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ADA barriers statement assesses 'tattered safety net'

Reforms achievable, says ADA President Dr. Gist

Washington—Major improvements in the dental safety net will not occur until the nation places greater value on oral health, the Association said Aug. 12 in the second of a series of statements on access to oral health.

“However, significant reforms are possible and the tattered safety net can be repaired and enhanced in ways that cost little and that could extend good oral health to many more underserved and neglected individuals and communities,” Dr. Raymond F. Gist, ADA president, said in an introduction to Breaking Down Barriers to Oral Health for All Americans: Repairing the Tattered Safety Net. The first ADA barriers statement on The Role of Workforce was released in February 2011. Future papers will address patient utilization, oral health education, disease prevention and funding the delivery system.

Success hinges on fundamental principles

Washington—The Association is committed to working with all stakeholders to repair and grow the oral health safety net, says an ADA statement issued Aug. 12 as the second in a series on access to oral health. “Our degree of success will hinge on these fundamental principles.”

  • Prevention is essential.
  • Everyone deserves a dentist.
  • Availability of care alone will not maximize utilization.
  • Coordination is critical.
  • Treating the existing disease without educating the patient is a wasted opportunity, making it likely that the disease will recur.
  • Public-private collaboration works.
  • Silence is the enemy. Let’s take the ‘silent’ out of ‘silent epidemic.’ 

“As the nation’s economy continues to struggle, increasing numbers of Americans find themselves unable to pay for dental care, whether indirectly through their individual or employer sponsored insurance, or directly out of pocket,” Dr. Gist said in the introduction. “Many also lack other resources to access care even when it may be available to them. For this growing population, the so-called oral health safety net is the only recourse for preventing and treating oral disease.

“Prefacing the term ‘safety net’ with the qualifier ‘so-called’ is a key to fully understanding its ramifications. While details differ within the public health community, the general definition of safety net is the sum of the individuals, organizations, public and private agencies and programs involved in delivering oral health services to people who, for reasons of poverty, culture, language, health status, geography or education, are unable to secure those services on their own. But the sum of these entities does not constitute a whole. Referring to these entities collectively facilitates discussion, but they cannot realistically be called a system, nor referred to as an effective safety net.”

The ADA’s second barriers statement defines the safety net “system” in terms of its private practice and public clinical service and non-clinical support service components and says, “Any serious effort to increase the amount of care available to the underserved in any meaningful way must better incorporate the approximately 170,000 privately practicing dentists who represent some 91 percent of the nation’s professionally active dentists.”

Though critical of “many oral safety net components,” the ADA statement “should not be perceived as critical of the thousands of dentists, allied health professionals, or public and private sector workers and volunteers who constitute the backbone of the oral health safety net,” Dr. Gist said in the introduction. “To the contrary, its sole purpose is to serve as another expression of the ADA’s commitment of support for them and their tireless efforts through education, advocacy and action.

“With the acknowledgement that change to the current system is necessary and is in fact a process and not an event, the ADA is determined to lead what must be the concerted efforts of not only the dental profession but also governments at all levels, the private and charitable sectors, and all Americans with the will and desire to achieve the goal of a healthier, more productive nation,” the Association president said.

“If all of the stakeholders involved keep that goal at the forefront of our thinking and actions, we can truly progress toward better oral health for all Americans.”

A comprehensive coordinated approach for health education and promotion, care coordination and effective prevention is critical to improving the oral health of the underserved, the access statement concludes. “The ADA is committed to working with all stakeholders to repair and grow the oral health safety net.”