Regarding Sterling Speirn’s commentary, “Midlevel Providers Are Critical to Improving Oral Health” (Roll Call, May 17), the American Dental Association is delighted to have even a partial endorsement for our new campaign, Action for Dental Health: Dentists Making a Difference, from so prestigious an organization as the Kellogg Foundation.
Kellogg is a recent and welcome entry into the fight to improve access to dental care in the U.S. However, its effectiveness would be far greater if Kellogg would broaden its focus beyond advocating midlevel dental providers as a one-size-fits-all solution to the dental crisis. The need for more broad-based solutions is why the American Dental Association developed Action for Dental Health to address the dental health crisis in three distinct areas: Providing care now to people suffering with untreated disease; strengthening and expanding the public/private safety net to provide more care to more Americans; and bringing dental health education and disease prevention into communities will go much further to address the dental divide in our nation.
A recent analysis of comparative rates of untreated dental decay in 5- to 11-year-olds showed no difference between New Zealand, which has employed midlevel dental providers for decades, and the U.S., where there are only a handful of midlevels. The ADA continues to study the efficacy and cost-effectiveness of midlevel providers and welcomes others’ contributions to the body of knowledge. But ongoing debates about workforce models have threatened to drown out discussions of how to extend known, proven solutions to greater numbers of Americans who lack access to dental care. And proven solutions are where the ADA’s focus remains.
The size and distribution of the dentist workforce also are not major impediments to receiving care, as Speirn asserts. Georgia is a good example: A study by Market Decisions and the Georgia Health Policy Center commissioned by the Georgia Dental Association found that the vast majority of the state’s dentists (3,312) reported that while their practices are busy, they are still accepting new patients. Additionally, the report says, “Startlingly, 43 percent of public health clinics reported that they are not busy because patients schedule, but fail to show up for treatment.” These statistics echo anecdotal reports from other states.
Disparities in dental health are varied and complex — there is no single, simple answer. Barriers include affordability, oral health literacy, language and culture. Preventive measures such as community water fluoridation and dental sealants are underutilized. Too many parents — in all demographic and income groups — fail to get children to the dentist by their first birthday, as recommended by the ADA and the American Academy of Pediatrics.
Clearly, there is more to the dental health crisis in America than one issue with one solution. The initiatives under ADA’s Action for Dental Health are demonstrating measurable progress at helping to shrink the dental divide in a number of ways. We’re helping dentists provide care to the nation’s 1.3 million nursing home residents; reducing the number of patients turning to hospital emergency rooms for treatment of dental pain; bringing oral health education and disease prevention into underserved communities such as inner cities, remote rural areas and Native American lands; and helping people in these areas secure and keep appointments with dentists. We know these measures work, because they are already occurring in some parts of the country. Our job is to expand their reach — exponentially.
Dentists are committed to making a difference — but we cannot do it alone. We must all work together to make real progress toward bridging the dental divide in America.
Robert A. Faiella is president of the American Dental Association.