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Putting Teeth in Health-Care Reform: Advocates Pursue Dental Issues

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By Mary Otto
Special to The Washington Post
Tuesday, June 23, 2009

The 2007 death of a Prince George's County boy because of an untreated dental abscess was a tragic reminder of the connection between oral health and overall health.

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Yet dental care remains the most common unmet health-care need of children in the United States. Tooth decay is five times as likely to be found in children as is asthma, which, like most common illnesses, is covered by health insurance. But at least 26 million children lack dental coverage, more than twice as many as lack medical insurance, according to federal health statistics.

Among adults, oral cancer kills more Americans than cervical cancer, and research suggests that oral infections can affect pregnancy outcomes and complicate chronic diseases such as diabetes. Still, 82 million adults have no dental insurance.

As the Obama administration rolls out its massive health-care reform effort, many dental-health experts worry that a golden opportunity is being missed. "Is oral health care getting enough attention in the current health-care reform discussion? The fast answer is no, and the door is closing," said Yolanda Bonta, a New Jersey dentist who is active in the national Hispanic Dental Association.

"We're always left out a little," said Michael Battle, a Charlotte dentist and president of the National Dental Association, which represents 6,000 black dentists.

Oral-health professionals fear that dental issues have a tenuous place at best in the national debate. "If we could be at the table instead of on the menu it would be great," said Kathleen T. O'Loughlin, a Massachusetts dentist, educator and executive director of the American Dental Association, which has more than 157,000 members. Dental care, said O'Loughlin, "is an essential part of overall health, and it shouldn't be overlooked."

Burton Edelstein, a professor of dentistry and health policy management at Columbia University, says it has been "very challenging" to try to join the debate: "The mouth," he said, "is the only body part or essential organ that is excluded from policymakers' routine consideration of health and health care."

No Easy Task

Closing the gap between the worlds of dental care and medical care, with their separate histories and cultures, and their separate finance and delivery systems would be a formidable task. Edelstein, who is the founding chairman of the nonprofit Children's Dental Health Project, sees a glimmer of hope in the inclusion of several dental provisions in the 615-page first draft of the Senate Health, Education, Labor and Pension Committee's health-care reform bill.

The draft includes dental care in a list of benefits that children should receive and cites the importance of disease prevention and surveillance, safety net programs, and changes in the dental workforce and public-health infrastructure.

Advocates aren't focusing solely on the Senate bill, as there are other, competing bills still to come. Rep. Elijah Cummings (D-Md.), who has emerged as a leading congressional proponent of oral health, is working to keep the issue visible as the House of Representatives crafts its own version.

"It is important that the health reform plan includes full integration of oral health into our nation's health-care system," said Cummings. He called himself "cautiously optimistic" that such principles as incentives for dentists to treat more poor patients, oral-health literacy education for parents, preventive care programs for children and innovations to increase the dental workforce will be included in the House health-care reform bill.

The death of 12-year-old Deamonte Driver a few miles from the Capitol reminded lawmakers of the disparities that dental-care advocates had been warning about for years. One of these was David Satcher, who as U.S. surgeon general in 2000 called oral disease a "silent epidemic" afflicting millions of minority and low-income Americans.


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