More than a decade ago, the first U.S. Surgeon General’s Report on oral health outlined a “silent epidemic” of dental and oral diseases in...

More than a decade ago, the first U.S. Surgeon General’s Report on oral health outlined a “silent epidemic” of dental and oral diseases in the nation.

Dental problems affected large numbers of children and adults, and were also linked to major health conditions, said the landmark report, released in 2000. Dr. David Satcher, who was surgeon general at the time and produced the report, said poor Americans and children were especially vulnerable, and that members of racial and ethnic groups had a disproportionate level of oral health problems.

Satcher, reflecting on that data 12 years later, says progress has been made in improving access to dental care, including in Georgia.

Satcher added Tuesday that the oral health report led to increased funding for dental schools and the creation of oral health research centers.

But he said, “We still have a long way to go in this country’’ on access to dental care.

Satcher spoke to an Atlanta audience of dental professionals and health officials at a conference sponsored by Morehouse School of Medicine. Speakers outlined the extent of the dental care problem and possible solutions, both for the nation and for Georgia.

A major factor in limited availability of treatment is a shortage of dental professionals, especially in rural areas.

Dr. Louis Sullivan, a former U.S. secretary of health and human services, wrote in a New York Times editorial earlier this year that nearly 50 million Americans live in rural or poor areas where dentists do not practice.

“Most dentists do not accept Medicaid patients,’’ Sullivan wrote in the editorial. “And the shortage of dentists is going to get only worse: by 2014, under the Affordable Care Act, 5.3 million more children will be entitled to dental benefits from Medicaid and the Children’s Health Insurance Program.”

Untreated dental problems often lead to emergency room visits.

More than 800,000 visits to hospital ERs nationwide in 2009 were for preventable dental problems, according to Sullivan, who also attended the conference. He is president emeritus of Morehouse School of Medicine.

Tooth decay is the most common chronic illness among school-age children. Students nationally may miss as many as 51 million hours of school per year due to dental health problems.

Satcher, now director of the Satcher Health Leadership Institute at Morehouse School of Medicine, also noted the importance of oral health for speaking, smiling and social interactions.

He added that the health reform law provides ‘’the best opportunity we have to expand access to health care,’’ including preventive dental services.

Georgia’s dental deficits appear to mirror those in the rest of the nation. The statistics include:

* One in four Georgians did not receive care in 2008 because they did not have a dentist or could not find one who would accept Medicaid or PeachCare.

* In 2009, more than half of Georgia high school and middle school children reported having dental pain in the past year.

* More than $28.7 million was charged for Georgia emergency room dental conditions in 2008.

* Georgia has just one dental school, and the state is 46th among states for dentists per capita.

* Though the state’s third-grade oral health survey has found significant improvements, children from low-income households and Hispanic children still have poorer oral health outcomes than other kids.

“Tens of millions of Americans can’t get dental care,’’ David Jordan of Community Catalyst, a Massachusetts-based consumer advocacy group, told conference attendees. “Too many people in Georgia don’t have access to care.’’

Edward Green, an Albany dentist, said the managed care companies running the Medicaid and PeachCare programs have limited the number of dentists who treat those patients. Green called for the opening of the companies’ networks, and for broader dental coverage for adults on Medicaid.

Rural areas of the state, in particular, have dental workforce shortages, said Carol Smith of the Georgia Department of Public Health, who told GHN that services delivered by dental hygienists in public health settings should be reimbursed by Medicaid.

The dental leaders also discussed the potential of “dental therapists” as a solution to the access problem.

Dental therapists are midlevel practitioners who can provide preventive care and routine procedures outside a traditional dentist’s office. Dental therapists, though common worldwide, are authorized in only two U.S. states, Alaska and Minnesota, but other states are considering this option.

The extent of the dentist access problem will be identified soon, the Georgia Dental Association says.

Martha Phillips, GDA’s executive director, said the organization is doing a survey of dentists in the state to find out exactly what the workforce problems are. The results are expected in September.

“We are committed to solving what the problem is,’’ Phillips said.

(The statistics in this article come from the Community Voices program at Morehouse School of Medicine; the Kaiser Commission on Medicaid and the Uninsured; and the Oral Health Status of Georgia’s Third Grade Children, a state report.)

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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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