Re: Poor Economy Negatively Impacts Dental Health

This Research in Action highlights dental care research sponsored by the Agency for Healthcare Research and Quality (AHRQ). Studies look at the impact of factors such as reimbursement, race, income, and age on access to and use of care.

Research suggests that educating families about how to enroll in and access the Medicaid system, streamlining Medicaid administrative procedures, and adjusting provider reimbursement could facilitate broader access to dental care. Studies show that specific treatments such as dental sealants for children may have a positive impact on both health outcomes and costs. The quality of dental care can be further improved by developing and using performance measures for specific treatments. Finally, the production of evidence reports evaluating research on various aspects of care helps to advance evidence-based dental practice and thereby improve the quality of care.

The Surgeon General’s recent report states that oral health is essential to the general health and well-being of all Americans.1 Although oral health extends beyond dental health, the report clearly stresses the importance of the two leading types of dental disease:

* Tooth decay (dental caries).
* Periodontal disease.

Dental care can be either preventive or restorative. Preventive care, such as tooth cleaning and dental sealants, is aimed at avoiding dental problems. Restorative care repairs problems such as those caused by tooth decay and periodontal disease.
Making a Difference

Poor children receive fewer preventive health care visits than those with higher incomes.

Dental sealants can reduce the number of cavities and decrease the cost of care in the Medicaid program.

Minority elderly receive less dental care because of financial barriers to care.

Unexplained variations in dentists’ clinical decisions are widespread.

Relative cost-effectiveness of dental crowns and their alternatives has not been established.

Use of performance measures by dental plans could improve quality of care.

Evidence-based practice is advanced by evidence reports evaluating various interventions.
Oral Health Improves Overall but Gaps Exist

Over the past several decades, oral health in the United States has improved.a Among most age groups, the average number of teeth per person affected by dental caries has decreased. Also, the average number of teeth per person that show no signs of infection, as well as the proportion of the population that is caries free, has increased. In addition, a lower proportion of U.S. adults have lost all their natural teeth (a process associated with both tooth decay and periodontal disease) now than was the case two decades ago. This improvement is most pronounced at older ages.

Despite the overall improvement in oral health status, gaps in the provision of care remain. Over the 20-year period 1977-96, the gap in the use of services between low-income people (those with incomes under 200 percent of the Federal poverty level) and higher income people (those with incomes over 400 percent of the Federal poverty level) increased.2 The number of preventive visits is below recommended levels, and access to dental care remains problematic for minorities, the elderly, children on Medicaid, and other low-income children. For example:

* More than one third (36.8 percent) of poor children ages 2 to 9 have one or more untreated decayed primary teeth, compared to 17.3 percent of nonpoor children.
* Uninsured children are half as likely as insured children to receive dental care.3
* Untreated dental decay afflicts one-fourth of children entering kindergarten in the United States.
* Low-income and minority children have more dental cavities than other children.
* Poor Mexican-American children ages 2 to 9 have the highest proportion of untreated decayed teeth (70.5 percent), followed by poor non-Hispanic black children (67.4 percent).
* Poor Mexican-American and non-Hispanic black children see the dentist less often than other children.
* Less than one of every five poor children enrolled in Medicaid receives preventive dental services in a given year, even though Medicaid provides dental coverage for enrolled children.

In addition to the considerable access problems faced by poor and Medicaid-eligible children, poor elderly people and minorities have their own problems with access.

* In the 50-69 age group, non-Hispanic blacks (31.2 percent) are more likely than Mexican Americans (28.2 percent) or non-Hispanic whites (16.9 percent) to have at least one tooth site with periodontal disease.
* In the age category 70 years and over, the percentages rise to 47.1 percent, 32.0 percent, and 24.1 percent for the three groups.

With more elderly people having discretionary income and retaining their natural teeth, demand for dental services among the elderly has grown. But this demand can be substantially influenced by financial barriers and other health concerns. Studies show that the elderly typically underuse needed dental services.

The underuse of cost-effective preventive services such as dental sealants, plastic coating applied to protect the chewing surface of teeth, also illustrates that dental care in the United States has room for improvement.