Improving Oral Health Care: ACA Initiatives and IOM Recommendations

Good oral health is essential to good overall health. The largely preventable problem of poor oral health has widespread repercussions ranging from lost time at school and work to reduced quality of life and increased incidence of non-oral health problems. It is exacerbated by lack of access to quality care and disproportionately concentrated among underserved people.
In 2000, the Surgeon General released a groundbreaking examination of the state of oral health in America. While noting that progress had been made over the previous half-century, the Surgeon General concluded that a ?silent epidemic? of untreated dental and oral diseases exists throughout the country. He called for a national partnership to improve the oral health care delivery system and address disparities in access to care.2
In 2011, the Institutes of Medicine (IOM) released two reports that examine the progress that has been made since the Surgeon General?s report.3 The IOM concludes that many oral health problems stem from poor oral health care and sets forth strategies and recommendations to improve access to care, particularly among underserved and vulnerable populations. The Patient Protection and Affordable Care Act (ACA) contains a number of provisions that target poor oral health directly, as well as a large number designed to increase access to and quality of health care in general.
This Issue Brief describes the problem of poor oral health care in America. It then discusses the solutions suggested by the 2011 Institute of Medicine reports and the provisions of the ACA intended to positively impact oral health care in America.
Nearly all adults have had cavities and most adults over age twenty-five have some form of periodontal disease.4 Many Americans also suffer from other oral health conditions, including oral and throat cancer, oral herpes, and cleft palate.5 Cavities, which strike five times more five- to-seventeen year olds than asthma, are the most common chronic illness of childhood.6
Approximately one in five children aged two to eleven have untreated tooth decay in their primary teeth.7 Forty-two percent of six- to-nineteen-year-olds have had cavities in their permanent teeth, and approximately fourteen percent have untreated tooth decay.8 By age seventeen, over seven percent of American children have lost at least one tooth due to decay; the average fifty-year-old has lost twelve teeth and by age sixty-five over one quarter of Americans have lost all their teeth.9
Poor oral health has severe negative repercussions on overall health, productivity and quality of life. Untreated oral health problems in children can result in attention deficits, trouble in school, and problems sleeping and eating.10 Employed adults lose more than 164 million hours of work each year due to dental disease and dental visits, and in 2009 over 830,000 emergency room visits were the result of preventable dental conditions.11 Poor oral health is also associated with a number of other diseases, including diabetes, stroke and respiratory disease.12 In older adults, poor oral health is significantly associated with disability and reduction in mobility.13
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