18 years ago the Surgeon General issued a report describing how important oral health is to our overall health. The report showed that oral health is related to chronic conditions like diabetes and can influence child learning and employment outcomes. Since the statement was made public, oral health has been improving among children in the United States. There are still oral health disparities by income and race that need to be addressed, but generally, the trends for children are headed in the right direction. More children are visiting the dentist, including those coming from low-income populations. Low-income children are “catching up” to high-income children regarding their dental care utilization rate.
Unfortunately, the same cannot be said about adults. Fewer adults are visiting the dentist, notably those in low-income populations. Income disparities in dental care utilization have grown for adults. The cost of dental care is the top reason adults are not visiting the dentist, and many studies, show that dental care is thought of as being the most expensive service in healthcare. Emergency department visits for preventable oral health conditions have skyrocketed over the past decade, a trend driven mainly by young and low-income adults.
Medicaid and the Children’s Health Insurance Program (CHIP), require dental coverage for children, covering 40 percent of children in the United States. The Affordable Care Act lists dental care for children as one of the ten essential health benefits.
The Affordable Care Act, Medicaid, and 22 state Medicaid programs view dental care for adults as either not essential, or won’t cover anything beyond emergency dental care services.
The ADA Health Policy Institute has released a comprehensive, state-by-state report on oral health and well-being in the United States showing how much of an impact oral health issues have on the lives of adults. Almost 30% of low-income adults say that the condition of their oral health affects how they interview for a job. Two out of five low-income adults say they have difficulty biting and chewing because of the state of their mouth and teeth. Nearly one in four reports they have reduced participation in social activities because of oral health issues. Most concerning is the sharp disparities in all aspects of oral health and well-being according to income level.
Expectations differ markedly by income, as well. While about half of high-income adults say, they expect to lose some of their teeth as they age, among low-income adults, this is a much higher 74 percent. Cost is the top reason for not visiting the dentist more frequently among all age and income groups, including high-income adults with private dental coverage.
Looking at our current access to dental care, specifically the vast difference in dental care coverage for adults in comparison to children, a change is definitely in order with how dental care is handled in the U.S. health care system.
Adult dental benefits with Medicaid are optional and provide only primary coverage in most states. Putting a comprehensive dental interest for Medicaid adults in to place is estimated to cost on average $1.5 billion per year; the estimated state portion of this bill translates to about one percent of total Medicaid spending when about $1.6 billion is spent each year on hospital emergency room visits for dental conditions, of which about 33% is being paid for by Medicaid. Broadening adult dental benefits under Medicaid has been shown to increase access to care under proper enabling conditions.
The dental benefits for adults in both Medicaid programs as well as the private dental coverage market need to be reevaluated. With cost being the top reason why both Medicaid and privately insured adults bypass dental care clearly shows that the current dental insurance model is not anything.
Dental benefits should be constructed so that they pay for oral health and well-being – the things measured in the ADA Health Policy Institute survey. It could be modeled after the dental benefits for children in Medicaid and CHIP. Policymakers need to consider how children’s dental benefits are handled differently than adult dental benefits in health insurance marketplaces as well. There has been an increase in private medical insurance plans in the health insurance marketplaces covering dental benefits for children, but there are not as many options for adults, even though dental care is a high priority among adults, notably young adults when they are shopping around for insurance.
The definition and measure of oral health should be adjusted as well. The current focus is only on if there is a dental disease and it’s severity – typically limited to cavities and gum disease – and the type and how often dental care services are being used. There is not much emphasis on oral health and well-being in the United States compared to that of physical, social and emotional well-being. The new measures developed by the ADA Health Policy Institute are a considerable improvement in this area, but this should be treated as a starting point for other research organizations.
Even the Surgeon General said we could not be healthy without good oral health, so it is time for a significant change and more emphasis on healthy teeth.
At Implantation Dental Center in South Florida, we are passionate about the health and well-being of our patients. Implantation Dental Center provides the best prosthodontics, and periodontal services in South Florida, including dental implant placement, single implant crown, implant supported denture and bone and soft tissue regeneration. Call us today at 954-476-0770 to find out how we can help you smile with confidence.
