Keeping America’s Oral Health Safety Net Strong

Ask any American what they think about healthcare reform and, for better or worse, you’ll probably find very strong opinions about the role of government and spending.

However, backstage, away from the public debate about the new law, a quiet revolution is underway to help the 59 million Americans who go without medical care and the 100 million who have not had dental care this year, get the care they desperately need.

It’s not the individual mandate or the state health exchanges. It’s the most significant investment in primary care you’ve probably never heard of—an $11 billion commitment to community health centers and $15 billion to prevention programs. It may sound like small potatoes compared to the estimated total cost of healthcare reform--$940 billion over 10 years--but the impact will be significant, especially for those who need it the most.

These funds, reopened for debate by Congress, would double the capacity of community health centers (CHCs) from serving 20 million people a year to 40 million. As the only access point for care besides the emergency room, CHCs provide critical prenatal care, behavioral health services, primary and specialty care for 1 out of 7 uninsured individuals. By 2015, with new capacity, CHCs will serve 1 out 3 uninsured.

Healthcare reform requires that CHCs offer oral health services. This means as many as 17 million children will get to see a dentist, some for the first time ever. Currently, these children are significantly underserved because they can’t access to care to prevent tooth decay and, once they have decay, to get timely treatment.

There’s a reason why former U.S. Surgeon General David Satcher declared childhood tooth decay a “silent epidemic”. 6.5 million children have untreated dental disease, the majority of whom are from low-income households. Half of these children are estimated to go to school with mouth pain—as children who cannot eat properly or pay attention in class and do well in school.

For infants 3 years old and younger, this can mean a mouth full of diseased baby teeth that can only be treated through surgical intervention. This is followed by a life time of being at greater risk for tooth decay, because the corrosive bacteria that cause tooth decay have colonized their mouths in greater proportion.

Tooth decay not only disrupts development and educational attainment, it can also turn deadly. The 2007 death of a 14-year-old Maryland boy is a tragic reminder of how one ‘simple’ toothache can develop into an unchecked infection that can quickly spread to the brain. His death could have been prevented with a timely dental care, but, at the time, oral health services were difficult to find for families on Medicaid.

From our work as president of a foundation focused solely on oral health and as a lifelong practicing dentist in both a private practice and a community health center, we see evidence every day of how oral health disparities in underserved communities are every bit as cruel as violence, inadequate housing, or poorly performing schools.

Fortunately, dental disease is nearly 100% preventable with education, regular check-ups for prevention, and treatment. That is why we’re committing DentaQuest Foundation resources to supporting and strengthening the community care safety net for oral health. We want to make sure that greater numbers of health centers will be prepared to provide effective, high-quality oral health services to children and families. The DentaQuest Institute and its Safety Net Solutions program are joining us to make sure that happens.

It may take decades before the impact of this investment in community health centers is fully appreciated. That’s okay. Today we are thinking about the millions of children who will have greater opportunity in life because of accessible health care.

Blog post by Ralph Fuccillo and Dr. Mark Doherty.

Ralph Fuccillo is President of the DentaQuest Foundation.
Dr. Mark Doherty is Executive Director of the DentaQuest Institute. Its Safety Net Solutions Program is helping community health center dental programs become more efficient, effective and financially stable.

What does Good Oral Health Mean to You?

I spend a lot of time educating people about good oral health. And if you scroll through this blog, you’ll see there is a lot that can be said on the topic.

That made me wonder, what does good oral health mean to you?

I really would like to know.

Rating the Performance of Your State’s Health System

There’s an interesting new report by the Commonwealth Fund, Securing a Healthy Future: The Commonwealth Fund State Scorecard on Child Health System Performance, 2011 that is worth looking at.

The Commonwealth Fund’s researchers took a number of objective measures for good health -- such as access to prevention and treatment, the potential to lead a healthy life (defined as factors such as low prevalence of specific health problems, low obesity, and lack of habits and behaviors that impact health, such as smoking) and socio-demographic dimensions (such as income and where you live) -- and looked at how each of these measures impact the others. The result is a very interesting and comprehensive picture of elements that contribute to children's health in each state.

We’re pleased that this report includes preventive dental care and the absence of dental problems as measures of access to prevention and treatment and a factor in healthy lives. The Report concludes that the high rate of poor yet preventable dental health outcomes among children in many states points to the need to improve preventive dental health care.

Better access to oral health services can reduce tooth decay and lead to a better quality of life for children, as well as reduce financial and societal costs. The Commonwealth Fund found that almost one third of children did not see a dentist for a preventive visit in the bottom-ranked state and more than 10 percent did not have a dental check-up in the top-ranked state. Want to know who they are? Click the link on the report title and check out the report!

Dental disease is nearly 100% preventable when people have access to information about keeping their mouths healthy and access to dental services. Public education, expansion of access to dental care, and integration of oral health into routine well-child care are smart ways to do this.

It works best when FAMILIES are able get the services they need to maintain their oral health since parents need dental care themselves for their own good health AND so they can be a good example for their children. The U.S. Department of Health and Human Services Healthy People 2010 goals recommend that children have at least 1 dental visit annually. And the American Dental Association says that you can start this at the age of 1 or when the first tooth erupts.

So, check out the data for your state. And then let me ask you -- is an annual visit to the dentist something that you do for yourself and for your children?

Report from the Field: National Oral Health Conference, 2011

If you’re involved in public health dental care, are a health researcher, dental educator, legislator, public health official, Medicaid/CHIP dental program staff or consultant, or provide dental care at a community health center, chances are, you are in Pittsburgh, PA this week (April 11-13) at the National Oral Health Conference.

