Dental Health Frequently Asked Questions
Question:
How do I start a dental service in my local
community?
Answer: There are several possibilities
for funding to help get a clinic stocked, staffed and running.
One of the best tools is the Safety Net Dental Clinic Manual. This guide discusses start-up costs, picking a location, construction, square footage, rules and regulations, mobile dental unit, required staffing, plus much more.
Question: What is the advanced dental hygiene practitioner program?
Answer: For the past few years, there has been a move by the American Dental Hygienists Association (ADHA) to pursue the concept of an Advanced Dental Hygiene Practitioner (ADHP). This would be a baccalaureate degreed dental hygienist who then completes an advanced educational curriculum, resulting in a Masters level dental hygienist who would be the dental equivalent to the Nurse Practitioner. This would prepare her/him to provide diagnostic, preventive, restorative and therapeutic services. For further information, see the American Dental Hygienists' Association website on ADHP. Also see Draft Competencies for the ADHP as well as several frequently asked questions.
Question:
What is the State Children’s Health
Insurance Program (SCHIP): Dental Care for Kids?
Answer: The Balanced Budget Act of
1997 (P.L. 105-33) added a new Title XXI to the Social Security
Act, creating the State Children's Health Insurance Program. The
program is designed to help states cover more uninsured children
with new federal money that must be matched with state dollars.
The State Children’s Health Insurance Program (SCHIP) may provide a dental benefit to low-income children as well. Check out what your state covers.
The National Conference of State Legislatures has additional information on SCHIP and Oral Health.
Question:
Does Medicaid cover oral health services?
Answer: Actual benefits vary by state.
The Kaiser Commission on Medicaid and the Uninsured has searchable state-by-state information on Medicaid dental benefits.
All children enrolled in Medicaid are entitled to comprehensive
dental services. Medicaid's "Early and Periodic Screening,
Diagnosis and Treatment (EPSDT)" program, the nation's primary
source of well-child care for low-income youth through age 20,
must provide dental examinations for all children. Despite the
efforts of EPSDT programs across the country, many eligible children
lack access to comprehensive dental care. Also see Guide to Children's Dental Care in Medicaid.
Question:
Where is there information on low-cost
or free insurance for children that includes dental care?
Answer: Insure Kids Now! is
a program through the U.S. Department of Health & Human Services. This
is a national campaign to link uninsured children to free and
low-cost health insurance, with some states providing dental care.
Kids that do not currently have health insurance are likely to be eligible, even if you are working. The states have different eligibility rules, but in most states, uninsured children 18 years old and younger, whose families earn up to $34,100 a year (for a family of four) are eligible. Check to see what Insure Kids Now! offers in your state.
Question: Where is there information on obtaining dental care in my area?
Answer: There are various programs that provide services to those in need of dental care.
National Foundation for Dentistry for the Handicapped provides provides services for disabled, elderly or medically compromised who have no other way for paying for dental care.
Find a Dentist allows the public to search for dentists in your area by speciality.
Smile Line is 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.
Association of State & Territorial Dental Directors provides information on state oral health programs.
Question:
Are there any loan repayment programs for
dental clinicians?
Answer: Yes. General practice dentists
and registered clinical dental hygienists may qualify for the
National Health Service Corps Scholarship & Loan Repayment Program.
Further information on loan repayment programs are available in
an information guide titled Health Education Financial Aid, specifically in the frequently asked questions section on loan repayment.
The Indian Health Service also has a loan repayment program for those who qualify.
Question:
Are there oral health/dental programs for
American Indians?
Answer: Yes. The U.S. Department of
Health & Human Services Indian Health Service has an Indian Health Dental
Recruitment Program. This agency is responsible for addressing the health needs of over 1.6 million American Indians and Alaska Natives in over 230 hospitals and clinics in 35 states. Over 1800 dentists, hygienists, and dental assistants work in these programs to help prevent dental disease.
The Alaska Native Tribal Health Consortium (ANTHC) Community Health Aide Program (CHAP) has a component called the Dental Health Aide Program, which is designed to address the oral health needs of Alaska Natives in rural settings.
Question: What kinds of successful oral health programs do other states have?
Answer: There are numerous successful oral health programs throughout the United States. The Association of State and
Territorial Dental
Directors provides a list of state oral health programs.
The CDC also has a listing of all oral health plans by state.
In addition, here are some specific, successful programs -
Give Kids a Smile Day - Sponsored by the American Dental Association, this is a nationwide, yearly event.
