The NCSL Blog


By Erik Skinner

Oral health policy is more than filling cavities and a source for bad puns.

Many legislators who attended NCSL’s Legislative Summit in Boston this month were surprised to learn that poor oral health can affect everything from annual income to the Army’s ability to deploy troops overseas.

The Summit session, Oral Health: Polishing Up Systems of Care, featured Meg Booth, executive director of the Children’s Dental Health Project and a panel of state legislators.

Booth highlighted state oral health challenges and opportunities for innovation and improvement. She made the connection between poor dental coverage and decreased school attendance and presented a few lesser known facts about the impacts of poor oral health in the U.S., including the Army reference:

  • In 2012, 62 percent of U.S. Army recruits were not immediately deployable because of a significant dental issue.
  • According to a survey from the American Dental Association’s Health Policy Institute, 29 percent of low-income respondents said the appearance of their mouth and teeth affected their ability to interview for a job.
  • Good oral health can increase annual earnings by 5 percent.

From left, Assemblyman Gordon Johnson (D-N.J.) Representative Dave Heaton (R-Iowa) Senator Josh Green (D-Hawaii) Senator Judy Lee (N.D) Representative April Weaver (R-Ala.)

Representative April Weaver (R-Ala.) moderated a bipartisan panel discussion on state successes and challenges in oral health. The panel featured four legislators: Senator Judy Lee (R-N.D.), Senator Josh Green (D-Hawaii), Representative Dave Heaton (R-Iowa) and Assemblyman Gordon Johnson (D-N.J.). 

Lee discussed the difficulty of achieving a high quality oral health delivery system in a predominantly rural state. When populations require dental services over vast geographic areas, and when resources are finite, states get creative.

“A fully equipped dental facility inside a semi-trailer, staffed by a dentist, hygienists, and assistants, provide services to underserved children in western North Dakota," she said. "It is just one tool to try to overcome the dental workforce shortage.”

Onerous regulations requiring dentists to obtain a separate license to practice on tribal lands, she said, also keep available dentists from practicing on reservations, and adds to the dental shortage areas. 

Green led off with the fact that only 11 percent of Hawaiians drink fluoridated water, mostly on military bases. Hawaii often ranks near the top for overall health and fitness and, yet, the state struggles with lagging pediatric dental health. Currently, Hawaii utilizes community wellness clinics, funded by a tobacco tax, to address chronic oral disease and divert preventable oral health conditions from emergency rooms.

Heaton outlined Iowa’s three public dental plans, I-Smile, the Dental Wellness Plan and I-Smile Silver. The three plans break down enrollees by age groups and cover eligible Iowan’s of all ages. A common theme through all three plans is the intent to build referral relationships among dental offices. This makes it easier for enrollees to establish and maintain a dental home. An outline of these programs can be found on the Summit website.

Johnson detailed New Jersey’s attempts to establish a state dental director and an oral health commission to better understand their oral health systems’ strengths and weaknesses. New Jersey is connecting community health clinics with emergency rooms to reduce ER visits for preventable conditions. This reduces the cost of care and increases accesses to preventative care for the patient.

This session was made possible through a grant from the DentaQuest Foundation.

Erik Skinner is a policy associate in NCSL's Health program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.