Expanded Access

Oral health care is not always easy for Americans to access. Lack of insurance is one key barrier, but far from the only one. Others include a shortage of nearby providers, transportation issues, and cultural and emotional hurdles. Working to find solutions to those barriers is one of the key tenets of the CareQuest Institute for Oral Health. Without improving access, we will never realize a future where equitable systems promote better health, allowing every person to reach their full potential.

The good news is that promising solutions to expand access are available — and some of them have already started to prove their value.

In Need of Oral Care

More than 56 million Americans live in areas with a shortage of dental professionals. And only six states have most of the dentists they would need to eliminate these shortages if those dentists were distributed more evenly. Dental access is clearly a concern in rural communities, but people living in urban or suburban areas, including seniors with limited mobility and others with complex medical issues, also encounter barriers to care in traditional settings.

When people don’t receive dental care, extensive research has shown, both oral health and overall health can easily deteriorate. A lack of access to care can lead to untreated tooth decay or other infections, leaving people with no viable options other than visiting hospital EDs, where treatment is costly and can disrupt more urgent needs in a time of crisis.

In fact, each year in the United States, there are approximately 2 million hospital ED visits for nontraumatic dental problems. Most of these visits were for oral health needs that could have been addressed at a dental office. Getting to the dental office isn’t always easy, though. For many Americans, inadequate transportation and lack of job flexibility impede their ability to schedule regular dentist appointments.

These barriers are exacerbated by racial inequities, which are prevalent in oral health. For example:

Improving Access to Oral Care

One important part of the solution is to expand insurance coverage, for example, by providing or protecting adult dental benefits within Medicaid and Medicare. One recent student showed that Medicaid, even with its limited dental coverage, significantly improved adults’ access to and utilization of dental services, compared to those who lack medical coverage.    

Other solutions include thinking innovatively about care delivery — within oral health and beyond. New models of convenient, person-centered care are complementing the traditional models of a patient physically coming into an office solely dedicated to dentistry.

Here are a few innovations with great potential to expand access to better oral health:

Medical-Dental Integration

All too often, oral health is siloed from the rest of the health care system, even though extensive research demonstrates the connections between dental health and overall health. Integrating oral health care into primary care and behavioral health has demonstrated positive patient outcomes, along with reductions in total cost of care. Many community health programs and Federally Qualified Health Centers (FQHCs) are already taking this approach, and there is a great deal of potential to expand it.

MORE Care (Medical Oral Expanded Care), for example, is a CareQuest Institute initiative that aims to integrate oral health competencies and capabilities into primary care offices. The initiative builds patient-centered referral networks with local dental providers using health information technology.

Teledentistry

Teledentistry — care delivered virtually through various mechanisms — offers several avenues to increased access. It provides a viable alternative for people who live in areas without providers in the vicinity; for those without means of transportation; and for those who fear going to the dentist. It can also be a good option in cases of emergencies that arise at night or on weekends. During the COVID-19 pandemic, in particular, it has offered a way for patients to get care without risking exposure to the virus. In one recent study, patients have reported overwhelmingly positive responses to their teledentistry experience, with 86% saying they would recommend teledentistry to another person. 

Providing care in non-traditional settings

When it’s difficult for patients to get to providers, providers may need to find ways to get to patients. That means offering care in non-traditional settings, such as schools, nursing homes, pharmacies, and community centers. Recent CareQuest Institute research found that nearly 1 million Medicaid-enrolled children nationwide already rely on schools to access basic preventive dental care. This number could rise to reach even more children in need.

When we think creatively, beyond the traditional visit to the dentist’s office, we can make real progress toward reaching more people. We can overcome the barriers to care that so many Americans face. Expanding access to dental care means improving oral health — and overall health — for all.

 

Communications Brief

Healthy Adults: Why They Matter for Adults and State Budgets

A CareQuest Institute communications brief explain that states should be encouraged to expand Medicaid dental coverage, seizing the opportunity to improve their residents’ health while maintaining the state’s fiscal health.

 

Report

School Dental Programs Face Stiff Challenges

A report from the CareQuest Institute and the Association of State and Territorial Dental Directors (ASTDD) found that this disruption has major implications for the oral health of children.

 

Report

Poor Families Spend 10 Times More of Their Income on Dental Care than Wealthier Families

A CareQuest Institute report finds that those living in poverty and with low incomes use fewer dental services, spend a significant portion of their annual income on dental care and still have substantial unmet dental needs.