CDC's oral health division on the chopping block?

The Centers for Disease Control and Prevention (CDC) has announced a restructuring proposal that would fold its Division of Oral Health (DOH) into the Division of Adult and Community Health (DACH).

The agency has been vague about its reasons for the potential restructuring, but public health experts speculate it is related to budget concerns. But they also emphasize that submerging the oral health division within the adult health division runs the risk of diluting the government's efforts in improving pediatric oral health.

The proposal has elicited strong condemnation from the dental and legislative communities. The ADA, Academy of General Dentistry (AGD), American Academy of Developmental Medicine and Dentistry, Congressman Mike Simpson (R-Idaho), and a group of former chief dental officers of the U.S. Public Health Service have all sent letters to U.S. Department of Health and Human Services Secretary Kathleen Sebelius and CDC Director Thomas Frieden, MD, MPH, voicing their opposition.

In each case, the organizations emphasize that if such consolidation occurs, oral health would inevitably become less of a priority.

"Dissolving one of the separate dental divisions from the department would only seem to decrease and take away from highlighting the importance of preventing and treating oral disease," the ADA stated in a letter signed by the organization's president, Raymond Gist, DDS, and executive director, Kathleen O'Loughlin, DMD, MPH.

This concern is "fully warranted," according to Scott Tomar, DDS, DrPH, a professor and chair of the department of community dentistry and behavioral science at the University of Florida College of Dentistry.

"There has been quite a bit of discussion about this on the Association of State & Territorial Dental Directors Listserv," Dr. Tomar told DrBicuspid.com. "State dental directors were saying, 'This is exactly what happened in our state when we were moved from a division of oral health in our health department down to a branch within another division -- it almost always came with a reduction in budget and in staffing.' "

The AGD is concerned about the proposal's potential impact on public health. "Our primary concern is the fact that this reassignment conflicts with one of the primary objectives of the DOH: to protect the health of children," the group's letter to Sebelius stated.

Congressman Simpson, a former dentist, suggested that the DACH may not be well-suited to address children's oral health needs. "I question if it is even appropriate for oral health to fall under the jurisdiction of the DACH, which has a larger mission focused on adults," he said in a letter to Sebelius.

Several of the letters noted the abrupt change in tack from the CDC's commitments to oral health made in 2010.

"Such organizational changes would diminish the visibility of oral health at CDC during a time of critical need for public health leadership less than a year after the Department of Health and Human Services announced and began to implement a department-wide oral health initiative, and at a time when specific oral health provisions of the Patient Protection and Affordable Care Act are directed to the CDC," a letter from former chief dental officers of the U.S. Public Health Service stated.

The ADA has enjoyed a close working relationship with the CDC through the DOH, the organization noted in its letter to Sebelius, calling the CDC "a collaborator on some of the most important initiatives benefitting the public's oral health over the past decade."

The ADA also cited a number of its collaborative accomplishments, such as water fluoridation, recommendations for evidence-based care, and infection control in dental offices.

"The current organizational structure promotes clear dental leadership, unity of purpose, and responsiveness that will be undermined if the DOH is subsumed into a division with a larger public health mission focused on adults," the ADA letter stated.

Dr. Tomar agreed. "Having been in the CDC, this move almost guarantees that even less attention will be paid to oral health," he said. "The division director will not have the ear of the centers' director the way the other divisions are able to. When push comes to shove, the oral health component will become a neglected stepchild."

There appears to be no clear timeline on when the CDC will render its decision on the proposal.

"We'll consider everything and try to do the best we can to address all public health needs," Rhonda Smith, public affairs officer at the agency, told DrBicuspid.com. "It's a proposal still under discussion and review; no decision has been made to this point."

Linda Orgain, MPH, health communications specialist at the DOH, said CDC management is in the process of obtaining suggestions and comments from the staff.