A Silent Epidemic

Surgeon General’s Report Promotes Community-Based Solutions to Improve Oral Health

The first-ever Surgeon General’s report on oral health was recently released at a press conference in an elementary school in Washington D.C. As teachers and first-grade students looked on, Surgeon General David Satcher M.D. Ph.D., announced that the state of affairs in the mouths of Americans is poor and that oral disorders are common. "There have been dramatic improvements in oral health," Surgeon General Satcher said. "However, this report illustrates profound disparities that affect those without knowledge or resources to achieve good oral care. Those who suffer the worst oral health include poor Americans, especially children and elderly." Research has shown that good oral health and general health are inseparable. The mouth is a mirror for general health and well being and there is an association between oral health problems and other health problems, such as diabetes, heart and lung disease, stroke and low-birth-weight babies.  The Surgeon General is calling for a national partnership to increase awareness by changing perceptions regarding oral health and by emphasizing community-based approaches to assist substantial portions of the undeserved-population.  CPA and progressive state legislators have stepped up to the challenge. CPA’s recent policy brief on oral health for the Kellog Foundation’s Community Voices Initiative, provides state policy recommendations and models to increase access to oral health care.  CPA is working with the Northern Manhattan Community Voices Project whose Community DentCare, formed by the Columbia University, School of Dental and Oral Surgery, brings needed preventive and treatment services to the northern Manhattan population, composed of mainly Latinos and African Americans who for too long have had little to no access to the benefits of good oral care. "We are demonstrating that by reaching out and collaborating with community and providers we have the capacity to prevent children from suffering from toothaches and to bring regular oral heath services to the undeserved. The Surgeon General’s Report puts America on notice that all sectors need to work together to eliminate the disparities that exists in oral health and make access to care available to all children regardless of race, ethnicity or poverty," states Dr. Alan Farmicola, Dean of the Columbia Dental School.  State legislators have increased access to dental care for improved oral health. Maryland has passed innovative legislation (HB543) that establishes the Maryland Dent-Care Program to provide educational loan assistance to dentists who agree that 30% of their patients treated for a three-year period will receive free dental care. Delegate Verna Jones, (Flemming Fellow 2000) a cosponsor of HB543, also sponsored legislation that provides tax credits to dentists to practice in geographically underserved areas. "Oral health is severely neglected in areas with high concentrations of poor people and people of color. We must provide incentives such as tax credits to generate support for better oral health programs. State and federal government must take responsibility for this," says Delegate Jones. Other states have taken action on oral health: Missouri – H1336 encouraged the location of healthcare practitioners and dentists in areas designated as health resource shortage areas. California – AB1065 provides dental cleaning and examinations to children on Med-Cal. Maine – H1226 reviews adequate reimbursement rates to dentists that serve Medicaid and CHIP patients and is studying the use of mobile vans to provide dental care in remote or underserved areas. HIGHLIGHTS OF THE SURGEON GENERAL’S REPORT Despite fluoridated water and better dental care, dental diseases threaten the health of low-income people, who are more likely to lose their teeth. Poor people of all ages, especially children and elderly, suffer the worst oral health.   Minorities are profoundly affected by poor dental health. Nearly half of all poor blacks and Hispanics have untreated tooth decay compared with27 percent of poor whites.   Lack of dental insurance compounds the problem. As many as 108 million Americans have no health insurance for adequate dental care. StateAction.org Links: Oral Health for All: Policy for Available, Accessible and Acceptable Care, Dr. Rueben Warren   CPA’s Fact Sheet, Dental Coverage Under Medicaid   CPA’s State of the States: Overview of 1999 State Legislation on Access to Oral Health   Oral Health State Issues page