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Health Affairs highlights oral health in December issue

December 08, 2016

By Jennifer Garvin

Equity issues: Dr. Jaffer A. Shariff discusses how receiving dental care has not resulted in equity in children’s oral health. At right is Dr. Natalia Chalmers.
Washington — "The divide between dental care and medical care is vast, has significant consequences for patients and is entirely of our own making."

These were the opening words of editor Alan Weil's editorial in the December issue of Health Affairs, a national journal focusing on health care and health policy. For the first time, the peer-reviewed publication devoted its entire December issue to the state of oral health, which Mr. Weil said he hoped would raise its profile.

The issue showcases 24 papers on oral health exploring such challenges as cost, access and workforce and also looks at the cost-effectiveness of community water fluoridation and school-based dental sealant programs.  

"The timing of this issue could not be better," said Dr. Richard Manski, chair, Department of Dental Public Health, University of Maryland, School of Dentistry. "These papers are the foundation and roadmap to improve oral health and bridge the divide between medical and dental."

Dr. Natalia Chalmers, director of analytics at the DentaQuest Institute, agreed: "Some of us have been waiting all of our lives for this moment!"

During a Dec. 7 briefing in Washington, Health Affairs hosted three panel discussions on cost, use and access; Medicare, Medicaid and oral health; and the oral health workforce.

Cost and access: Dr. Chad Meyerhoefer discusses a point during a Dec. 7 briefing to discuss articles in the December issue of Health Affairs. For the first time, the journal featured an issue dedicated to the state of oral health. At right is Dr. Joan O’Connell.
"We know the top reason people don't access dental care is cost," said Marko Vujicic, Ph.D., ADA chief economist and vice president of the ADA Health Policy Institute, who led off the discussion on cost and access. "It's far more than fear and it crosses all age groups. This matters. When people delay, it has consequences."

In the study "Dental Care Presents the Highest Level of Financial Barriers, Compared to Other Types of Health Care Services," Dr. Vujicic and coauthors analyzed data from the 2014 National Health Interview Survey, comparing the responses of nonelderly adults with children and seniors. They found that 12.8 percent of adults aged 19-64 reported not obtaining dental care because of cost, compared to 4.3 percent of children and 7.2 percent of seniors 65 and older.

Dr. Vujicic was joined by Chad Meyerhoefer, Ph.D., an economics professor and research associate at the National Bureau of Economic Research; Joan O'Connell, Ph.D., a professor of community and behavioral health at the Colorado School of Public Health; and Susan Griffin, Ph.D., a health economist at the Centers for Disease Control and Prevention.

Dr. O'Connell talked about the cost savings opportunities with community water fluoridation, which she said, "for every dollar invested, $20 is saved."

Q & A: Dr. Jim Crall raises a point during the Dec. 7 Health Affairs briefing.
During the discussion on Medicare, Medicaid and oral health, Dr. Jaffer A. Shariff discussed how receiving dental care has not resulted in equity in children's oral health. One of the reasons, he noted, could be a difference in parental reporting data, or, he said, it could be another factor such as social or environmental influences.

In the same panel, Dr. Chalmers discussed how the majority of dental cases in the emergency rooms don't belong there. In the paper After Medicaid Expansion In Kentucky, Use Of Hospital Emergency Departments For Dental Conditions Increased, Dr. Chalmers, director of analytics at the DentaQuest Institute, and coauthors Dr. Jane Grover, director of the ADA Council on Advocacy, Access and Prevention, and Dr. Rob Compton, president of DentaQuest Institute, examined the impact of the expansion on adult Medicaid in Kentucky on hospital emergency departments for dental conditions from 2010–14. They found that ER visits increased significantly, from 1,833 per 100,000 in 2013 to 5,635 in 2014, leading them to conclude that to guide patients into the appropriate location for care, dental case management is necessary.

The briefing concluded with a panel on workforce that covered topics ranging from expanding scope of practice for hygienists and midlevel providers to integrating medical and dental care at federally qualified health centers to increasing the number of minority dentists.

The study "Dental Care Presents the Highest Level of Financial Barriers, Compared to Other Types of Health Care Services" is free, available here. The rest of the Health Affairs articles are available by subscription only. For more information visit

The Health Policy Institute regularly publishes research briefs on critical policy issues. Read all past research briefs here.