Introduction
According to the National Conference of State Legislatures Rural Health Brief, Where Have All the Dentists Gone, children, adults, and elders living in rural areas face special challenges when it comes to good oral care. Geographic isolation, lack of transportation, lack of fluoridated water, poverty stricken areas, low Medicaid reimbursement, and the fact that most rural dentists are older and therefore retiring, are all a factor. The elderly lose their dental insurance when they retire, and Medicare does not pay for routine care. Therefore, nearly a third of those over 65 have untreated cavities.
Tooth decay is a common health problem, second in prevalence
only to the common cold. It has been estimated that 90% of
people in the United States have at least one cavity, and
that 75% of people had their first cavity by the age of
five. Children and senior citizens are the two groups at
highest risk. Other high-risk groups include people who
eat a lot of starchy and sugary foods; people living in
areas with inadequate fluoridated water supplies; and people
who already have numerous dental fillings and crowns.
The surgeon general’s report, Oral Health in America, reports that research has shown chronic oral infections can lead to heart and lung diseases, diabetes and stroke, premature births, and low birth weights. Tooth decay and associated pain effect daily activities for four to five million children and adults a year.
Oral health is important to everyone’s general health
and well-being as well as quality of life. Dental care involves
educating people, raising awareness of oral health and oral
health issues, involving local governments, day care providers,
and corporate and community sponsors in the fight against
tooth decay, finding solutions to access problems for older
Americans, providing dental care to children, and developing,
implementing, and facilitating educational and service programs
designed to increase the visibility and public understanding
of oral health.
Frequently Asked Questions
Tools
Children's Health Insurance Program
Web site
Provides information on the Children's Health Insurance Program (CHIP).
Community Oral Health Station
Web site
Provides a list of model oral health programs throughout the U.S, plus available educational resources and funding opportunities.
Dental Volunteer
Database
Searchable database of dental health volunteering opportunities in the United States and abroad. Individuals can search for volunteer opportunities and organizations can use the site to seek dental health volunteers.
Find Shortage Areas: HPSA by State & County
Database
Provides searching for Health Professional Shortage Areas (HPSAs) by region, state, county, designation status, and type of service- primary medical care, dental, and mental health. Includes date of latest designation status.
Foundation Funding Guide: Oral Health
Web site
Lists state and national foundations with an interest in oral health.
Health Professional's Guide to Pediatric Oral Health Management
Tutorial
Series of seven self-contained online modules designed to assist health professionals with performing oral screenings to identify infants and children at increased risk for oral health problems, offering referrals to oral health professionals, and providing parents with anticipatory guidance.
Indian Health Service Division of Oral Health Recruitment Program
Web site
Provides work opportunities, a loan repayment program, and continuing dental education for oral health professionals or students.
Knowledge Path: Oral Health and Children and Adolescents
Database
Guide to resources and informative tools that offer suggestions on how to improve the oral health of children and adolescents.
National Institute of Dental and Craniofacial Research (NIDCR)
Database
Helps meet oral health information needs for special care patients by producing and distributing patient and professional education materials.
National Oral Health Surveillance System (NOHSS)
Web site
Helps public health programs monitor oral disease, use of the oral health care delivery system, and the status of community water fluoridation on both a state and national level.
Open Wide: Oral Health Training for Health Professionals
Tutorial
Series of four self-contained online modules designed to help health and early childhood professionals working in community settings promote oral health in the course of promoting general health for infants, children, and their families.
Oral Health Resources
Web site
Contains articles, fact sheets, and publications on oral health and water fluoridation. Includes state-by-state reports.
Oral Histories: Report from a Dental Fair Video
Web site
This video profiles patients attending a dental fair in rural Virginia and highlights the impact of lack of coverage for oral health services.
Ronald McDonald Care Mobile
Web site
Through relationships with local healthcare providers, the Ronald McDonald Care Mobile program brings medical, dental and health education services directly to underserved children. There are many of these care mobiles throughout rural areas in the United States.
Rural Health Research: Dental health
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of dental health, produced by the Office of Rural Health Policy's funded rural health research centers.
