The debate over “Medicare for All” has sucked the oxygen from many other important health policy issues. Though 28 million Americans lack health insurance in the United States, there is an untold crisis of more than four times that population — 114 million Americans — without dental coverage.
Millions of Americans are suffering from decaying teeth, gum disease, and chronic pain. Yet, in the Democratic presidential debates thus far, barely a word has been spoken about this crisis. When we spend so much time talking about health care, why is oral health so easy to ignore?
Oral health affects overall health. The consequences of untreated decay and periodontal disease – slowly destructive gum infections – include increased risk of cancers, cardiovascular diseases, Alzheimer’s disease, and premature births. Yet, almost two-thirds of Medicare enrollees, a quarter of children, and 40 percent of adults under the age of 65 don’t have dental coverage.
The data clearly shows that when people can’t afford dental care, they skip it to their detriment.
To date, the debates have focused on the preferred media narrative — a gargantuan and TV-ready conflict between the centrists and the lefties over Medicare for All. The candidates don’t have an incentive to dive into these complex issues. Rather, they are rewarded for “clickable” moments of pithy remarks and curt comebacks to their political rivals.
However, the candidates running for president have a pulpit to draw attention to important issues. They should use this platform to highlight that every year, thousands of Americans flock to regional free dental clinic events because they don’t have dental coverage — highlighting a clear failure of the U.S. health-care system. They should release big ideas that would address the crisis of oral health in our country.
Members of Congress should act immediately to expand existing programs that will help the 114 million Americans who don’t currently have dental insurance.
Expand community dental health coordinators
In the 1970s, Community Health Workers (CHWs) were evolved as frontline public health workers to help address health and social issues within their communities. They acted as liaisons between health and social services and the community to help patients navigate the system and improve access, quality, and cultural sensitivity of service delivery.
The data shows that by helping patients navigate the system, they can improve outcomes and save money. In 2018, the Migrant Health Services CHWs led a cancer prevention program which saved $3.16 for every $1 spent on Medicaid-eligible adults.
That same model is now applied to oral health. Community Dental Health Coordinators (CDHCs) have emerged to help patients better access dental care and navigate the health-care system. These dental coordinators help patients bridge the gap between clinical and community services, help them make and keep appointments, and provide education and community-based prevention.
Many people don’t know that safety net programs exist in their communities to help the uninsured access oral health services.
In fact, 80 percent of Community Health Centers and Federally Qualified Health Centers (FQHCs) now offer dental services. CDHCs can help patients connect with these resources and bridge the gap for millions of Americans without coverage to access needed care.
Implement sealant programs in school-based settings
The Centers for Disease Control and Prevention (CDC) Community Preventive Services Task Force recommends school-based dental sealant efforts. Dental sealants can protect against 80 percent of cavities for two years. Children aged 6 to 11 years without sealants have almost three times more first molar cavities than children with sealants.
Dental sealants are simple to administer and can be applied by a trained community health worker like a CDHC. Applying dental sealants in schools is a proven, cost-effective, and efficient way to reach millions of children to prevent tooth decay. These programs help prevent cavities in school-aged children and save taxpayer dollars in Medicaid.
Include oral health in the existing maternal and infant health home visiting program
Finally, the Health Resources and Services Administration (HRSA) funds voluntary home visiting services for parents with young children. It sends nurses, social workers, or early childhood education experts into program enrollees’ homes, increasing public health and cost benefits. Integrating CDHCs to perform early dental screening and oral health education into the home visiting program is another way to improve upon an already successful model.
There is a wide-spread perception that oral health is secondary to medical care. Subsequently, policymakers don’t discuss dental health nearly as much as other click-worthy health-care issues. I challenge candidates to move beyond the narrow fight over Medicare-for-all and elevate the issue of oral health. In the meantime, Congress could act immediately to a provide relief to millions of Americans who lack dental coverage.
Arielle Kane is the director of Health Policy at the Progressive Policy Institute. Her research focuses on what comes next for health policy in order to expand access, reduce costs and improve quality.