Colorado, New Jersey, and Oregon - Bridge Campaign of Concern/Outreach Education - A program in Colorado, New Jersey, and Oregon. People with developmental disabilities often cannot care for their oral health and have difficulties getting treatment. BRIDGE staff provides in-service training to nurses, teachers, case managers, residential staff, and parents of adult DD children to help improve oral hygiene and to follow up with routine dental care.
Colorado - Kids in Need of Dentistry (KIND) - a non-profit children’s charity dedicated to providing low and no-cost dental care to children from low-income families throughout Colorado.
Connecticut - Connecticut Oral Health Initiative - through advocacy, coalition building, and education strives to create a public conscience that results in access to oral health care for all.
Idaho - The Regional Initiatives in Dental Education program, or RIDE, is a strategic expansion of the University of Washington School of Dentistry in conjunction with Eastern Washington University, designed to help meet the oral health needs of rural and underserved communities in the Northwest.
Iowa - Iowa I-Smile is a project working to provide every recipient of medical assistance who is a child twelve years of age or younger with a designated dental home, along with dental screenings and preventive care. Delta Dental of Iowa is a not-for-profit organization and focuses providing better oral health for employees and their dependents for an affordable price, along with long-term cost savings through preventive and educational services.
Kansas - Kansas Mission of Mercy - a program held twice a year throughout Kansas which provides free dental care to patients who are seen on a first-come, first-served basis. Kansas Donated Dental Services which provides free, comprehensive care for people who are permanently disabled, medically compromised or elderly and who are unable to afford dental care. Oral Health Kansas is a statewide oral health coalition dedicated to helping Kansas become a national leader in oral health education, prevention and treatment. The coalition's main areas of focus are advocacy, public awareness and education. Bright Smiles for Kansas Kids is a program that provides a one-hour online educational program for pediatric providers on fluoride varnish application along with a free tool kit featuring 50 free fluoride varnish applications for children ages 0-3.
Michigan - Varnish! Michigan
A Fluoride Varnish Program - a fluoride varnish
program to Early Head Start
and Head Start children
throughout the state, servicing over 15,000 children.
Minnesota - St. Joseph's Community Dental Clinic - a Minnesota hospital-based clinic which works to reduce dental disease.
Missouri - Missouri Coalition for Oral Health - a statewide oral health coalition working through advocacy, coalition building, education and policy development. Also, the Oral Health Network of Missouri is a statewide oral health provider network which provides oral care to medically underserved, uninsured and insured populations at over 24 delivery sites within Missouri's rural and urban communities.
Montana - Miles for Healthy Smiles program and Pilot Oral Health Collaborative. Also, Gallatin County
Dental Alliance provides oral health screenings in the schools in Gallatin County.
Nebraska - Dental Day Program - provides children in parts of Nebraska with free dental care for a day.
North Dakota - Red River Valley Dental Access Project - an oral health coalition committed to improving access to oral health care through advocacy, education, expanding and developing the workforce, assuring services and creating unified strategies to improve access.
Texas - Caring for Kids - a rural school-based dental program that provides care to children in South Texas.
Vermont - Tooth Tutor Program, which works to assure that every child has access to preventive, restorative and continuing care in a dental office; the School-based Fluoride Mouthrinse Program, which provides free weekly fluoride mouthrinse to children in schools that do not have community water fluoridation; and the Baby Bottle Tooth Decay Initiative, which identifies children who are at risk and to assure that those children have access to early preventive care.
Virginia -The School Fluoride Mouthrinse Program, where school children across Virginia are eligible to participate in a weekly topical fluoride mouthrinse program.
Washington - The Regional Initiatives in Dental Education program, or RIDE, is a strategic expansion of the University of Washington School of Dentistry in conjunction with Eastern Washington University, designed to help meet the oral health needs of rural and underserved communities in the Northwest.
West Virginia - Rural Health Education Partnerships - Dental students are scheduled, for a minimum of six weeks at a rural site, during their senior year.
Wisconsin - Wisconsin Seal-A-Smile Program - works with Children's Health Alliance of Wisconsin to administer mini-grants for school-linked and school-based dental sealant programs. Also, Donated Dental Services is directed at those people who are unable to afford needed dental care because of a limited income which is clearly linked to a permanent disability, chronic illness or advanced age (65 or over).
Community-Based Oral Disease Prevention Project: Rural Native American Population - development of a program to reduce the incidence and prevalence of early childhood caries in the rural Native American population.
