When it comes to oral health in the U.S., it's easy to focus on the work that still needs to be done. However, a hefty new ADA Health Policy Institute (HPI) report details a promising trend for oral health, even amid the sometimes dreary statistics.
Marko Vujicic, PhD, chief economist and vice president, ADA Health Policy Institute.The report, which was published on December 9, looked at oral health trends in the 50 states and the District of Columbia. It contained a number of promising findings, including that access to dental care has significantly increased for children enrolled in Medicaid.
In 2000, 29% of Medicaid children saw a dentist within the past year, but 48% had by 2013. The sharp increase helped to narrow the oral healthcare gap between Medicaid children and those with private insurance.
"To me there is one result that stands out as more important than all the others, and it's the tremendous progress that's been made in the U.S. in improving access to care for Medicaid kids," Marko Vujicic, PhD, HPI's chief economist and vice president, said in an interview with DrBicuspid.com. "All but one state between 2000 and 2013 have seen more Medicaid kids going to the dentist."
Still room for improvement
The report findings also show where there is room for improvement. For example, while nearly all adults reported valuing oral health, dental care use for adults with private insurance declined, and the gap between dental care use for adults enrolled in Medicaid and those with private insurance remains large.
Vujicic was particularly surprised by one statistic that found almost 1 out of 4 low-income adults reduced participation in social activities because of oral health issues.
"We have to start changing the conversation about what oral health means," he said. "It's much more than just the absence of disease. It's about the contribution of a healthy mouth to physical, social, and emotional well-being."
Also, half of adults could not answer eight basic oral health questions, demonstrating a need for more education, according to the report authors. Since dental teams see patients regularly, they serve as a valuable resource to patients. However, Vujicic stressed that education must be addressed beyond clinic walls.
"When you look at our methods, you can look at the questions we asked, they were not super complicated," he said. "A big part of patients' interactions and sources of information in healthcare is the provider community. Increasingly, though it's other stuff. It's social media, it's Web pages, it's networks. ... Certainly dentists play a role, but we need to think more broadly and be more innovative."
Some states are getting it right
The goal of the report, according to Vujicic was to create a "one-stop shop" where state and federal policymakers could learn facts to make evidence-based decisions about oral healthcare.
"Things are going in the right direction, but there's still a lot of work to do," Vujicic said. "Policymakers really need to implement evidence-based reforms in Medicaid. Thankfully we have so many success stories where you can do that."
The report specifically points to Connecticut, Maryland, and Texas, which all implemented comprehensive oral health reforms that included provider and Medicaid enrollee outreach, increasing provider reimbursement, and streamlining administrative procedures. As a result, all three states were able to drastically improve their oral health without majorly increasing the number of providers. In the case of Maryland, the state was able to increase by fivefold the number of Medicaid children accessing dental care within the past year.
"There's really good published research on those three states," Vujicic said. "The evidence is very, very strong that a combination of these things gets you pretty dramatic results."
However, even with the availability in-depth data, the Health Policy Institute was still not able to accomplish everything it set out to.
"We were limited, in my view, where we had reliable data for all states," Vujicic explained. "For example, you'll notice dental care use for adults enrolled in Medicaid is not on there, and that's simply because of data constraints. We don't have a national, reliable source for that."
Despite the fact that there are still a lot of oral health data gaps, the HPI team will continue to monitor the progress of oral health in the states.
"We definitely plan to do updates on this. We will be doing some follow-up analysis, looking specifically at some of these self-reported oral health measures ... and we're going to continue to monitoring the impact of the Affordable Care Act on access to oral health," he said.
To learn more,check out the infographic below, and visit the Health Policy Institute's website.
