State case studies: improving access to dental care for the underserved

Introduction: This article, a supplement to the work of the Institute of Medicine's Committee on Oral Health Access, examines dental access disparities, reviews societal strategies for reducing disparities, explores the relationship between state level public health and dental safety net efforts and utilization/oral health outcomes, and describes selected public health and safety net programs with special promise. Methods: Data were obtained from interviews with state dental directors and safety net leaders and a review of the literature. Findings: There is a two-fold difference in utilization rates between low- (<30 percent) and high- (56 percent) income families. The three societal strategies for reducing disparities - Medicaid, dental safety net system, and increasing the supply of dentists - all have significant limitations. The primary factor positively related to oral health is per capita income. Five promising programs for reducing access disparities include a dental home initiative for young children; a virtual dental home for school children and nursing home residents; a women, infants, and children early oral education and prevention intervention program; an enhanced Medicaid reimbursement program for educational institutions in North Carolina; and a school-based dental care system run by Connecticut Federally Qualified Health Centers. Conclusions: There are wide disparities in access to dental care, and current societal strategies to reduce disparities have significant limitations. At the state level, the primary determinant of oral health status is per capita income. Several states have promising programs to reduce disparities but most are still at the demonstration level and have not been adequately evaluated.