Safety Net Dental Clinic Manual
Web site
Offers information on partnerships and planning, facilities and staffing, financing, clinic operations, and quality awareness and improvement of dental clinics. Also includes links to sample policies, budget worksheets and design tips.
Smiles Across America
Web site
A national program which links local governments, businesses, and funders with care providers and schools to help fight untreated oral disease.
U.S. Licensure for International Dentists
Web site
Provides information to dentists who were educated outside the United States and Canada and wish to obtain a dental license in the U.S.
Maps & Map Collections
Health Professional Shortage Areas (HPSA) - Dental Health, Clinician Priority Scores
Geographic coverage: United States
Printable and customizable map that shows the clinician priority scores of dental HPSAs nationwide. These scores are used by the National Health Service Corps in determining priorities for assignment of clinicians. Scores range from 1 to 26, with higher scores having greater priority. Data source: Health Resources and Services Administration, Bureau of Health Professions, July 2008.
Date: 2009
Health Professional Shortage Areas (HPSA) - Dental Health, Designated Populations
Geographic coverage: United States
Printable and customizable map that shows the location and type of population that is underserved for population group dental HPSAs nationwide. Data source: Health Resources and Services Administration, Bureau of Health Professions, July 2008.
Date: 2009
Health Professional Shortage Areas (HPSA) - Dental Health, Designated Type
Geographic coverage: United States
Printable and customizable map that shows the designated types of dental HPSAs, Population Group, Single County, and Geographical Area, nationwide. Data source: Health Resources and Services Administration, Bureau of Health Professions, July 2008.
Date: 2009
Regulations, Forms & Other Useful Documents
A for Effort: Making the Grade in Oral Health
Sponsoring organization: Oral Health America
Focuses on initiatives that are advancing one or more of the five action steps outlined in the U.S. Surgeon General's National Call to Action to Promote Oral Health. Awards nine A's for Effort grades to Arkansas, California, Illinois,
New Jersey, New Mexico, New York, South Carolina, and Washington.
Date: 2005
Access to Dental Care for Rural Low Income and Minority Populations
Author(s): Michelle M. Casey, Gestur Davidson, Ira Moscovice, David Born
Sponsoring organization: University of Minnesota Rural Health Research Center
Examines the relationships between rural residence, income, race/ethnicity, and access to dental care, based on data from the 1999 National Health Interview Survey.
Date: 09 / 2004
Bridging the Gap: Partnerships Between Dental Schools and Colleges to Produce a Workforce to Fully Serve America's Diverse Communities
Sponsoring organization: Community Voices: HealthCare for the Underserved
Results of a study which supports the findings and recommendations of the surgeon general's report on oral health. Suggests a new approach be taken, a seven-year program from high school to dental school, with five of those years a combined college/basic science program and the final two years at a cooperating dental school.
Date: 05 / 2006
Coming Home: The Patient-Centered Medical-Dental Home in Primary Care Training
Sponsoring organization: Health Resources and Services Administration
Outlines nine recommendations for the Title VII, section 747 program to support primary care training and to prepare training programs to educate clinicians to practice in the patient-centered medical home and dental home (PCM-DH). Addresses issues and topics specifically related to rural areas.
Date: 12 / 2008
Crisis in Rural Dentistry
Sponsoring organization: WWAMI Rural Health Research Center
Lists issues related to oral health care in rural America. Discusses the need for intensified recruitment efforts to increase dental access and improve oral health in rural areas. Proposes potential solutions that may increase the rural oral health care workforce.
Date: 04 / 2009
Dental Health and Access to Care Among Rural Children: A National and State Portrait
Author(s): Amy Brock Martin, Eric Wang, Janice C. Probst, Nathan Hale, Andrew O. Johnson
Sponsoring organization: South Carolina Rural Health Research Center
Covers topics related to children and their access to dental health services. Information addresses the dental health status, preventive services and insurance received of children in rural and urban areas. Minority populations are also reported on.
Date: 03 / 2008
Filling an Urgent Need: Improving Children’s Access to Dental Care in Medicaid and SCHIP
Author(s): Shelly Gehshan, Andrew Snyder, Julia Paradise
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Summarizes recommendations on actions that states can take related to children’s access to oral health care in Medicaid and SCHIP. Addresses rural areas.