Question:
Are there any mobile oral health/dental
programs?
Answer: Yes. The International Mobile Health Association is available to assist in establishing mobile health programs. Also, several states have mobile
units, such as:
Ronald McDonald Care Mobile Program - 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 in both rural and urban areas around the world.
There are many of these care mobiles throughout rural areas in the United States.
Christina's Smile - travels throughout the United States to deliver quality comprehensive charitable dental care to children in need in the communities that host a PGA TOUR and Champions Tour tournament.
California - Tooth Mobile Dental Care Program - provides affordable and accessible mobile dental care; the Denti-Cal Outreach Program provides a mobile trailer that travels to a different rural northern California county each month to provide dental treatment to children; the Children's Oral Health Program of Monterey County helps families with children from age 0-5 years or pregnant woman with dental services and education; and the Clinica Sierra Vista's Mobile Health Services which delivers dental services to homeless adults, as well as schools.
Colorado, New Jersey and Illinois - Dental HouseCalls, or Van, enables people who cannot easily travel to dental offices because of disabilities or old age to receive comprehensive dental care. Portable dental equipment is taken into nursing homes, community mental health centers, special education centers, residences of the homebound, and facilities serving people with developmental disabilities.
Colorado - Miles for Smiles Mobile Dental Clinic, sponsored by Kids in Need of Dentistry, provides comprehensive, quality dental care, including emergency care when necessary, to children in rural communities throughout Colorado.
Connecticut - Across the Smiles - provides access to preventive and restorative dental care to many elementary and middle school children in the rural towns of Windham county in NE Connecticut.
Florida - Veterans Mobile Service Center provides homeless veterans dental screenings and treatment.
Idaho - Mobile Health and Dental Clinic - provides dental service to underserved, northern counties of Idaho.
Kentucky - The University of Kentucky College of Dentistry operates the Mobile Dental Unit; also the Ronald McDonald Care Mobile travels throughout the state offering dental care.
Maine - Miles for Smiles Program - provides access to oral health services through a fully equipped mobile center throughout Maine.
Michigan - SMILE! Michigan Dental Sealant Program - a
mobile dental-hygiene
program based in Jackson
County that provides direct
access to oral health care.
Minnesota - Apple Tree Dental Mobile Services - provides on-site services in nursing homes, group homes, Head Start centers, schools, and assisted living facilities in Minnesota.
Missouri - Elks Club provides funding for mobile dental clinic - provides basic dental care for children with special health care needs and other
special populations in Missouri. Missouri also has the Miles for Smiles program, a mobile dental clinic that travels to 12 counties in the Southwest Missouri area treating dental needs.
Montana - Holy Rosary Healthcare Foundation sponsors the Ronald McDonald Smile Savers Care Mobile Program.
Nevada - provides Preventative and Restorative Mobile Dental Outreach programs. Also the Ronald McDonald Care Mobile provides the Miles for Smiles Mobile Dental Service.
New Jersey - Southern Jersey offers the Mobile Medic - offers mobile medicine, including dental care and emergency dental care, to residents of Burlington, Atlantic, and Salem counties.
New York - University of Rochester Eastman Dental Center's Collaborative School-Based
Dental Program - provides access to dental care via mobile dental services or by establishing
onsite dental clinics linked with a school health clinic; Big Blue, the mobile dental van that brings dental care to children in low-income neighborhoods of northern Manhattan, including Washington Heights and Harlem; University at Buffalo School of Dental Medicine has a mobile dental van that tends to rural Chautauqua County children.
North Carolina - Access Dental Care - dedicated to providing dental care for older adults in long-term care settings and those with mental retardation and/or developmental disabilities in North Carolina. Also, Carolinas Mobile Dentistry is a fully mobile state-of-the-art dental office staffed by a geriatric dentist,
dental hygienist, and dental assistants providing oral hygiene and dental care
to nursing facilities, assisted living and retirement communities in
Mecklenburg, Cabarrus, Union and Gaston Counties in North Carolina.
Oregon - Keep Cavities Out provides free dental sealants to children in geographically underserved areas of the state, who may not have access to the dental care they need.
Pennsylvania - PennSmiles Program: Promoting Oral Health - an oral health outreach program that travels to area schools, Head Start
programs, and other neighborhood sites in West Philadelphia.
South Dakota - Ronald McDonald Care Mobile travels around the state, bringing dental care to thousands of South Dakota children.
Tennessee - Magnolia Mobile Dental Services provides dental care to nursing home patients.
