JADA article highlights key elements from Oral Health in America report, finding poor oral health limits participation in workforce, increases health care costs

ADA commends report's focus on meaningful strategies for achieving equitable care

Poor oral health reduces the economic productivity of American society by limiting participation in the workforce and increasing health care costs, according to an article published online May 25 by The Journal of the American Dental Association.

"Oral Health in America: Implications for Dental Practice," which will appear in the July print issue, highlights key elements from "Oral Health in America: Advances and Challenges," a larger report released in December 2021 by the National Institute of Dental and Craniofacial Research and National Institutes of Health.

The JADA article — authored by senior investigator Jeffrey L. Fellows, Ph.D., of the Kaiser Permanente Center for Health Research in Portland, Oregon, and four others from the University of California, Los Angeles; University of the Pacific; University of Maryland; and Delta Dental of Iowa — provides a sweeping assessment of changes in the state of oral health in the more than 20 years since the U.S. surgeon general reported on oral health in 2000.

While access to care has increased for children and young adults, considerable work remains to meet the oral health care needs of all people equitably, according to the article.

"Many low-income and minority adults lack dental insurance, and as a consequence seek care only for emergency needs," the authors wrote.

Data from 2001-20 show the number of people obtaining oral health care services at federally qualified health centers increased from 1.4 million to 5.2 million people, according to the article. In 2017, one-third of these patients were younger than 18 years old. Of these patients, 88.5% were Medicaid or Children's Health Insurance Program beneficiaries.

The article notes that in addition to improving oral health care delivery in the U.S., the dental profession should act to shape the future of oral health, including making the case that oral care is an essential health care service.

The commentary "Facing the Future and Deciding What We Want Oral Health To Become" appears in the same issue of JADA. It is co-authored by Bruce Dye, D.D.S., dental epidemiologist, an associate editor of JADA, professor and chair of the department of community dentistry and population health at the University of Colorado School of Dental Medicine; Rena N. D'Souza, D.D.S., Ph.D., director of NIDCR; and Judith Albino, Ph.D, professor emerita of public health at the University of Colorado Anschutz Medical Campus. While the Oral Health in America report was under development, Dr. Dye was the director of the Dental Public Health and Informatics Fellowship Program at NIH.

"It is clear that the dental safety net has expanded in this country, but that expansion has not helped everyone in need," the authors wrote.

The Oral Health in America report considers factors affecting oral care delivery, including the need to integrate oral and medical health care, improve insurance coverage and financing, and consider unmet needs in dental workforce planning. The report cites the work of both the ADA Health Policy Institute and ADA Science & Research Institute for valuable contributions of vital data and oral health research.

"While this report highlights that oral health is an integral part of overall health and the work of dentists in leading scientific advancements and clinical treatments that help improve patient health, we still have more work to do," ADA President Cesar R. Sabates, D.D.S., said.

The report focuses on three key strategies to improve oral health care in the U.S.:

• Making dental care services an essential benefit for both private and public insurance.

• Incorporating dental or oral health care services demand into workforce planning.

• Increasing integration of oral and medical care delivery.

The report states strategies involving public and private stakeholders should be implemented to eliminate barriers and inequities in oral health care access, reduce cost, and improve both patient-centered care and oral health outcomes.

The ADA challenges all health care professionals and health policymakers to raise awareness of the importance of oral disease prevention and to advocate for health care policies that will improve oral health care in the U.S. as equitably as possible, Dr. Sabates said.

"While I am encouraged to see the progress that has been made and applaud the recommendations for health professionals to work together in an interdisciplinary fashion, there is still important work to be done to address the challenges that remain, particularly when it comes to improving health equity," he said. "The ADA remains committed to advancing research, education, practice resources and advocacy on behalf of dental professionals and the public in order to improve oral health, particularly those facing barriers to access to care."