Dental Workforce Key to Overcoming Chronic Oral Health Disparities among Underserved Populations

By Alex McEllistrem-Evenson

Introduction

“Access to oral health care is an increasingly serious problem for many people in the United States,” begins “Help Wanted,” a May 2009 report on dental workforce policy produced by the Pew Center on the States and the National Academy for State Health Policy with support from the W.K. Kellogg Foundation. More specifically, “dental care is the single greatest unmet need for health services among children” and “may represent the biggest unmet health care need among adults as well,” according to sources cited in the report.

Disparities in oral and dental health are particularly acute among those from low-income families, racial and ethnic minorities, and who reside in rural or underserved areas. “Nearly 80 percent of dental caries – the disease that causes cavities – occurs among only 25 percent of children,” states a 1996 study cited in the report, “many of whom come from lower income families.” More recent studies indicate that these conditions have actually worsened in the intervening decade: the report specifies that in 2006, “only one in three Medicaid-enrolled low income children utilized dental care services” despite the fact that “the presence of dental caries among children ages two to five rose between 1999 and 2004.”

The Pew Center study identifies a number of “key underlying factors” which establish and exacerbate these problems: a lack of public funding, a pervasive belief that dental care exists outside of the realm of primary care, and the absence of “a safety-net system for the roughly one-third of the population not served by the private dental care system” are a few of these.

Without a doubt, workforce issues stand alongside these root causes: “the current dental workforce does not generally meet the needs of several special populations, such as young children, the elderly, people with developmental or physical disabilities and pregnant women,” states the Pew Center report.

Facts and figures, however, only go so far to illustrate the complexity and magnitude of any public health crisis, and this one is no exception. From the perspective of those on the front lines who work with patients and policy makers and who grapple with these issues on a daily basis, we begin to see beyond the numbers and understand the degree to which health workforce is crucial to overcome what at first may seem like insurmountable obstacles.

Included In This Feature:

• Perspectives on Dental Workforce Policy — Shelly Gehshan, Director of the Pew Children’s Dental Campaign, discusses the landscape of issues she and her campaign navigates and clarifies the various roles dental workforce plays in shaping this landscape.
• Coping with Disaster — In the aftermath of Hurricane Katrina, the sizable populations of working poor in New Orleans have an near-total absence of options for affordable dental care. Douglas Cross, DDS, a Public Health Dentist who has been practicing in the city since 1982, offers a troubling first-hand account of this dire situation.
• Step By Step – Greg Nycz, director of Family Health Center of Marshfield, a Federally Qualified Health Center (FQHC), and director of health policy for Marshfield Clinic in Marshfield, Wisconsin – “one of the largest private, multispecialty group practices in the United States” – describes his efforts, as well as those of his collaborators, “to end the oral health disparity between the people with limited incomes and everyone else.” Nycz received the American Dental Association’s Access Recognition Award in 1995.