Sens. McCain and Obama,

Americans deserve a healthcare policy with some teeth in it.

Although research has shown a strong link between oral health and overall health, including cardiovascular disease and diabetes, millions of Americans lack access to even basic dental care. In fact, for every adult without medical coverage, there are three without dental coverage.

Yet oral healthcare has been virtually ignored in the nation’s healthcare debate. It’s a big problem, and we need a big solution from our next commander-in-chief.

It starts with education and information. Many don’t understand the importance of proper brushing and flossing, a healthy diet and fluoridated water. As a result, tooth decay, a 100 percent preventable condition, is the cause of U.S. children missing more than 850,000 school days a year. In addition, many families enrolled in programs like the State Children’s Health Insurance Program (SCHIP) or Medicaid don’t know about the dental benefits that are also available to them.

But this information alone has no value without access to dental care. The most vulnerable populations in our society—

minorities, the elderly and children on Medicaid and other low-income children — have the most difficulty getting oral healthcare, especially when they live in urban and rural areas where there are not enough dental healthcare providers.

More dentists are needed in these underserved areas, and it’s up to the dental schools and professional societies to instill a sense of community responsibility as an integral part of professional responsibility. Some schools, including Temple’s Maurice H. Kornberg School of Dentistry, require that their students participate in community outreach service and care. And for the past several years, through the American Dental Association’s “Give Kids a Smile” program, oral healthcare professionals nationwide have provided free care to thousands of disadvantaged children.

Further, dental procedures are costly, and Medicaid reimbursement rates often don’t fully cover the dentist’s operating costs. New dentists are already faced with large student debts, some approaching $200,000, and they’ll be paying them off for decades. Without proper reimbursement, they cannot or will not practice in disadvantaged areas.


In addition to better education and greater access to care, we need more comprehensive, cost-effective dental coverage, starting with the inclusion of preventive dental care in Medicare coverage.

Currently, Medicare only covers specific conditions such as tumors, oral cancer or dental trauma, but if preventive care such as routine cleanings and checkups were covered as well, it would help to improve the health of elderly Medicare recipients, reducing the burden on patients, dentists and our healthcare system.

In addition, certain insurance programs or states participating in SCHIP will opt out of dental coverage altogether, because it’s seen as elective. The perception that oral healthcare is unrelated to overall health, and is merely optional, needs to be corrected. We cannot afford to opt out of dental care anymore than we can opt out of cardiac care.

It’s this perception that has contributed to a lack of funding, which is badly needed to expand community health centers, provide adequate Medicaid reimbursement, and establish educational programs for parents and in schools. Congress can make a step in the right direction by establishing a federal dental benefit in SCHIP, instead of leaving it up to the states to include dental benefits.

So what else can be done? Gov. Ed Rendell’s “Prescription for Pennsylvania” legislation is a step in the right direction, and a good example of what could be done at the federal level too. It expands the duties of a dental hygienist to perform certain procedures without the direct supervision of a dentist. As a result, they will be able to go into the community to provide basic oral care to a wider patient base, including schoolchildren, the elderly and those with minimal or no dental coverage.

So, Senators, as you campaign for better healthcare on your way to the White House, remember to include oral health coverage in that discussion. Improving the oral healthcare status of every American not only makes good public policy sense, but with its connection to overall health, it makes great healthcare sense.

—Written by Lisa Poole Deem, D.M.D., J.D.

Associate Dean of Admissions and Student Affairs, Maurice H. Kornberg School of Dentistry, Temple University

Member, Pennsylvania State Board of Dentistry