ADA examines dental safety net issues

The ADA has released the second in a series of papers that examine the challenges and solutions to bringing good oral health to millions of Americans, including the growing population whose only possible source of dental care is the so-called oral health safety net.

The latest paper, "Breaking Down Barriers to Oral Health for All Americans: Repairing the Tattered Safety Net," emphasizes the absence of a coordinated, systematic approach to treating underserved populations. It identifies common sense remedies that can greatly improve safety net programs, even absent the major funding increases that are unlikely to occur in the current economic climate.

"Major improvements in the dental safety net will not occur until the nation places much greater value on oral health," stated ADA President Raymond Gist, DDS, in a press release. "Treating disease that could have been easily prevented or treated in its early stages but has progressed to the point of chronic infection, and lost teeth, gum tissue, or bone is one of the major reasons why these clinical delivery systems remain overwhelmed."

The paper provides seven fundamental principles that should guide efforts to repair and enhance safety net programs:

• Prevention is essential. A public health model based on the surgical intervention in disease that could have been prevented after that disease has occurred is a poor model.

• Everyone deserves a dentist. The existing team system of delivering oral healthcare in the U.S. works well for patients in all economic brackets and can be expanded to accommodate millions more.

• Availability of care alone will not maximize utilization. In too many cases, people are unable or unwilling to take advantage of free or discounted care. This often can be remedied through better attention to social or cultural issues, oral health education, and assistance with child care, transportation, or securing permission to miss work in order to receive treatment.

• Coordination is critical. Too many government or government-administered programs suffer from a failure to manage and exchange information about best practices for safety net operations.

• Treating the existing disease without educating the patient is a wasted opportunity, making it likely that the disease will recur. Anyone who enters a dental operatory for restorative care should leave that operatory with an understanding of how to stay healthy and prevent future disease.

• Public-private collaboration works. Absent a highly unlikely population boom among dentists practicing in community-based and public health settings, private practice dentists will continue to deliver the hands-on care to most of the population. Better coordination between the public and private dental communities can help maximize existing resources.

• Silence is the enemy. Virtually every shortcoming in the safety net has at its root a failure to understand or value oral health. When people, whether lawmakers, the media, or the general public learn about oral health and the consequences of untreated oral disease, their attitudes and priorities change.

While the paper emphasizes the safety net's weaknesses, it does so in the context of the ADA's commitment to support the tireless efforts of thousands of dentists, allied health professionals, and other public and private sector workers and volunteers who constitute its backbone.

"Surely the various groups and individuals who seek to repair and enhance the safety net differ somewhat on priorities and methods," Dr. Gist said. "But we must all recognize that our common goal eclipses these differences. If all of the stakeholders involved keep the goal of a healthier, more productive nation at the forefront of our thinking and actions, we can truly progress toward better oral health for all Americans."

Future ADA papers will address such topics as patient utilization, disease prevention, oral health education, and funding the delivery system.