Older Americans' access to oral health care

To determine whether older Americans have difficulty obtaining access to dental care, we studied 7,265 adults nationwide. The objectives of this analysis are to: (1) determine the proportion of older Americans receiving dental services, (2) identify the types of services received, and (3) examine barriers to access to dental care in this population. Almost half of the respondents over the age of 60 reported a dental visit in the past year. This is consistent with the national trend of increasing utilization of dental services by older adults in the United States. However, older respondents reported significantly fewer dental visits in the past year than respondents aged 25-59. The mean time since the respondent's last dental visit increased with increasing age. Minority elders and those older adults with lower incomes, lower educational achievement, poorer perceived health status, chronic diseases, transportation problems, and those living in rural areas had disproportionately fewer dental visits than more socially advantaged respondents. In multivariate analyses, less education, lower income, increasing age, and poorer self-perceived health status were identified as independent risk factors for not having a dental visit, suggesting that certain subpopulations of older Americans are at risk for not receiving necessary oral health services.     

Improving access to oral health care in Florida

It is the position of the Florida Dental Association that every Floridian should understand that good oral health is important to overall health and well-being. Good oral health does not just happen; it is the result of both personal responsibility and professional care. The great majority of Floridians (more than 70 percent) receive high quality dental care. Unfortunately, that is not where the story of Florida's oral health ends. For the other approximate 30 percent of Floridians, the system is broken. Only 23.5 percent of Medicaid enrolled children and 11 percent of Medicaid adults receive any dental care annually. This White Paper explains the barriers to accessing dental care in Florida, what is currently being done to address the problem, and what solutions exist that, if implemented in totality, could improve the oral health of millions Floridians. Lack of access to care is the result of many factors, including patients' preceived need for care, lack of oral health literacy, geographic distribution of dentists and dental teams, financial support for care and transportation challenges to name a few. It is important that government, dental professionals, and advocates work together to identify and address the many barriers to access to care.     

Disparities in children's oral health and access to care

The oral health of Americans has improved in recent years, yet considerable gaps in the provision of dental care remain according to the U.S. Surgeon General's Report in 2000. This paper provides an overview of oral health disparities experienced by racial and ethnic minority children based upon the socioeconomic status. Many Americans, particularly children, continue to suffer disproportionately from oral pain and disease, including minority, low-income, and/or special care populations.     

Geriatric oral health issues in the United States

Of the more than 270 million people in the United States, about 13 per cent are aged 65 years or older. As in most other countries throughout the world, this proportion of the population is projected to increase in the coming years. To care for this ageing and racially/ethnically diverse population, health care professionals, especially dentists, must initiate changes in public policies, available resources and access to services. The dental profession especially must improve awareness among the general public and health care professionals of the link between oral health and general health. Immediate improvements should be made to increase the proportion of dentists who are willing and qualified to treat these patient groups. Increasing the reimbursement rates available through the Medicaid programme and expanding the types of services Medicaid recipients can seek are critical. Dental education programmes must continue to provide more training opportunities to prepare professionals to meet the needs of these patients.     

Oral health needs and access to dental care of homeless adults in the United States: a review

The homeless population in the United States is one of great diversity that continues to increase in number. Although data on the oral health status of individuals who are homeless is limited, studies consistently report both the perception and clinical evidence of dental needs among this population as well as a low utilization rate for dental services. This article reviews the oral health needs of people who are homeless as reported in literature, barriers to receiving dental care, and methods used to deliver dental care to this population. Many rehabilitation centers for adults who are homeless consider the establishment and maintenance of a state of good general and oral health as a priority and a key factor in helping homeless adults to return to the workforce and mainstream society.     

Placing oral health on the health care agenda: lessons learned from the United States

A symposium on Access and Care: Towards a National Oral Health Strategy was held May 13-15, 2004, in Toronto. The symposium's objectives were to develop key recommendations for a national oral health policy, and to identify knowledge, service and funding gaps in oral health. Dr. Dushanka Kleinman was the keynote speaker. A summary report of the symposium and selected presentations are available at http://individual.utoronto.ca/accessandcare.     

Underserved elderly issues in the United States: burdens of oral and medical health care

The elderly represent approximately 12.4% of the general population (2000 Census), yet their health care expenditure and consumption represent 14% of the total (2003). Although 10% of the elderly had no medical insurance in 2000, 78% had no dental insurance. Elderly Americans' burden of medical care overuse is worsened by their out-of-pocket expenses for oral health, because this is usually not a covered benefit. In underserved communities, the management of the oral health and dental care needs of older Americans approaches negligence.     

