In all the conversations about healthcare access in the US, dental care doesn’t get a lot of airtime. This omission is problematic considering the growing body of research showing that your oral health is deeply connected to your overall health, and the fact that in 2019, more than 70 million Americans lacked dental care — a number that’s likely grown during the pandemic.
Back in 2000, the Surgeon General released a report documenting the “silent epidemic” of oral diseases among poor Americans and people of color. Those same populations still face barriers to dental care today. Thankfully, steps are being taken to make oral health more accessible for everyone.
Dental technology innovations
As new technologies emerge, they continue to create new pathways for people to work with dentists and receive the preventative and disease-management help they need. Some notable technological innovations are:
Tele-dentistry
Tele-dentistry, like its counterpart telemedicine, involves receiving dental care virtually and exchanging documents (diagrams, X-rays, etc) digitally. This helps provide more affordable and convenient dental care access to those who live in rural areas and other underserved populations. It’s also been “tremendously helpful” during the pandemic according to Dr. Jonelle Grant-Anamelechi, a pediatric dentist who spent 12 years working in oral health policy. She believes it will remain important in the future.
Online booking services
Calling a dentist’s office on the phone can be intimidating (especially for Millennials and Gen Z who grew up in an era where texting largely supplanted phone calls). Online booking services remove the friction of calling to set up an appointment, and have been associated with reduced no-show rates among other benefits. They also allow parents and people with unorthodox schedules to make appointments during non-peak hours. “We have appointments made at one, two, three a.m.!” says Grant-Anamelechi.
High-tech prevention services
Preventing dental issues from arising in the first place is much cheaper and less invasive than managing a disease, and new technologies are making it easier for underserved people to access preventative care. One major innovation is the use of artificial intelligence software, which analyzes large collections of dental x-rays and other data for faster and more accurate diagnoses and treatment planning. These kinds of advancements could help reduce the cost and time required for dental care, making it accessible for a larger group of people.
Noninvasive procedures
Non-invasive dental procedures feel less intimidating than, say, getting a root canal. Not only are they quicker and more comfortable (read: less painful) for the patient, but they’re also more cost-effective, lowering the barrier to care for those without dental insurance. Non-invasive procedures are particularly important for people who are confined to their homes or can’t visit a dentist’s office for other reasons (something Covid has exacerbated), as dentists can perform non-invasive procedures outside of a clinic setting. Non-invasive procedures include things like crowns, laser dental treatment, and silver diamine fluoride to stabilize cavities forming in the mouth.
Medical-dental integration
Oral health has always been treated separately from overall health, with its own insurance plan and even its own education system. But as more data underscores the connection between preventive oral health care and overall health — and the subsequent savings — some insurance companies have been launching integrated medical-dental plans, and in 2020 the CDC announced a medical-dental integration partnership. This is a long overdue step in the eyes of many experts. “We as a dental community have much to contribute to the medical community. The mouth is a part of the body!” says Grant-Anamelechi.
Evidence shows that medical-dental integration not only leads to better patient outcomes and reduced costs, but also increases access to dental care. This kind of integrated care is particularly beneficial for underserved populations, like those in rural areas, as well as in cases where a medical condition and oral health have a reciprocal relationship.
Federal and state initiatives
In recent years, the Centers for Medicare and Medicaid services have improved dental care access for kids, with the share of low-income children receiving preventive dental care steadily growing. For low-income adults, however, there hasn’t been a comparable effort, largely because of the strict requirements to receive Medicaid — and the fact states are required to provide dental benefits for children, but not adults.
However, there are reasons to be hopeful that things might get better. For one, the ACA expansion extends Medicaid to non-elderly adults with income up to 138% of the federal poverty line, depending on your state, and includes dental services as an optional benefit. The Biden administration has also invested more than $6 billion into community health centers, which are a key source of dental care in underserved communities. Dr. Sarah Raskin, a medical anthropologist specializing in dental care, also notes that some states are introducing models of team-based care in which dental professionals work with varying degrees of autonomy to deliver care in community settings. “Many of them come from the communities they serve, which endows them with deep knowledge, relationships, and commitment to improving access above and beyond their formal training,” she says.
Oral health literacy improvements
In many ways, dental schools are at the forefront of oral health literacy improvements. Since 2015, the ADA Council on Advocacy for Access and Prevention has sponsored a health writing contest for dental students with the goal of increasing students’ knowledge about health literacy principles. Schools are also changing curricula to familiarize students with the ways that structural racism underlies oral health disparities, according to Raskin.
While these strides are important, experts believe that there need to be increased efforts to raise public awareness, especially since low oral health literacy may contribute to low-income adults leaving their Medicaid dental benefits unused.
Dental home approach
The dental home approach involves establishing a “home” for dental needs early in life (by age one) wih the goal of preventing childhood tooth decay and setting kids up for a lifetime of good oral health. Endorsed by the American Academy of Pediatric Dentistry in 2004, dental home takes a holistic, preventative approach to dentistry, focusing on good oral hygiene habits early. This is particularly important among low-income populations, where early childhood tooth decay is seen in “epidemic proportions.”
The dental home approach has been shown to be more cost-effective and high quality than emergency visits, and leads more children to receive appropriate preventative dental care. “This has been one of the most successful innovations of the last twenty years of dental service delivery for patients historically excluded from our market-based system of care,” says Raskin.
There’s still a long way to go in terms of truly accessible dentistry, and Raskin points out that even for those of us who currently have easy access to dental care, that might not always be the case. “But rather than feel demoralized by this thought, it inspires me to work even harder to strengthen and secure the safety net,” she says. Thankfully, she’s not alone in that effort.