Access to Oral Health in Kentucky and the United States

By: Jim Cecil, DMD, MPH

Oral health is intimately associated with overall health! By extension, oral diseases, infections and conditions are associated with systemic conditions and diseases. Recent reports indicate that oral infections are associated with diabetes, Alzheimer’s disease, cardiovascular disease, chronic obstructive pulmonary disease, obesity, stroke, adverse birth outcomes, and other common and chronic systemic diseases. Given these significant associations, I believe this represents a clarion call for integration of the health care delivery system – medical, dental, and mental health should all be included as integral parts of a comprehensive health care delivery system.

In my opinion, until we achieve an integrated health care delivery system, the health status of many in the United States will never rise above the health status of other countries which spend far fewer dollars on health care per capita than we do in the U.S.

The oral health profession has not done its job of protecting the oral health of Kentuckians. It has done an admirable job of protecting the profession of dentistry in Kentucky from outside influence. That is a harsh pronouncement coming from a professional life-long member of the Kentucky and American Dental Associations.  Likewise, the Kentucky Board of Dentistry has not sufficiently advanced its mission of protecting the public health of Kentuckians.

Now is the time for organized dentistry and the board of dentistry in Kentucky to act progressively to protect the oral and general health of its citizens.  Not the next millennium but now – our citizens are suffering and dying unnecessarily from oral diseases, infections, and conditions. The oral health of a significant segment of the population of Kentucky is abysmal based on scientific surveys done in the early to mid 2000s. There have been some minor improvements but not significant health improvements; more people, more organizations both dental and non-dental have been working on the oral health issues but the improvements are merely marginal at best.

What will it take to make the changes that I believe should be made? It involves more than just adding more dentists to the mix  – adding dentists only makes the current disparities worse in my opinion, by adding further to the mal-distribution of the dental manpower available in Kentucky.

As a partial solution, I believe we need to change the makeup of the dental team who provides dental services. At present, the dentist, the Captain of the Team, provides the majority of dental services in his/her dental practice alone. My belief is that the Captain needs to act like a real leader and off load some of the less complex tasks to appropriately trained and experienced dental professionals of various kinds. Dental assistants and hygienists are important, vital members of the dental team, and their expertise needs to be used and expanded to its fullest extent.

I envision a private office where the number of patients seen per day is increased significantly with the dentist performing the most complex procedures while other types of dental professionals perform less complex procedures under the leadership and supervision of a dentist. This model could enhance the income of the practice and allow it to be rewarding in other ways that enhance the quality of life of all involved: the Captain, the other dental professionals and particularly the patients who have more expeditious access to high quality dental care

The same approach could and should be applied to the public sector where significant disparities in access to high quality care exist. Public clinics in which a variety of appropriately trained and experienced dental professionals could be established where, more efficiencies could be achieved in providing care for the segments of the population where enormous disparities are most evident currently.

What does this mean with respect to integrated care?  A good model for the integration of oral health care into overall health care, in my opinion, lies within the world of the community health center in which the federal government has recently placed some new emphasis. With more resources devoted to integration, the community health center could provide high quality medical, dental and mental services as well as appropriate community preventive services in a more economical, flexible, highly effective and efficient manner.

One size does not fit all, and the community health center offers the opportunity to address, through its unique design, the special cultural needs and wants of the rural, urban or suburban practice to meet local health needs.  The barriers to successful practices are different for rural versus urban areas and the community health center offers the potential flexibility to address these sometimes overwhelming barriers to accessing health care as well as health status.

Will integration of medical, dental and mental services and prevention into a health care delivery model be easy? Absolutely not! It will take highly trained, highly motivated and highly engaged health care professionals to give up some autonomy, swallow hard and take a more holistic view of the world, alter to some degree their personal egos, and become more concerned about the health of their community– not just one patient at a time. No, this change will not be easy or without some major bumps in the road  – change is hard but change must happen if we are going to enhance the overall health of Kentuckians, of all Americans.

In my opinion, our economy can ill afford a sicker society – the technology to keep people healthy is well within our reach; all we have to do is adopt a more integrated, preventive, expanded duty and holistic approach to our health care delivery system with the aim of assuring a healthy society for all its members.

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