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We always welcome an organization of the stature of the WK Kellogg Foundation to join us in our mission to improve the oral health of the nation's most vulnerable populations.  However, the ADA believes that prevention, oral health literacy, and rebuilding our public health infrastructure should guide concerned stakeholders as we seek a permanent solution to the access to care crisis in this country.

Alaska is unique among the states in the degree to which geography presents a profound barrier to care.  It is not representative of the remaining 49 states in this great nation. In many rural states for instance, residents are accustomed to driving hours to reach a shopping or entertainment destination and can be expected to travel similar distances to reach a dentist.

The published report on the study of the dental health aide therapist (DHAT) model was based on a very small number of participants in Alaska-it examined five therapists and 300 residents-and does not constitute the kind of empirical health outcomes data on which to base major health policy decisions. Even the report's principal investigator concedes that the evaluation did not assess the overall impact that treatment by dental therapists could have on improving the oral health of Alaska natives.

The ADA believes that workforce innovations such as our own community dental health coordinator (CDHC) show greater potential in helping underserved people overcome the profound barriers that limit or completely block their access to dentists. The CDHC is based on a proven model-the community health worker-which has been extraordinarily successful in educating patients in their various communities to seek medical care. We feel that a similar model could be equally effective in promoting dental care.

The degree and severity of disease among underserved communities, whether they are in inner cities, remote rural communities, or on Tribal lands, demands sustainable solutions. The ADA feels that any investment of our limited resources should be directed to improving the ability of our current workforce to address this problem. The nation needs a concerted effort by all who are concerned about the oral health of the underserved to help the dental profession locate dental homes for our entire population. This will require adequate funding for safety net programs, implementing loan reduction/forgiveness programs for new graduates from dental schools, boosting our efforts to educate our patients to properly maintain their oral health with effective hygiene, providing urgent care by dentists for patients with immediate needs, and the inclusion of all of our initiatives to prevent and control the epidemic of untreated disease.

The American Dental Association welcomes input from and dialogue with all stakeholders who are dedicated to overcoming the barriers to dental care that too many in this country face. A concerted effort that reflects a long term, evidence-based approach will enable the dental profession to implement a sustainable system for delivering high-quality, dental care to those Americans who currently lack it.