Bulletin of Dental Education

New IOM Report Outlines Opportunities for Dental Education Community to Address Access to Care Challenges

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Caswell A. Evans Jr., D.D.S., M.P.H., Associate Dean for Prevention and Public Health Sciences, College of Dentistry; Photo courtesy the National Academy of SciencesA report released in August 2011 by the Institute of Medicine (IOM), Improving Access to Oral Health Care for Vulnerable and Underserved Populations, details recommendations to meet the oral health care needs of the underserved in the United States. Its motive is to bring into sharp focus the greatest barriers faced by the most vulnerable populations and ensure that oral health care is included in the national conversation that continues around health care.

A 15-member committee was charged with providing recommendations for removing barriers that limit access to care for vulnerable and underserved populations, which in 2008 included 4.6 million children who did not obtain needed dental care because their families could not afford it. The committee based its recommendations on current approaches to oral health education, financing, and regulation that inhibit equitable access to oral health care.

“Ensuring access to oral health is a responsibility shared by a multitude of stakeholders. Engagement of the oral health community, as well as the broader health professions community, is therefore essential,” said ADEA President Leo E. Rouse, D.D.S. “ADEA will respond to the report’s call to work with a myriad of stakeholders to address this societal problem.”

The report notes that graduating dental students feel unprepared to care for older patients and those with special needs. The committee suggests directing HRSA Title VII funding to support and expand opportunities for dental residencies in community-based settings in geographically underserved areas. States are recommended to require one-year mandatory dental residencies. The report stresses the need for more clinical experiences with young children, individuals with special health care needs, and other adults.

“We recognize throughout the report that we are in a climate of limited resources, but still the resources are there. It’s a matter of casting those resources in a different format with a different level of distribution than in the past,” said Dr. Caswell A. Evans, Jr., at a news conference announcing the report’s release. Dr. Evans is Associate Dean for Prevention and Public Health Sciences, University of Illinois at Chicago College of Dentistry, and a committee member.

Shelly Gehshan, M.P.P., Director, Pew Children’s Dental Campaign, Pew Center on the States; Photo courtesy the National Academy of SciencesThe committee also recommends increased recruitment and support for dental students from minority, lower-income, and rural populations, as well as increasing the number of dental faculty with expertise in caring for underserved and vulnerable populations. The report calls on foundations and the private sector to help fund these activities.

“Dental disease can have sometimes fatal and often costly consequences for those without access to care, the same as any other medical condition,” ADEA Executive Director Richard W. Valachovic, D.M.D., M.P.H., said. “Consequently, it must be given equal priority and public resources. This effort will require the engagement of accrediting agencies, national testing agencies, state boards, and state dental and allied dental associations to review and modify, where appropriate, policies, regulations, and attitudes. Most importantly, responding to the access to oral health challenge will require the commitment of federal and state lawmakers who must make appropriate and needed investments in oral health.”

In all, the report is organized on a set of domains that include: 1) integrating oral health care into overall health care; 2) creating optimal laws and regulations that maximize access to oral health care; 3) improving dental education and training; 4) reducing financial and administrative barriers; 5) promoting research; and 6) expanding the capacity of states to provide core dental public health functions.

More information about the report and its recommendations can be accessed at http://iom.edu/oralhealthaccess. This report complements an earlier IOM report released in May 2011, Advancing Oral Health in America. Both reports were commissioned by HRSA and the California HealthCare Foundation. 

ADEA is working with other health professions organizations to ensure that all health professionals are prepared to recognize and respond appropriately to oral health needs. ADEA, HRSA, the Josiah Macy Jr. Foundation, the Robert Wood Johnson Foundation, the ABIM Foundation, and five other health professions education associations are developing a framework that will teach students across the health professions what they need to know to function effectively in an integrated health team and provide holistic, patient-centered care.

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