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
Community Oral Health Station
Web site
Provides a list of model oral health programs throughout the U.S. Lists educational resources as well as funding opportunities.
Community Voices for the Uninsured
Web site
Comprised of eight sites across the country, and launched by the W.K. Kellogg Foundation, this is a group of national, community-based demonstration projects which seeks to develop programs that actually improve the accessibility of people to quality health care, based on real-life demonstrations of what does and can work.
Dental Resource Net: Patient Education Archive
Web site
Lists patient education handouts in 17 foreign languages that focus on dental health and care.
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.
Foundation Funding Guide: Oral Health
Web site
Lists state and national foundations with an interest in oral health.
Health Professional Shortage Area Database
Database
Provides searching for Health Professional Shortage Areas (HPSAs) by region, state, county, designation status, type of service and more. Includes date of latest designation status.
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.
Insure Kids Now!
Web site
Information on free and low-cost health insurance programs for children.
Call toll-free at 877.543.7669.
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.
Medicaid Benefits: Services Covered, Limits, Copayments and Reimbursement Methodologies for 50 States, District of Columbia and the Territories
Database
State-by-state information on Medicaid benefits, searchable by state and by benefit. Lists coverage for various services, including dental.
MedlinePlus: Child Dental Health
Database
Contains listings of research articles, and health information on child dental health.
MedlinePlus: Dental Health
Database
Contains listings of research articles, and health information on dental health.
National Institute of Dental and Craniofacial Research
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
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.
Oral Health Resources
Web site
Contains articles, fact sheets, and publications on oral health and fluoride. Includes state-by-state reports.
Ronald McDonald Care Mobile Program
Web site
Through relationships with local healthcare providers, the Ronald McDonald Care Mobile program brings cost effective, high-quality 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.
Smile Line
Hotline/Toll Free Telephone
A national dental health toll free hotline that consumers can call to talk one-on-one with a dentist regarding questions or concerns about oral health. 1-800-SMILE33 (800-764-5333) from 8:00a.m. to 8:00p.m. (EDT)
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.
State Children's Health Insurance Program
Web site
Provides information on the State Children's Health Insurance Program (SCHIP).
Maps & Map Collections
Health Professional Shortage Areas (HPSA) - Dental Health, Clinician Priority Scores
Geographic coverage: United States
Printable 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, January 2008.
Date: 2008
Health Professional Shortage Areas (HPSA) - Dental Health, Designated Populations
Geographic coverage: United States
Printable 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, January 2008.
Date: 2008
Health Professional Shortage Areas (HPSA) - Dental Health, Designated Type
Geographic coverage: United States
Printable 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, January 2008.
Date: 2008
Regulations, Forms & Other Useful Documents
2003 Oral Health Report Card - Keep America Smiling: Oral Health in America
Sponsoring organization: Oral Health America
Discusses the 2003 oral health report card for the United States.
Date: 05 / 2003
2004 Report to the Secretary: Rural Health and Human Service Issues
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
Report to the Secretary of the U.S.
Department of Health and Human Services. Overview of key issues and trends affecting health and human service delivery in rural communities. Detailed information on the coordination of behavioral health and primary care, access to oral health care, and access to human services for the elderly.
Date: 04 / 2004
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
Access to Oral Health Services for Low-Income People: Policy Barriers and Opportunities for Intervention for The Robert Wood Johnson Foundation
Author(s): Shelly Gehshan, Tara Straw
Sponsoring organization: National Conference of State Legislatures
Highlights the results of a study on policy barriers to oral health care for low-income people.
Date: 10 / 2002
Addressing Oral Health Needs: A How To Guide
Sponsoring organization: Community Catalyst
Provides communities and organizations ideas in addressing oral health needs.
Date: 2002
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
Children's Dental Care Access in Medicaid: The Role of Medical Care Use and Dentist Participation
Author(s): Karen VanLandeghem, Janet Bronstein, Cindy Brach
Sponsoring organization: Agency for Healthcare Research and Quality
Reports on children's dental care use in the Alabama and Georgia Medicaid programs and strategies for improving access to dental care.
Date: 06 / 2003
Children's Dental Care: Periodicity of Checkups and Access to Care, 2003
Author(s): May Chu
Sponsoring organization: Agency for Healthcare Research and Quality
Looks at whether dental checkup advice was ever offered by a physician or other health care provider, the periodicity of receiving dental checkups, and affordability of dental care among children between the ages of two and 17 in the U.S. civilian noninstitutionalized population.
Date: 01 / 2006
Dental Care: Improving Access and Quality
Sponsoring organization: Agency for Healthcare Research and Quality
Highlights dental care research sponsored by AHRQ.
Date: 07 / 2003
Dental Coverage and Care for Low-Income Children: The Role of Medicaid and SCHIP
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Provides an overview of dental care access and coverage for low-income children. Includes information about rural dental care access.
Date: 08 / 2007
Effects of State Dental Practice Laws Allowing Alternative Models of Preventive Oral Health Care Delivery to Low-Income Children
Author(s): Lea Nolan
Sponsoring organization: George Washington Department of Health Policy
Examines state dental practice laws and the extent to which they encourage alternative models of delivering preventive oral health care.
Date: 01 / 2003
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 salient 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).
Date: 2006
Guide to Children's Dental Care in Medicaid
Sponsoring organization: Centers for Medicare & 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
Health Care Disparities in Rural Areas: Selected Findings from the 2004 National Healthcare Disparities Report
Sponsoring organization: Agency for Healthcare Research and Quality
Presents findings related to rural health care from the 2004 disparities report by describing the quality of care for diabetes and heart attack, access to health insurance coverage, and utilization of dental services. Examines socioeconomic and racial disparities and tracks progress in eliminating them.
