Often overlooked, untreated tooth decay and poor oral health have become an epidemic in the United States. In fact, tooth decay is the most common childhood disease, five times more common than asthma.

On March 6th, The New York Times reported that an alarming number of preschoolers were facing oral surgery due to untreated tooth decay. According to the CDC, for the first time in forty years there is an increase in the number of preschoolers with cavities.

While last month’s New York Times story captured the need for more awareness about the importance of oral health to overall health and the need for better diets to prevent tooth decay, it did not explore the fact that there are more than 83 million people who do not receive regular dental care because the existing system is not capable of serving them. An entire quarter of the population, these 83 million people do not receive dental care because they live in communities where there are not enough dentists to meet the need or because the dental care offered is unaffordable.

Without a delivery system in place that provides routine care and preventive services, the proportion of the population that this epidemic effects will persist and grow larger.

Through further examination of the dental delivery system, it is clear America’s oral health is suffering as a result of the systemic problem caused by too few dentists in underserved rural and urban communities. Nearly 50 million Americans live in communities without enough dentists to meet their needs. Compounding the dental shortage problem is that not enough providers accept Medicaid. In 2009, 56 percent of Medicaid-enrolled children did not receive dental care—not even a routine exam.

Last year a study in the American Journal of Pediatrics showed that Medicaid patients were 18 times more likely to be denied care than children with private insurance.

With no place to turn for affordable dental care in their community, patients turn to the emergency room at a high cost to the patients, the health care system and to taxpayers. Last year, the Washington Hospital Association reported that dental visits were the number one reason uninsured patients visited the emergency room and it was the sixth reason for Medicaid enrollees to visit the emergency room.

According to a report released last month by the Pew Center on the States nationally, more than 830,000 visits to emergency rooms nationwide in 2009 were for preventable dental problems, highlighting the substantial cost of ER care. For example, Florida saw dental-related, emergency hospital visits produced charges exceed$88 million in 2010.

Recognizing the need for a better way to address America’s unmet oral health needs, Dr. Louis Sullivan, former Secretary of the United States Department of Health and Human Services, offers a systematic approach on how to better deliver care in underserved communities in Monday’s New York Times.

Dr. Sullivan notes that, “A more immediate solution is to train dental therapists who can provide preventive care and routine procedures … outside the confines of a traditional dentist’s office. [They] are common worldwide, and yet in the United States they practice only in Alaska and Minnesota, where state law allows it. Legislation is pending in five more states.

The dental profession has resisted efforts to allow midlevel providers to deliver this kind of care, and the government has so far failed to push for the change. It must do so now. [They] could encourage states to pass laws allowing these providers to practice by calling for demonstration projects proving their worth.”

Dr. Sullivan is not alone in recognizing the need for a comprehensive approach to addressing our oral health needs. Recently Senator Bernard Sanders (I-Vermont) released a report, “Dental Crisis in America: The Need to Expand Access,” that details the problems Americans face in accessing care and potential solutions, including mid-level providers such as dental therapists.

Additionally, Dr. David Nash of the University Of Kentucky College Of Dentistry released a monograph on Tuesday detailing the history of dental therapy both internationally and in the United States. After rigorously reviewing more than 1,100 documents on the care provided by dental therapists worldwide, the authors concluded that these practitioners deliver safe, effective dental care in addition to improving access to care. Included as part of the oral health workforce, they have the potential to decrease the cost of care as well.

With more attention on the dental crisis and solutions, like adding a mid-level provider to improve access to care, we need to keep the momentum up by supporting efforts at the state and federal levels to improve access to care and how care is delivered.

 – David Jordan,  Dental Access Project Director