Date: 07 / 2008
Financing Dental Education: Public Policy Interests, Issues and Strategic Considerations
Sponsoring organization: U.S. Department of Health and Human Services
Informs State and Federal officials about key issues concerning the structure and financing of dental education and, in particular, to highlight public policy considerations. The report's primary focus is on predoctoral dental education (i.e., programs that award D.D.S. or D.M.D. degrees to graduates of U.S. dental schools). Addresses issues related to the dental care workforce in rural areas.
Date: 2006
Guide to Children's Dental Care in Medicaid
Sponsoring organization: Centers for Medicare and Medicaid Services
Contains information on clinical practice, evolving technologies, and recommendations in dental care.
Date: 10 / 2004
Head Start Oral Health Resource Guide
Sponsoring organization: National Maternal and Child Oral Health Resource Center
Describes a variety of resources including recent journal articles, materials for use by health professionals and Head Start staff, and organizations that may serve as additional resources.
Date: 08 / 2007
Increasing Access to Dental Care in Medicaid: Targeted Programs for Four Populations
Sponsoring organization: California HealthCare Foundation
Describes strategies that several states have used to better address the oral health of young children, pregnant women, people with developmental abilities, and people living in rural areas.
Date: 03 / 2009
Maternal Oral Health Resource Guide
Author(s): Michelle Clark, Katrina Holt
Sponsoring organization: National Maternal and Child Oral Health Resource Center
Assists health professionals, educators, program administrators, and others working to promote and improve the oral health of pregnant women, infants, and young children.
Date: 12 / 2006
Mobile-Portable Dental Manual
Sponsoring organization: Association of State and Territorial Health Officials
A companion to the Safety Net Dental Clinic Manual. This online reference tool focuses on using public health approaches to create health care systems to serve populations that have difficulty accessing the traditional system of oral health service delivery.
Date: 2007
Oral Health Coverage and Care For Low-Income Children: The Role of Medicaid and CHIP
Author(s): Julia Paradise
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
This updated policy brief provides an overview, with statistics and charts, of oral health care access and coverage for low-income children.
Date: 04 / 2009
Oral Health Promotion, Prevention, & Treatment Strategies for Head Start Families: Early Findings from the Oral Health Initiative Evaluation, Volume I: Final Interim Report
Author(s): Patricia Del Grosso, Amy Brown, Heather Zaveri
Sponsoring organization: Mathematica Policy Research, Inc.
Describes the early implementation experiences of the Oral Health Initiative grantees.
Date: 09 / 2007
Oral Health Promotion, Prevention, & Treatment Strategies for Head Start Families: Early Findings from the Oral Health Initiative Evaluation, Volume II: Site Profiles
Author(s): Patricia Del Grosso, Amy Brown, Heather Zaveri
Sponsoring organization: Mathematica Policy Research, Inc.
Discusses the sites selected to participate in the Oral Health Initiative.
Date: 09 / 2007
Oral Health: Chapter 21 of Health People 2010
Sponsoring organization: U.S. Department of Health and Human Services
Presents data, issues, trends, disparities, objectives, and terminology relating to oral health issues in the United States.
Date: 2000
Oral Health: Preventing Cavities, Gum Disease, and Tooth Loss: At a Glance 2009
Sponsoring organization: Centers for Disease Control and Prevention
Highlights CDC's focus on promoting oral health through public health interventions, helping states strengthen their oral health programs, and promoting oral health in communities, schools, and health care settings nationwide.
Date: 2009
Oral Histories: Report from a Dental Fair for Uninsured Adults
Author(s): Michael Perry, Meredith Lewis, Julia Paradise
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Conveys insights gained from interviews at the Onley, Virginia dental fair in which eight patients, a dentist providing services there, and the fair organizer talk about the oral health care challenges they face.
Date: 09 / 2009
Recruitment and Retention of a Quality Health Workforce in Rural Areas, Number 4: Oral Health
Sponsoring organization: National Rural Health Association
Overview of issues related to the oral health workforce in rural areas. Part of a series of issue papers addressing rural health care workforce development through career pipeline programs.
Date: 11 / 2006
Retail Dental Clinics: A Viable Model for the Underserved?
