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Debate Continues on How to Provide Quality Dental Care to All Residents

CONTACT: Jane Lane
617-338-2726

BOSTON, June 16, 2009 -

BOSTON -- For too long, oral health has been considered separate from overall health. That gap narrowed in 2000 following the publication of a Report by the Surgeon General which stated ‘oral health means much more than healthy teeth . . . oral health is integral to general health.’ That same year, improving oral health was included as a goal of the Healthy People 2010 initiative sponsored by the US Department of Health and Human Services. This national attention, together with local leadership, has helped spur important oral health initiatives across Massachusetts.

Yet the question remains: In the midst of a deep economic recession, what can be done by the public and private sectors to ensure that all Massachusetts residents have access to high-quality, affordable oral health care? At a Massachusetts Health Policy Forum held today, the discussion was focused on whether enough is being done to increase access to high-quality oral health care for the state’s most vulnerable population – from pre-schoolers to the elderly.

The Forum was sponsored by the DentaQuest Foundation and the Massachusetts Dental Society and featured the following speakers: Sen. Harriet Chandler and Rep. John Scibak, chairs of the Legislative Oral Health Caucus, Conan Davis, chief dental officer for the Centers for Medicate and Medicaid Services, Dr. Catherine Hayes, professor and chair of public health and community services at Tufts School of Dental Medicine, Dr. Judith Jones, professor and chair of the department of general dentistry at BU School of Dental Medicine, and Frank Robinson of the BEST oral health program in Springfield.

“The DentaQuest Foundation is pleased to have this opportunity to spotlight oral health in the Commonwealth as a public policy issue,” President Ralph Fuccillo said. “With the appropriate focus and attention on prevention, fewer children will start school with the pain and suffering caused by oral disease.  Today’s Forum is another step forward in increasing awareness and encouraging public-private partnerships to improve oral health.”

“We are very excited to be co-sponsoring this event to collaborate with legislators, other health organizations, and the public in addressing public health policy,” said Dr. David Samuels, president of the Massachusetts Dental Society. “The Massachusetts Health Policy Forum presents a wonderful opportunity to address a wide range of important issues that we hope will lead to improvements in the oral health care system in Massachusetts, which will ultimately benefit all residents of the Commonwealth.”

Over the past decade, Massachusetts has become aware of the need to improve the delivery of oral health care. In 1998 a bipartisan Special Legislative Commission on Oral Health identified barriers to care for high-risk populations and compared alternatives for increasing dental services for at-risk children. In 2000 the Commission released ‘The Oral Health Crisis in Massachusetts’, which found that the oral health care needs of the most vulnerable were not being met. At the core of the crisis was that MassHealth dentists were withdrawing from the program due to low reimbursement at the same time that the overall MassHealth population was increasing.

Since the release of the report, a strong stakeholder community has mobilized to improve oral health in Massachusetts. In 2002, after a series of budget cuts resulted in the elimination of adult dental benefits in Medicaid. The Oral Health Advocacy Task Force was established. The task force took on many of the objectives outlined by the 2000 Commission report. The priorities of the task force included: increased access to dental insurance, bolster the safety net of oral health providers in Massachusetts, increase the prevalence of community water fluoridation and expand awareness of oral health issues through the Watch Your Mouth Campaign.

In 2005, a decision was issued in a court case filed by Health Care for All against the Commonwealth stating that Massachusetts was not meeting its federal statutory obligations under Early and Periodic Screening, Diagnosis and Treatment. The court ordered the state to proceed with the implementation of caseload capacity to allow MassHealth dentists to limit the number of MassHealth participants served by the practice. To further increase access, the court ordered that MassHealth dental reimbursement rates for participants under 21 be increased by $13.74 million for fiscal year 2007, starting July 1, 2006. The state is required to annually assess the MassHealth dental reimbursement rates for children and adjust them as necessary to adequately meet children’s dental needs.

Yet reimbursement for adult dental benefits covers only half the cost of providing the care. Evidence suggests that to increase provider participation through increased reimbursement, rates need to be set at least equal to the cost of providing the care, typically 60 to 65 percent of the dentists’ charge. In its ‘Call to Action: A plan for improving the oral health of Massachusetts residents by 2013,’ the Massachusetts Dental Society pledged that at least 65 percent of their membership would participate in the MassHealth program within the next five years.

Financial barriers and income are some of the greatest impediments to accessing oral health services. State Medicaid dental benefits significantly expand access to dental care for some of the most vulnerable, but coverage and access barriers remain. Between fiscal year 2001, prior to the cuts, and fiscal year 2004 following the cuts, the proportion of adults on MassHealth who were reimbursed for dental services decreased from 24 to 11 percent. On July 1, 2006, as part of the broader healthcare reform in this state, dental benefits were reinstated for adults over 21 years in the MassHealth program, expanding eligibility for dental services to 540,000 adults. Despite the success of the MassHealth dental program, there is a real possibility that adult dental benefits may once again be wiped out as of July 1.

In January, 2008, the Catalyst Institute (now the DentaQuest Institute) released a report on the oral health of Massachusetts’ Children’, establishing a baseline for the prevalence of caries and other oral health conditions among school-aged children across Massachusetts. According to the study, in 2007 more than a quarter of kindergartners in the state had a history of dental caries. Although Massachusetts has surpassed some of the federal government’s Healthy People 2010 targets of reducing untreated dental decay in children, there has been more modest success in prevention, according to the Catalyst Institute report.

Educating the public about the importance of oral health is an important step in the prevention of dental disease. The Watch Your Mouth Campaign has been particularly effective at reaching this goal to educate the public about the realities of tooth decay, the links between oral health and school performance and the connection between oral health and overall health. In addition to education and awareness, experts agree that the fluoridation of community water and the availability of topical fluoride and sealants are effective approaches to reducing dental decay among the general population.

Forum participants agreed that recent collaborative efforts have expanded the capacity of advocates and stakeholders to work together to evaluate new initiatives from other states to improve the oral health for all Massachusetts residents. While there is significant work to be done at a time of limited resources, with its rich network of oral health practitioners, experts and advocates, Massachusetts can continue to lead the way in the promotion of good oral health care and overall health.

To read the issue brief: ‘Putting the Mouth Back in the Body: Improving Oral Health Across the Commonwealth’ go to www.masshealthpolicyforum.brandeis.edu