. The grants that fund community health centers play a critical role in financial support to provide dental services for patients in Medicaid non-expansion states who are more likely to be uninsured. Grant funding enables community health centers to provide services not covered by most programs, such as adult dental care, transportation, translation services, and use sliding fees for privately insured patients who cannot afford their deductibles and cost-sharing (Henry J. Kaiser Family Foundation, 2017).

The accessibility of dental care in relation to race, ethnicity, income level, and overall socioeconomic status is evaluated. Across the board, a huge lack of dental care is seen in individuals of low-income levels and minority groups. In addition, the most susceptible groups to dental disease are identified as children, low-income adults, and the elderly. Ways to improve the oral health status of these groups are recognized. The various needs of underserved communities with respect to the access of dental care are assessed, despite a lack of sufficient dental insurance coverage of individuals who are members of these communities. This includes the improvement of both preventative and restorative care via public health programs, such as

As the number of older Americans continue to rise, along with dental practitioners who are entering retirement, it would benefit this under-served population for the dental profession to develop new models of mid- level care. To expand training as well as additional licensing for dental hygienists, along with more training for other health care professionals would be a great beginning towards improved access to care (Overview of oral health,

While most of the patients I interacted with were seeking non-dental care, I met patients who were seeking care to health conditions that stem from their oral health such as oral abscesses, which our team was unable to treat except for prescribing antibiotics or painkillers. I encountered similar situations when I shadowed physicians in the emergency room of hospitals, observing a variety of craniofacial disorders originating from a preventable tooth decay. From these observations, I learned that patients often did not receive treatment that addressed the root of their problems: their oral health. As the result, I learned that many physicians saw the same patient repeatedly for problems that would otherwise be easily prevented through proper preventive dental care. Determining to address the unmet needs for accessible preventive dental care, I decided to pursue a career in dentistry so that I can provide a positive and meaningful impact to the underserved community on their oral health and ultimately their overall

The provision of dental treatment in Australia is a topic that ignites a wide range of opinions and emotions among the various stakeholders involved. Much of dentistry in Australia is provided in the private setting, some estimates suggesting 83%1. Australians fund up to 60% of dental care via out of pocket payments1,2. Only a relatively small amount of dental care is provided in the public sector to patients who are often disadvantaged in regards to their oral health1. It is estimated that a large amount of the population is unable to access dental care due to finances; however the capacity of the public sector to provide dental care is limited. With limited funding and resources, the public sector is unable to provide dental care for all Australians and a large proportion of people are on long wait lists, some estimates of 650,0002.

In the first case study, the public health dental hygienist is responsible for evaluating the daily fluoridation test that is submitted by each state to make sure it is in the optimal range 0.7 to 1.2 milligrams per liter. (Centers for Disease Control and Prevention [CDC], 2011) She is also responsible for working with the state if the test results do not measure up the standards set forth by the CDC. In addition the dental hygienist reports all of these results to Centers for Disease control and Prevention (CDC) so the CDC can determine a national average. This case study shows the “assessment” part of the essential public health services.

Hundreds of years ago, the dental profession and the medical profession was perceived as two separate entities, however, this bifurcated health system has created an epidemic in oral disease with our aging population (Nagro, 2016). Dentistry should be more closely integrated with medicine and the health care system, however, organized dentistry has fought to stay a monopoly. They have protested regarding dental personnel being independent, even in the advancement of serving more rural areas, just as they repelled being part of Medicare. Finally, there are a few states that have alternative choices for a dental hygienist to travel to people who can’t get to a traditional dental office. Some of these states include Minnesota, Colorado, Oregon,

Primary care is the first person’s contact with the health system, in which mostly provided for the community by self-employed general practitioner (Biggs 2013). In primary dental care setting, dentist can work for children and adolescents in schools, a public dental health programmes and some dental care for adults (the elderly, disabled, single parents with health care cards and the unemployed) in community

This proves that the lack of dental insurance within these low-income households plays a key role in whether or not these children will receive dental care. When these children do not visit the dentist, they increase their chances of developing dental caries significantly. The British Dental Journal disclosed that, “Sugars consumption varies by social class. National food surveys reveal a higher consumption of sugar and sugar-containing foods and drinks amongst low income groups”(Watt 8). Healthy food is expensive; therefore lower class families resort to unhealthy food because it is significantly cheaper. This extensive consumption of sugar-ridden foods is extremely detrimental to the enamel. The British Dental Journal also declared that “oral inequalities will only be reduced through the implementation of effective and appropriate oral health promotion policy”(Watt 6). The dental program will make the inequalities in dental care known and work to reduce those inequalities. Dental health is often times overseen because it is typically expensive and people are unaware of how the condition of their teeth affects the condition of the rest of their body. The all-inclusive dental health program will give people the treatment they need, regardless of their socioeconomic status.

Adults in the rural areas have increased rate of dental caries, increased loss of permanent tooth and debilitating chronic oral conditions due to under utilization of dental care, mainly attributed to the poverty, lack of or fewer dentists and increased distance from the nearest federally funded primary health care center. (4). (ADA)(5) National rural health association states that there are about 22 dentists for 100,000 people in rural areas and only 2% of dental care providers’ work for the federally funded programs. (ADA 6).

Studies on oral health range from the impact of dental health insurance to the efficiency of state or federal programs and services. More recently, studies have also highlight the role of less advantageous populations. In the study by Edelstein, Hirsch, Frosh, & Kumar (2015), a Medicaid population is examined on its available interventions in an effort to reduce childhood dental carries. The researchers used systems model analysis of the Medicaid population in New York in order to assess the cost savings and disease reduction capacity of nine interventions, which include the following: fluoride varnish application, water fluoridation, fluoride toothpaste, fluoride varnish, medical screening, motivational interviewing, secondary prevention,

accept Medicaid and this might result in higher utilization in particular wards over others. We did not have information about parental marital status and other private insurance, which could be used for dental services and not reflect in Medicaid billing data. Also, there could be a potential bias due to delayed reporting of the data which might not be included in the dataset when we received it. Also, Centre for Medicaid Services (CMS) uses the information from these datasets and presents it by financial year whereas this analysis was done by calendar year, which may not match with the generally available information. Also, the composition of Medicaid population might not be a true representation of over-all population. People having private dental insurance might have a different utilization pattern for assigned dental home and preventive dental services. We also feel that the information of ward might not be an accurate representation of utilization since people may seek services from a provider in different wards than the one in which they reside. Having data about unique providers, along with unique patient might make a robust database to get more accurate information. Last but not the least, we restricted our definition preventive dental services to a combination of examination and fluoride application, which is not the same as followed by

While the private sector provides excellent quality of oral health care for its patients, many vulnerable groups have difficulty with access.2 It is also these vulnerable groups who demonstrate extremely high levels of oral health disease. According to a 2014 report issued by the Canadian Academy of Health Services (CAHS), the following represent Canada’s most vulnerable groups: individuals with low incomes; younger age children living in low-income families; individuals working without dental insurance; elderly populations with low incomes and/or living in institutions; aboriginal people, immigrants/refugees; people with disabilities; and, populations living in rural/remote communities.2 The CAHS authors report that increasingly and in light of challenging economic times, families from lower-middle income strata are also demonstrating difficulty with accessing oral health care (this is partially attributable to an increasing tendency toward part-time employment rather than full-time employment with benefits).

The economy plays an important factor of what people want to spend their money on. Dental/ oral health care is important to most people in today’s today world. Since the dental/ oral health industry is very big there are many trends that are arising such as the cost of dental care increase or decreasing, market of the industry and lastly global dental industry.