Sponsoring organization: California HealthCare Foundation
This report, based on interviews with dentists and other experts, consumer surveys, and published reports, examines factors that would support or inhibit the emergence of retail dental clinics in California and elsewhere.
Date: 11 / 2009
Rural Dental Dilemmas Growing
Author(s): Hope Hanson
Sponsoring organization: Rural Assistance Center
Discusses the oral health programs in rural areas including geographic isolation, lack of transportation, lack of dentists, lack of fluoridated water in certain communities, and lack of dental insurance. Highlights Apple Tree Dental, a Minnesota dental program.
Journal citation: Rural Monitor Volume 2006 Issue Winter
Date: 02 / 2006
Rural Dental Practice: A Tale of Four States
Author(s): C. Holly A. Andrilla, Denise M. Lishner, L. Gary Hart
Sponsoring organization: WWAMI Rural Health Research Center
Reports the findings of a study investigating rural dentist issues, such as demography, training, practice characteristics, staff, and job satisfaction, in Alabama, California, Maine, and Missouri.
Date: 03 / 2006
Rural Healthy People 2010: The State of Rural Oral Health
Author(s): Pete Fos, Linnae Hutchison
Sponsoring organization: Southwest Rural Health Research Center
Addresses rural health issues associated
with the Healthy People 2010 focus area on
oral health.
Date: 2003
Spotlight on Rural Research: Rural Oral Health- All in the Family?
Author(s): Hope Hanson
Sponsoring organization: Rural Assistance Center
Highlights research in rural oral health throughout the United States. Discusses several oral health research reports.
Journal citation: Rural Monitor Volume 2006 Issue Winter
Date: 02 / 2006
The Good Practice: Treating Underserved Dental Patients While Staying Afloat
Author(s): Scott, Mary Kate
Sponsoring organization: California HealthCare Foundation
Outlines techniques and tools related to creating a strategic plan, the reimbursement process and payer mix, achieving a smooth patient flow and staffing patterns, the importance of effective business systems, and implementing new technologies and clinical programs. Website also offers access to an audio clip in which three dentists describe their experiences with treating uninsured and Medi-Cal patients and how they were able to improve their practices.
Date: 08 / 2008
Journals
Oral Health America eNewsletter
Monthly newsletter that provides news regarding oral health programs and initiatives, dental industry and research updates, and opportunities to become involved in helping improve oral health for all.
Oral Health Resource Bulletin
Periodic publication designed to stimulate thinking and creativity within the maternal and child health community by providing information about selected materials of current interest.
Organizations
Academy of General Dentistry (AGD)
National organization
Strives to represent the interests of general dentists and improve the quality of comprehensive dental services, health promotion and wellness.
America's Dentists Care Foundation Missions of Mercy (ADCF MOM)
Nonprofit/Foundation
A gathering of volunteer dental professionals who, along with a volunteer staff of several hundred, hold free, two-day dental clinics at locations around the country.
American Academy of Pediatric Dentistry (AAPD)
National organization
Represents the specialty of pediatric dentistry. Advocates policies, guidelines and programs that promote optimal oral health and oral health care for children.
American Association of Public Health Dentistry (AAPHD)
National organization
Promotes effective efforts in disease prevention, health promotion and service
delivery and educates the public, health professionals and decision-makers regarding the
importance of oral health to total well-being.
American Dental Association (ADA)
National organization
Professional association of dentists committed to the public's oral health, ethics, science and professional advancement. Includes state directory of dental organizations.
American Dental Hygienists' Association (ADHA)
National organization
Represents the interests of dental hygienists. Includes publications on oral health.
Association of Clinicians for the Underserved (ACU)
National organization
A nonprofit, transdisciplinary organization of clinicians, advocates, and health care organizations working to improve the health of America's underserved populations and to enhance the development and support of the medical and dental clinicians serving these populations.
Association of State and Territorial Dental Directors (ASTDD)
State/regional organization
Represents the directors and staff of state and territorial public health agency programs for oral health.
Centers for Medicare and Medicaid Services (CMS)
Federal government
Runs the Medicare and Medicaid programs - two national health care programs that benefit about 75 million Americans. Part of the U.S. Department of Health and Human Services.
