Oral Health

Access to dental care in the U.S. is a severe problem for young children, underscored by the fact that only a quarter of all children under six had a dental visit in 2004. In an effort to address these access issues, many states have begun reimbursing medical providers for delivering basic oral health services to children. This issue brief provides an update to the 2008 State Health Policy Monitor, The Role of Physicians in Children’s Oral Health, which highlighted state efforts to increase access to preventive dental care through the use of medical providers. Currently, 34 state Medicaid programs reimburse primary care providers for performing preventive oral health care services on children, including nine new state programs since last year’s study. These preventive oral health care services include the application of fluoride varnish, anticipatory guidance/caregiver education, risk assessment, and an oral examination/screening.

Access to dental care is an increasingly serious problem for many people in the United States, particularly for children.  There is a shortage of private dentists and a limited availability of affordable, or government-supported dental care. This is further compounded by the small number of private dentists willing to participate in public health insurance programs, or treat young children and other underserved populations, especially in rural areas. 

Dental disease is the most common chronic disease among children in the United States. Although Medicaid entitles children to medically necessary dental care under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, many children do not see a dentist until age 3 or later – even though cavity risk factors can be well established before a child’s first birthday and before the first tooth erupts. Untreated dental disease can lead to dietary problems, infection, missed school days, and a lower quality of life.

This paper discusses the options that states have to include dental benefits in a health care reform plan, if the state desires to do so. Oral health resides, for all intents and purposes, in a different world from general health. Dental care is separate in financing and insurance; provider education, licensing, and regulation; and service delivery. While ambitious health care reform plans have been undertaken in several states and proposed in others, no recent reforms have included dental benefits for the majority of those who are included in the new coverage. The primary barrier for states in including dental coverage is cost – although the traditional separation of general health and oral health – is a factor.