Evaluating access to pediatric oral health care in the southeastern states

BackgroundIn this article, the authors addressed shortcomings in existing research on pediatric oral health care access using rigorous data and methods for identifying statistically significant disparities in oral health care access for children.MethodsThe study population included children, differentiated by insurance status (Medicaid, Children’s Health Insurance Program, private, none). The authors measured provider-level supply as the number of oral health care visits, stratified by provider type and urbanicity-rurality. The authors defined demand as the number of dental visits for children and derived demand and supply mainly from 2019 and 2020 data. Using statistical modeling, the authors evaluated where disparities in travel distance across communities or by insurance status were statistically significant.ResultsAlthough Dental Health Professional Shortage Areas are primarily rural, this study found that the proportions of rural, suburban, and urban communities identified for access interventions ranged from 24% through 66% and from 8% through 86%, respectively. For some states (Florida, Louisiana, Texas), rural and suburban communities showed a need for interventions for all children, whereas in the remaining states, the lack of Medicaid and Children’s Health Insurance Program access mainly contributed to these disparities. Variations in access disparities with respect to insurance status across states or by urbanicity-rurality were extensive, with the rate of communities identified for reducing disparities ranging from 1% through 100%.ConclusionsAll states showed a need for access interventions and for reducing disparities due to geographic location or insurance status. The sources of disparities were different across states, suggesting need for different policies and interventions across the 10 states.Practical ImplicationsThe study findings support the need for policies toward reducing disparities in oral health care access.     

Linking mother access to dental care and child oral health

Abstract – Objectives: The authors examined whether low‐income mothers, who have a regular source of dental care (RSDC), rate the dental health of their young children higher than mothers without an RSDC. Methods: From a population of 108 151 children enrolled in Medicaid aged 3 to 6 years and their low‐income mothers in Washington state, a disproportionate stratified random sample of 11 305 children aged 3 to 6 years was selected from enrollment records in four racial/ethnic groups: 3791 Black; 2806 Hispanic; 1902 White; and 2806 other racial/ethnic groups. A mixed‐mode survey was conducted to measure mother RSDC and mother ratings of child’s dental health and pain. The unadjusted response rate was 44%, yielding the following eligible mothers: 816 Black, 1309 Hispanic, 1379 White, 237 Asian, and 133 American‐Indian. Separate regression models for Black, Hispanic, and White mothers estimated associations between the mothers having an RSDC and ratings of child dental health. Results: Across racial/ethnic groups, mothers with an RSDC consistently rated their children’s dental health 0.15 higher on a 1‐to‐5 scale (where ‘1’ means ‘poor’ and ‘5’ means ‘excellent’) than mothers without an RSDC, controlling for child and mother characteristics and the mothers’ propensity to have an RSDC. This difference can be interpreted as a net movement of one level up the scale by 15% of the population. Conclusions: Across racial/ethnic groups, low‐income mothers who have a regular source of dental care rate the dental health of their young children higher than mothers without an RSDC.     

Access to oral health care: Professional and societal considerations

Access to health care is a complex subject with vast personal, economic, political, and societal ramifications. Issues concerning the rights and responsibilities of health care professionals-collectively and as individual members of a profession-comprise an important topic within ongoing debates concerning access to care, and constituted the overarching focus of the deliberations that form the basis of this publication. This article provides definitions of key terms; data concerning demography, oral health status, and use of dental services for children and seniors; and a contextual framework for examining broad underlying professional and societal considerations. It concludes with reflections on joint responsibilities and guiding principles that apply to dental professionals and government agencies charged with administering public benefits programs and the consequences likely to ensue if these vital stakeholders fail to respect fundamental principles of professionalism and economics.     

Improving patient retention and access to oral health care: the CARES program

Improving access to dental care for patients experiencing barriers such as financial, transportation, or mental health is a public health concern. Dental schools have an obligation to assist patients experiencing such barriers as well as to educate future dentists and allied professionals on how to assist these patients in overcoming barriers. Once admitted to the dental clinic, retention issues can further complicate the provision of dental care. This article will describe an innovative program designed to address biopsychosocial barriers to dental care. Needs assessments of patients sitting in the waiting room of the dental clinic were conducted by master's of social work (M.S.W.) students. Based on needs assessment results, common dental care barriers were identified and served as the foundation for the establishment of a social work program in the dental clinic. Dental students, faculty, and staff refer patients to the social work program when barriers to care are found. These biopsychosocial barriers are addressed by social workers, uniquely qualified professionals in providing case management, advocacy, referrals, education, and services (CARES). Over the course of three years, 80 percent of patients experiencing an identified barrier to the receipt of dental care were retained through social work intervention. These patients were able to receive dental care within the past year. Dental schools can collaborate with social work schools to establish a protocol and assistance program for dental patients experiencing difficulty accessing care, thereby improving oral health status, retention rates, and dental student education.     

Disparity in our nation's health: improving access to oral health care for children

The American public and its policymakers are beginning to recognize oral health as an integral part of overall health. Utilization of new technologies and preventive treatments has set a higher standard in the public's expectations of oral health and dentistry. There have been marked improvements in oral health indicators in the United States during the past century. However, some populations have not enjoyed the benefits realized by most Americans.     

Culture, health care, and birth defects in the United States: an introduction

Culture impacts both professional practice and patient health behaviors. This paper introduces the concept of culture and examines how it may be of importance to health professionals engaged in craniofacial care. The taking of a cultural history is presented as a way of assessing cultural differences. This paper is the first in a series of interrelated papers that define cultural perspectives toward health and craniofacial care in United States subpopulations.