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ADA and Community Catalyst lay contrasting strategies for dental care to underserved populations

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drsnehamaheshwari's picture
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Joined: 16 Mar 2013

In dueling reports published this month, the American Dental Association (ADA) and Community Catalyst have laid out contrasting strategies for expanding dental care to underserved populations.
Community Catalyst, a consumer health advocacy group, issued a study showing that dental health therapists have proven to be economically viable in Alaska and Minnesota.
The ADA's report focused on a survey it commissioned from Harris Interactive showing disparities between lower-income and higher-income adults.
Some key points from the survey are:
Nearly half of lower-income adults said they had not seen a dentist in a year or longer compared with less than a third of middle- and upper-income adults.
Eighteen percent of lower-income adults have reported that a member of their household had sought treatment for dental pain in an emergency room compared with only 7% of wealthier adults.
Only 6% of the adults who visited an emergency room reported that the problem was solved.
Harris surveyed 1221 US adults, of whom 310 had an annual household income of less than $30,000 and 911 had an annual household income of $30,000 or more. (Harris declined to provide a margin of error on the grounds that too many types of error are possible and that they are difficult to quantify.)
The findings come at a time when dental coverage for children has been improving, largely as a result of initiatives involving Medicaid and the Children's Health Insurance Program.
Coverage for children will increase even further under the Affordable Care Act, which expands Medicaid and requires that new health insurance exchanges offer pediatric dental benefits according to a separate study commissioned by the ADA.
This study, by Milliman, a consulting firm, found that about 8.7 million children and 17.7 million adults would gain coverage by 2018, but that 8.8 million of the adults would get emergency-only coverage.

The ADA laid out a multipronged proposal for bridging the rest of the gap:
Increase the number of private practice dentists contracting with Federally Qualified Health Centers so that 175% more patients could get dental care in these clinics by 2020.
Increase by 10% the number of states with Medicaid credentialing for dentists that takes less than a month.
Ensure that 80% of Americans have fluoridated public water by 2020.
Increase from 7 to 15 the number of states with Community Dental Health Coordinators (dental professionals licensed to provide prophylaxis, counseling, and education).
Increase the number of private practice dentists who visit nursing homes in at least 10 states by 2015.
Reduce by 35% by 2020 the number of people who visit emergency rooms for dental conditions by instead referring them to public clinics or private practices.
Increase dentists' volunteer work.
Increase dentists' collaborations with other health professionals and organizations.
The organization did not suggest any source of funding for these initiatives and could not immediately provide a spokesperson.
"We've made great progress, with each generation enjoying better dental health than the one before," said ADA President Robert A. Faiella, DMD, MMSc, in a media release. "But there's still a dangerous divide in America between those with good dental health and those without."
The ADA report drew an immediate response from Community Catalyst, which is working with the W.K. Kellogg Foundation to expand the number of states in which dental therapists are operating.
Currently such therapists operate in Alaska and Minnesota. Credentialing and scopes of duty vary among the 3 programs in the 2 states. All the therapists can carry out some of the most common procedures done by dentists, including many types of extraction and restoration, with fewer years of education.
The report reached these key findings:
"Seventy-eight percent of the patients served by dental therapists in Minnesota are publicly insured.
"In Alaska, dental therapists have been able to expand access to more than 40,000 people in rural areas.
"Nearly 85% of all services provided by dental therapists are routine and preventive."
Salaries were from 27% to 29% of the revenue the therapists generated.
David Jordan, dental access project director for Community Catalyst, said the ADA should recognize the value of this contribution.
"In a lot of ways the ADA's report confirms that there is a real need for dental care in this country," he said. "The ADA's solution is really dentist-centered. It's disappointing that overlooked as part of the ADA's solution was a proven provider such as a dental therapist," he told Medscape Medical News.
The fact that therapists' salaries took up less than a third of the revenue they brought in suggests they can be incorporated into existing dental practices and might even make money for dentists, he said.
In previous statements, the ADA has argued that only dentists have the training sufficient to safely carry out irreversible dental procedures.

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