Date: 05 / 2005
Health Professional's Guide to Pediatric Oral Health Management
Sponsoring organization: National Maternal and Child Oral Health Resource Center
Series of seven self-contained online modules designed to assist health professionals in managing the oral health of infants and young children.
Date: 2006
Improving Oral Health: Promise and Prospects
Author(s): Jennifer Ryan
Sponsoring organization: National Health Policy Forum
Reviews barriers to dental care, opportunities and challenges of public financing sources and safety net programs for dental care for low-income children and families.
Date: 06 / 2003
Improving the Oral Health Status of all Americans: Roles and Responsibilities of Academic Dental Institutions
Sponsoring organization: American Dental Education Association
Examines the role of academic dental institutions in addressing the oral health needs of all Americans.
Date: 03 / 2003
Interface Between Medicine and Dentistry in Meeting the Oral Health Needs of Young Children
Sponsoring organization: Children's Dental Health Project
Examines issues related to the coordination of medical and dental primary care systems around children's oral health.
Date: 07 / 2003
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
National Call to Action to Promote Oral Health
Sponsoring organization: U.S. Department of Health and Human Services
Discusses expanding plans, activities, and programs designed to promote oral health and prevent disease, especially those who are vulnerable because of special oral health care needs.
Date: 05 / 2003
Openwide: Oral Health Training for Health Professionals
Sponsoring organization: National Maternal and Child Oral Health Resource Center
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.
Date: 2006
Oral Health and Overall Health: Why a Healthy Mouth is Good for Your Body
Sponsoring organization: Mayo Foundation for Medical Education and Research
Discusses how researchers are discovering new reasons to brush and floss. An unhealthy mouth, especially if you have gum disease, may increase your risk of serious health problems such as heart attack, stroke, poorly controlled diabetes and preterm labor.
Date: 12 / 2005
Oral Health in America: A Report of the Surgeon General
Sponsoring organization: U.S. Department of Health and Human Services
Alerts Americans to the full meaning of oral health and its importance to general health and well-being.
Date: 09 / 2000
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 Risk Assessment Timing and Establishment of the Dental Home
Sponsoring organization: American Academy of Pediatrics
Examines organizational principles to guide and define the child health care system and/or improve the health of all children.
Date: 05 / 2003
Oral Health Status and Practices Among Native Hawaiian Elders
Sponsoring organization: National Resource Center on Native American Aging
Highlights of a study on Native Hawaiian Elders and oral care.
Date: 08 / 1997
Oral Health Tip Sheet for Head Start Staff: Working With Parents to Improve Access to Oral Health Care
Sponsoring organization: National Maternal and Child Oral Health Resource Center
Contains tips to ensure that pregnant women, infants, and children enrolled in Head Start receive proper oral care.
Date: 2003
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: Dental Disease is a Chronic Problem Among Low-Income Populations
Sponsoring organization: Government Accountability Office
Analyzes dental health and data from four national health surveys.
Date: 04 / 2000
Oral Health: Factors Contributing to Low Use of Dental Services by Low-Income Populations
Sponsoring organization: Government Accountability Office
Discusses the high level of oral diseases affecting vulnerable populations.
Date: 09 / 2000
Oral Health: Preventing Cavities, Gum Disease, and Tooth Loss
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: 2008
Report of the CDC Division of Oral Health
Sponsoring organization: Centers for Disease Control and Prevention
Discusses the CDC's Oral Health Program.
Date: 09 / 2003
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
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
Safety Net Dental Clinic Manual
Sponsoring organization: Association of State and Territorial Health Officials
Covers dental clinic development and operations. Includes information on partnerships and planning, facilities and staffing, financing, clinic operations, and quality awareness and improvement. Also includes links to sample policies, budget worksheets and design tips.
Date: 2006
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
Date: 02 / 2006
State and Community Models for Improving Access to Dental Care for the Underserved - A White Paper
Sponsoring organization: American Dental Association
Identifies five access-to-care model programs
for states as they consider how to strengthen their public programs to improve access to dental care for underserved populations.
Date: 10 / 2004
State Efforts to Improve Children's Oral Health
Author(s): Brendan Krause
Sponsoring organization: National Governors Association Center for Best Practices
Discusses what states are doing to improve oral health for children, education programs, access to care, and workforce issues.
Date: 11 / 2002
State of Decay: The Oral Health of Older Americans
Sponsoring organization: Oral Health America
Examines older adults' lack of access to good oral care. Gives a D to the oral health report card for older Americans.
Date: 09 / 2003
United States Licensure for International Dentists
Sponsoring organization: American Dental Association
Provides information to dentists, who were educated outside the United States and Canada and wish to obtain a dental license in the U.S.
Date: 01 / 2006
Where Have All the Dentists Gone?
Author(s): Dianna Gordon
Sponsoring organization: National Conference of State Legislatures
Discusses the need for dental care services in rural areas. Includes examples of programs from several states that address rural oral health needs.
Journal citation: NCSL Rural Health Brief
Date: 2004
Journals
Children's Dental Health Project News Bytes
Biweekly email newsletter that collects and disseminates press reports on children's oral health and dental care.
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.
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 Academy of Pediatrics (AAP)
National organization
Committed to the attainment of optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults.
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
Works to improve the health of underserved populations by enhancing the development and support of the health care 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 & 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 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
Helps health care professionals, including dentists and dental hygienists find practice opportunities in rural areas throughout the country. Includes individual state information as well as 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 who are hospital based dental professionals, 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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