Our oral health system is at an inflection point.
Over the past two years, the pandemic has forced us all to confront the shortcomings of our overall health care system — inequitable care, lack of access, a widening gap between the haves and have-nots. And we’ve seen those same shortcomings within the oral health system. If 2020 put a glaring spotlight on the deeply entrenched inequities that permeate the system, 2021 began a more concerted effort to better understand and, at times, address the root causes.
In 2021, we saw millions of Americans who still lack access to dental care, with many more losing their insurance during the pandemic. As Congress pushed dental benefits in Medicare farther than ever before, we uncovered more links between the body and mouth, and oral health’s connection to diabetes, heart disease, and Alzheimer’s. We saw the impacts of oral health on pregnancy, especially Black maternal health. And we saw providers in new roles, including many who raised their hands to help distribute COVID-19 vaccines.
As we begin 2022, we have an opportunity to create an oral health care system that is more accessible, equitable, and integrated — but only if we take the lessons of the past two years to heart.
What are those lessons?
1. GAPS IN EQUITY GO DEEPER THAN WE THINK
Equity gaps in oral health access and outcomes are both persistent and pervasive. CareQuest Institute’s State of Oral Health Equity in America 2021 reinforced this, showing that people of color and low-income populations consistently experience poor oral health. We saw a similar trend with veteran oral health.
A new white paper, a collaboration between CareQuest Institute and the American Institute of Dental Public Health (AIDPH), found that veterans suffer from worse oral health outcomes — higher rates of tooth decay, higher rates of gum disease, and an increased need for restorative dental care — compared to nonveterans.
A major factor contributing to these disparities is cost. Even among those with coverage, the costs are a significant barrier to accessing care. In fact, recent data show that among all Medicare recipients, at least 75% of total dental costs were paid out-of-pocket. This lack of affordability impacts people’s health.
A recent article from the Journal of the American Dental Association reported stark differences in the severity of oral diseases experienced by those enrolled in Medicaid and commercial dental plans. While this data paints a bleak picture, it also shines a light on opportunities to design systems and innovations that put equity at the center.
2. TELEDENTISTRY WILL HELP SHAPE THE FUTURE OF DENTISTRY
The use of telehealth skyrocketed in the early days of the pandemic, and dental offices were no exception. Teledentistry’s popularity among both patients and providers has continued to rise over the past two years, proving that it’s not just a short-term, crisis tool.
Teledentistry has the potential to drive progress on everything from reducing costs, to equitably increasing access, and ultimately supporting better health outcomes. In fact, even before the pandemic, data showed that patients with at least one teledentistry visit cost 10% less to treat in 2018 than dental patients who didn’t use teledentistry.
Fast forward and the expansion and interest — among both providers and patients — continues to grow. A new Best Practice Approach Report, a collaboration between the Association of State and Territorial Dental Directors (ASTDD) and CareQuest Institute, provides a framework for states and territories to identify opportunities and strategies to incorporate teledentistry into their oral health delivery systems. The Report includes several examples of teledentistry in use across the country.
3. THE FIGHT TO STRENGTHEN DENTAL BENEFITS ISN’T OVER
Oral health advocates were disappointed when Congress did not include dental benefits in Medicare, despite massive, bipartisan support by the American people. But the fight to expand access won’t end there. In 2022, advocates will continue to push for Medicare expansion and a Medicaid adult dental benefit at the federal level.
Recent CareQuest Institute research found regular preventive dental visits were linked with lower dental costs, reduced emergency department visits for nontraumatic dental conditions, fewer dental-related opioid prescriptions, and fewer oral surgeries.
Advocates across the country continue to fight for comprehensive oral health benefits in their states because the results are clear. Colorado is a great example. A review of the state’s Medicaid data showed that Medicaid patients seen at the University of Colorado School of Dental Medicine increased by almost 350% after the state expanded benefits. Outcomes improved and costs declined.
Oregon and other states that have expanded coverage have seen similar results. Maine passed legislation in July, expanding its MaineCare Medicaid program to offer comprehensive oral care to low-income adults. Virginia also added a comprehensive Medicaid adult dental benefit for the first time, which was deemed a “real breakthrough” in the state.
This has promising implications for 2022 and beyond, as more states look to do the same.
The oral health industry — like any system — has shortcomings. But it also has many opportunities to design a better future. As we begin to 2022, it’s time to build on the lessons of the past two years and create a system that is accessible, equitable, and integrated.
ABOUT THE AUTHOR
Michael Monopoli, DMD, MPH, MS, serves as vice president for grant strategy for the CareQuest Institute for Oral Health. In this role, Michael leads the organization’s strategic philanthropic grantmaking activities to promote healthy communities and improve the overall system to create better oral health for all.
Michael leverages his expertise to collaborate with grantees and partners on a systems change approach to local, state, and national investment to strengthen communities and promote health equity. Prior to joining CareQuest Institute, Michael held a number of senior roles with the DentaQuest Partnership and Delta Dental of Massachusetts, an affiliate of CareQuest Institute. He also previously served as dental director at the Office of Oral Health for the Massachusetts Department of Public Health.
Michael is a past President of the American Association of Public Health Dentistry and is a Fellow of the American College of Dentists and a Fellow of the International College of Dentists. He also serves on the boards of directors of the Forsyth Institute and the OSAP Foundation. Michael serves on advisory councils of the Forsyth School of Dental Hygiene at the Massachusetts College of Pharmacy and Allied Health Sciences and the Massachusetts Department of Public Health.
Michael earned his Doctor of Dental Medicine degree from Tufts University School of Dental Medicine and two master’s degrees from Harvard University Chan School of Public Health. He also completed a fellowship in geriatric dentistry at the Harvard School of Dental Medicine and the U.S. Department of Veterans Affairs.
FEATURED IMAGE CREDIT: Martin Slavoljubovski from Pixabay.