This is the 12th time the Association of State and Territorial Dental Directors (ASTDD), the American Association of Public Health Dentistry (AAPHD) along with the Centers for Disease Control and Prevention (CDC) have brought the national public oral health community together to highlight the many areas where public health systems can converge toward achieving “optimal oral health” for America’s citizens. As a leader in the national conversation about improving oral health for Americans, DentaQuest is playing a visible role.

The ASTDD board invited the leadership of the DentaQuest institute and the DentaQuest Foundation to its annual Board meeting to update them on the significant investments we have planned for 2011.

In the 1st general session of the conference, Mark Doherty, DDM, MPH, Executive Director of the DentaQuest Institute, Ralph Fuccillo, President of the DentaQuest Foundation and Marcia Brand, PhD, the Deputy Administrator of HRSA, walked participants through “Strategies for Achieving and Maximizing Return on Investment in Oral Health.” ARRA and the Affordable Care Act have made significant investments in the health safety net. Oral health programs will benefit. With good planning, this once in a lifetime investment can lead to increased access, improved oral health outcomes, and financial sustainability and potential partnership with private foundations to extend the dollars available for oral health expansion. DentaQuest Institute Director of Practice Improvement, Dr. Jay Anderson is representing the Institute on an ASTDD- and ADA-sponsored panel discussion on working in community health centers. The American Association of Medical Colleges Advisory Group on Oral Health Curricula is discussing adoption of the Smiles for Life online oral health training for health care clinicians.

The DentaQuest Institute is featuring information on Safety Net Solutions technical assistance services throughout the conference at its booth.

The DentaQuest Foundation and Institute look forward to these national events for the opportunity they provide us to connect with dental public health leaders from across the United States. It makes us better at the work we do with our partners in supporting effective approaches to preventing and caring for oral disease.

Blog post by Dr. Michael Monopoli, Director Policy and Programs, DentaQuest Foundation and Brian Souza, Managing Director DentaQuest Foundation and DentaQuest Institute, reporting from NOHC.

Smokeless Tobacco – YOU’RE OUT!

Images of opening day should be of cheering fans, baseball diamonds, baseball caps and crisp new uniforms, and NOT containers of smokeless tobacco anywhere near the dugout. Smokeless tobacco in all its forms -- chewing, plug, twist, snus, snuff, dissolvable -- is a dangerous (and dirty) habit that I hope will no longer be glorified on baseball fields – professional or neighborhood. This year Congress is putting pressure on Commissioner Bud Selig and MLB players association chief Michael Weiner to ban smokeless tobacco all together this baseball season. I can’t agree more. We do not want impressionable children and teens to see their sports heroes using smokeless tobacco and get the wrong message about the dangers. Make no mistake about it, smokeless tobacco is dangerous.

• Smokeless tobacco contains higher quantities of nicotine than most cigarettes. And it increases the likelihood that the person using it will become a smoker.1


• It shocked me to learn that according to the Academy of General Dentistry (AGD) 4% of boys in middle school and 20% of high school boys use smokeless tobacco. Half of them will likely develop pre-cancerous white patches in their mouths. ·


• Smokeless tobacco products, just like cigarettes, contain at least 28 cancer-causing chemicals. And the sugar that is often added to enhance the flavor increases the risk for tooth decay.2 ·


• Smokeless tobacco is known to cause cancers of the mouth, lip, tongue and pancreas. Users may also be at risk for cancer of the voice box, esophagus, colon and bladder, if they swallow toxins in the juice.2

April isn’t just the time that baseball comes back in full swing; it’s also Oral Cancer Awareness Month. That makes this a great time to remind you that oral cancer affects males and females, adults and kids. And even if you are not a smoker, make sure your dentist does an oral cancer exam [pulls and twists your tongue] at every visit.

Please share these facts with the teens and youth in your life. And I’d be curious to know what they think about smokeless tobacco and keeping it out of baseball? Check out the facts:

• University of Iowa
• CDC

Eradicating Early Childhood Caries

This year, the Centers for Medicare & Medicaid Services and other experts estimate that more than 300,000 children under the age of six, many from lower-income households, will suffer from Early Childhood Caries (ECC) and require hospitalization. These young children often have a mouthful of cavities and a potentially life-threatening bacterial infection that may cause them to seek hospitalization. Another 1.5 million children are considered at risk for ECC. Hospital resources are so limited that children requiring operating room care at one of the few hospital-based dental clinics commonly wait up to six months before receiving treatment. In the meantime, parents rely on powerful antibiotics to keep the infection in check. (Not much can be done about the pain).

Early Childhood Caries can be prevented. But to do this, young parents need the right information about the oral health of their babies and toddlers in time to prevent infection. Without access to preventive education and care, children may find themselves facing rampant cavities, a hospital stay, and residual lifelong disadvantages—such as malnutrition, school absences, and missed work.

We at the DentaQuest Institute are tackling this preventable, chronic childhood disease head on. Working in partnership with researchers at Children’s Hospital Boston, we have developed a clinical protocol for treating Early Childhood Caries that works with primary care providers and parents to improve treatment in the hospital and, most importantly, at home. This program is using education and case-management to help change behavior at home and the dental office. Where this treatment plan has been used, we have been able to reduce the percentage of young children (under 60 months) with new cavities by 69 percent; reduced those who needed treatment by 55 percent; and reduced reports of children with mouth pain by 50 percent. The DentaQuest Institute is now working to expand the ECC program to 10 dental clinics across 8 states—including MA, RI, OH, NY, FL, CA, WA and NY. In many ways, Early Childhood Caries is a parable for what plagues healthcare: small problems that turn into big problems because the right information and resources weren’t available in the first place to stop the progression. Preventive health care is part of the solution, but it means nothing unless you know how to use it.

Dr. Mark Doherty, Executive Director, DentaQuest Institute and Dr. Jay Anderson, Director of Quality Improvement, DentaQuest Institute