Children's Dental Health Project (CDHP)
Nonprofit/Foundation
Promotes public and clinical policies to improve health and increase access to comprehensive dental care for children and other vulnerable populations. Includes publications, news, resources, and projects.
International Mobile Health Association
National organization
Works to develop, enhance, and implement global mobile health services that promote access to health care. Offers educational forums and communication tools focused exclusively on mobile health issues.
Mobile Health Clinics
National organization
Dedicated to providing community outreach via the use of mobile medical and dental clinics. Includes news briefs, publications, and funding opportunities.
National Association of County and City Health Officials (NACCHO)
National organization
Provides education, information, research, and technical assistance to local health departments.
National Foundation of Dentistry for the Handicapped (NFDH)
National organization
Provides qualified disabled and elderly people in numerous states with free, comprehensive, donated treatment by volunteer dentists.
National Maternal and Child Oral Health Resource Center (OHRC)
National organization
Responds to the needs of states and communities in addressing current and emerging public oral health issues. Supports health professionals, program administrators, educators, policymakers, and others with the goal of improving oral health services for infants, children, adolescents, and their families.
National Rural Recruitment & Retention Network (3RNet)
National organization
Works to help health care professionals, including dentists and dental hygienists, find practice opportunities in rural areas throughout the country. Includes state information and a list of state contacts.
Oral Health America
National organization
Develops, implements, and facilitates educational and service programs designed to raise awareness of oral health's importance to total health. Includes programs such as Smiles Across America, National Sealant Alliance, National Fluoridation Center, and National Spit Tobacco Education Program.
Special Care Dentistry (SCD)
National organization
Promotes the oral health of special needs patients. Comprised of dentists from the American Association of Hospital Dentists, American Society for Geriatric Dentistry who treat geriatric, homebound and cognitively impaired adults, and the Academy of Dentistry for Persons with Disabilities who are dental professionals who treat physically challenged individuals.
Terms & Acronyms
Caries Tooth decay or cavity.
Crown A "cap" that covers a cracked or broken tooth to reproduce its normal size and shape.
Deciduous Teeth Primary or baby teeth.
Dental Amalgams Also known as silver fillings, dental amalgams are comprised of a mixture of mercury (45 to 50 percent), and an alloy of silver, tin, and copper (50 to 55 percent).
Dental Implants Small dental appliances that are inserted into the upper and lower jaws to help restore a mouth that has little or no non-restorable teeth.
Dental Safety Net Comprised of dental schools, community-based clinics, school-based programs, hospital clinics, and mobile vans, are few in number compared to the medical safety net.
Dentist Workforce Number of dental school graduates at any given time.
Doctor of Dental Medicine (DDM) Degree given to dental school graduate.
Doctor of Dental Surgery (DDS) Degree given to dental school graduate.
Health Professional Shortage Area (HPSA) Geographic regions that have shortages of professionals working in primary medical care, dental or mental health care. HPSAs may be urban or rural areas, population groups or medical or other public facilities. Geographically, HPSAs can be cities or towns, counties or groups of counties. HPSA designations are reviewed and revised annually by the Secretary of Health and Human Services based on criteria set forth in the Public Health Service Act.
Health Professional Shortage Area - Dental Care (HPSA - Dental Care) The federal designation for a shortage of dental care health professionals that meets the following three criteria. First, the area must be a rational area for delivery of dental care services. Second, the ratio of population to existing providers must meet or exceed 5,000 people to every single provider or meet or exceed a ratio of 4,000 to 1 and have an unusually high level of need for dental services. Lastly, the area under consideration must have dental care professionals in continuous (nearby/adjoining) areas that are over utilized, excessively distant or inaccessible.
Malocclusion Orthodontic problem that means "bad bite," including crowded, missing, or crooked teeth, extra teeth, or a misaligned jaw.
Orthodontics Dental specialty that focuses on the development, prevention, and correction of irregularities of the teeth, bite, and jaws.
Periodontal Diseases Also called gum diseases, periodontal diseases are serious bacterial infections that destroy the gums and the surrounding tissues of the mouth.
Plaque Thin, sticky film of bacteria that appears on teeth and must be removed professionally.
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