Washington - Yakima Valley Farm Workers Clinic maintains two mobile clinics. The mobile units travel to towns, farms, and orchards, opening their doors to anyone who needs medical or dental care.
Oral health resource list for various states - a state listing of various oral health programs and contacts.
Question: What oral health disparities are present in rural America?
Answer: Rural areas face a number
of unique challenges that limit access to dental services for
many residents. These include geographic and transportation barriers,
fewer fluoridated community water supplies, an acute shortage
of dental professionals relative to the rest of the country, and
a lower rate of dental insurance.
In 2004, U.S. health spending was about $963.9 billion, with dental care accounting for 7.5 percent. Although 47 million Americans lack health insurance, 108 million lack dental insurance.
For additional information on rural oral health disparities, including statistics and data, consult
the following research articles:
Brock-Martin A., "Analysis of State Dental Hygiene Practice Acts and Medicaid Policies for Children’s Dental Care: Services Covered and Practitioners Reimbursed South Carolina Rural Health Research Center. Research Project, August 2008 anticipated completion date.
Fisher-Owens S., Barker J., Adams S., Chung L., Gansky S., Hyde S., Weintraub J., "Giving Policy Some Teeth: Routes To Reducing Disparities in Oral Health." Health Affairs. 2008; 27(2): 404-412.
Ramos-Gomez F., Cruz G., Watson M., Canto M., Boneta A., "Latino Oral Health: A Research Agenda Toward Eliminating Oral Health Disparities." Journal of American Dental Association. 2005; 136:1231-1240.
Older, but significant research articles on rural oral health disparities:
Vargas C., Dye B., Hayes K., "Oral Health Care Utilization
by US Rural Residents, National Health Interview Survey 1999."
Journal of Public Health Dentistry. Summer 2003; 63(3):150-157.
Vargas C., Dye B., Hayes K. "Oral Health Status of Rural Adults
in the United States." JADA. December 2002; 133:1672-81.
Vargas C., Ronzio C., Hayes K. "Oral Health Status of Children
and Adolescents by Rural Residence, United States." The Journal
of Rural Health. Summer 2003; 19(3):260-268.
Vargas C., Yellowitz J., Hayes K. "Oral Health Status of Older
Rural Adults in the United States." JADA. April 2003; 134:479-486.
Question:
What proportion of rural community water supplies are fluoridated,
and where can I find additional information about community water
fluoridation?
Answer: According to the National Conference of State Legislatures Rural Health Brief, Where Have All the Dentists Gone, more than 100 million Americans do not drink fluoridated water. Community water fluoridation
is consistently found to be one of the most effective means of
preventing tooth decay. According to the Journal of Public Health Dentistry, every $1
spent on fluoridation saves $38 in treatment costs. Unfortunately,
exact data on rural community water fluoridation are not available.
However, it is proportionally much more expensive to fluoridate
small community water supplies than large ones. The CDC reports
that it is six times more costly per person to fluoridate water
supplies with less than 5,000 people than those with greater than
20,000. In addition, most of the 12.6 percent of U.S. residents
using private wells are located in rural areas. These wells are
typically unfluoridated.
The Centers for Disease Control has information about water fluoridation, including maps, safety guidelines, and state statistics. The CDC also provides information on the fluoridation status of your community water
supply.
Question: Is a J-1 Visa Waiver an option for a dentist who was educated outside the United States and wishes to obtain a dental license in the U.S.?
Answer: If the dentist is from a country that doesn’t object and there was no U.S. government funding, the case can usually be pursued. The grounds for a J-1 Visa Waiver for dentists are different than for physicians. For instructions on the waiver process, please see Instructions for Applying for a Waiver of the Two-Year Foreign Residence Requirement Pertaining to Exchange Visitors on the J-1 Visa.
For further information on international dentists who wish to receive their U.S. licensure, please see the document U.S. Licensure for International Dentists, which has been published by the American Dental Association. This document also contains information on state licensure, educational opportunities, and contact information for dental schools, boards, and agencies.
Credits
Input was also given by:
Mountain Plains AIDS Education & Training Center
Kathy Hayes, DMD, MPH
CAPT, U.S. Public Health Service
Office of Rural Health Policy, HRSA
301-443-2669
khayes@hrsa.gov
Lisa Kilawee, MPA
Director, Rural Health Services
Avera Rural Health Institute
Sioux Falls, SD 57108
605-322-4741
Developed by:
Aubrey Madler
aubrey@raconline.org
Last revised 09/01/2008
