By Erik Skinner
Trips to emergency departments for preventable dental conditions cost the U.S. health system $1.6 billion in 2012, the most recent year for which figures are available.
“The most extreme cases of untreated dental infections have cost hundreds of thousands of dollars in hospitalization and some have tragically ended in needless death,” according to the American Dental Association (ADA),
With these jarring realities in mind, legislators and legislative staff from 22 states sat down to consider state policy options at NCSL’s Oral Health Preconference: Smart Investments in Oral Health in Chicago.
“As we work to improve our oral health system, we must identify what services insurance companies will pay for by opening a dialogue with the actuaries themselves. Then, we must determine when it makes sense for policymakers to separate coverage or merge dental benefits with traditional nondental plans," said Colorado Senator Beth Martinez Humenik (R).
Marko Vujicic, chief economist for the American Dental Association’s Health Policy Institute, kicked off the preconference with a presentation that framed the improvement of oral health in the U.S. by comparing the capacity of our oral health system to the realities of its utilization.
For instance, from 2005-2015 only three states did not see growth in the proportion of dentists per 100,000 people. Additionally, 35 percent of dentists nationwide report they are not busy enough and could take on more patients.
Given these trends, it is surprising that the percentage of adults with private dental insurance that received a dental visit in the last 12 months has not increased over the last decade. In fact, rates went down from 60 percent in 2005 to 59 percent in 2013.
Brief summaries of faculty presentations and links to resources follow.
In its most basic form, teledentistry increases the speed of medical information between providers. It can be an important tool in preventing oral disease as well as intervening early to prevent oral disease. Teledentistry can also strengthen connections between dental care providers and allied health care providers working in different geographic locations.
Early childhood cavities (or caries) are five times more common than asthma, the next most prevalent chronic childhood illness. Socioeconomic factors help determine one’s risk for cavities. Poor children are twice as likely to develop caries than their nonpoor counterparts. Braun also presented three criteria on which to evaluate policy aimed at reducing cavities: Is the care coordinated, co-located and integrated? Answering these questions may assist state policymakers seeking strategies to close disparities in oral health, improve care across the dental home and avoid unnecessary expenditures.
“In Oregon, the legislature has expanded the scope of practice for dental hygienists, implemented pilot programs for telemedicine across the state and passed telehealth legislation with insurance companies in the room.," said Oregon Senator Laurie Monnes Anderson (D).
Prevention and chronic disease management will reduce the overall burden of disease and help allocate limited resources more efficiently. Edelstein cited oral health disparities and dental Medicaid challenges as the problems best addressed through public health approaches to oral health policy. For instance, providing dental sealants in public schools is a low cost option for reducing early childhood caries.
Policymakers across the country are adjusting to the level of care provided by dental hygienists through scope of practice laws. Lynch outlined Direct Access Laws and charted their expansion throughout the U.S. over the last eight years. According to her presentation, Direct Access Laws give dental hygienists and other midlevel providers the ability “to initiate treatment based on their assessment of a patient’s needs without the specific authorization of a dentist, treat the patient without the presence of a dentist and maintain a provider-patient relationship.” Utilizing midlevel oral health providers has the opportunity to increase oral health access and build upon the readily available dental hygiene workforce, according to the American Dental Hygienists’ Association. It is up to individual states to engage stakeholders to focus on the policies that will work best for their state.
This preconference was made possible through a grant from the DentaQuest Foundation.
Erik Skinner is a research analyst in NCSL's Health program.