ADA urges IOM to include practicing dentists

Washington鈥擳he Association commended a public-private approach advanced March 4 at an Institute of Medicine hearing to improve access to care and called for the engagement of private practice dentists in the two-year study.

“Our efforts to improve access to care have taught us that there are many contributing factors and barriers to the problem,” Dr. Ron Tankersley, ADA president, testified as an IOM committee convened to assess the current oral health system of care. “Some are economic and others environmental; some are direct and others indirect; some are related to the individual and others to the provider. The ADA has been in the vanguard of advancing access solutions, including:

• “Designing and implementing a pilot program for the prevention-focused Community Dental Health Coordinator, a community health worker with dental skills now active in Philadelphia, rural Oklahoma and Indian tribal areas;
• Convening the Access to Dental Care Summit in 2009 for a broad range of 144 stakeholders to identify short- and long-term ways to improve oral health for underserved populations;
• Creating a public health advisory committee to provide a formal presence within the ADA to receive input on issues of public health significance;
• Convening the 2007 American Indian/Alaska Native summit to collaboratively address the unique needs of these populations;
• Implementing an Association-wide initiative to address oral health needs of the vulnerable elderly, one outcome of which will be the introduction of federal legislation;
• Seeking to increase collaboration among private practice dentists and those working in federally qualified health centers and other dental safety-net clinics, where about 69 percent of the dentists are ADA members;
• Lobbying for virtually every federal program that could effectively improve access for the dentally underserved.”

The ADA, Academy of General Dentistry and American Academy of Pediatric Dentistry witnesses took the IOM to task in separate statements for what Dr. Tankersley said was “the IOM’s failure to include representatives of the private practice dental community on either of its two oral health panels. We respect the experience and knowledge of the committee members. But the nation’s 167,000 private practice dentists represent some 92 percent of professionally active dentists in the U.S. Without them, there can be no significant impact on access to oral health care, regardless of the delivery system.”

The National Academy of Sciences IOM has undertaken a two-part study of national oral health policy, starting with access to care. The project is sponsored by the U.S. Department of Health and Human Services and the California HealthCare Foundation. Frederick P. Rivara, M.D., chairs the committee on oral health access to services. He is currently The Children’s Hospital Guild Association Endowed Chair in Pediatrics and professor of pediatrics at the University of Washington School of Medicine.

The access study will assess the current U.S. oral health system of care, explore its strengths, weaknesses and future challenges, describe a desired vision for the oral health care system, and recommend strategies to achieve that vision http://www8.nationalacademies.org/cp/projectview.aspx?key=49196.

A separate IOM ad hoc consensus committee will explore ways to increase public awareness of the relationship and importance of good oral health to good physical health, promote prevention and improve oral health literacy to health providers and the public, and recommend ways to improve access to oral health care www.iom.edu. The panel’s first meeting is set for March 31-April 1.

At the March 4 hearing, committee members quizzed representatives of the HHS Health Resources and Services Administration about the relationship and intent of separate oral health studies and said they might overlap. “I’m certain there will be some overlap,” HRSA’s Marcia Brand, Ph.D., replied. The access study should address “safety-net” issues and the oral health initiative offer advice “about what HHS can do,” she said. “Access to oral health care will require a public-private partnership.”

Dr. Tankersley, ADA president, told the IOM panel the Association agrees that “this does need to be a public-private partnership.”

He also noted, “To exclude the private practice community from representation is tantamount to forming a panel on air traffic safety and excluding pilots.”

Dr. Terry Dickinson, executive director of the Virginia Dental Association, described the Virginia Dental Health Foundation’s Missions of Mercy in terms of “pathways to collaboration” involving public need and private sector response. “The tragedy is that there is a MOM project,” he told the committee.

The HHS department includes several public health agencies with dental activities including the HRSA, Centers for Disease Control and Prevention and Centers for Medicare & Medicaid Services.