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Recently, “Town and Country Magazine” published an article describing various “upscale dental products” that are becoming increasingly available. Published in the “beauty” section, the piece includes a list of luxury toothcare products including a $55, two-ounce tube of toothpaste and immediately precedes an article about the best skin serums. At first glance, this seems like a niche, if not a bit quirky, article to file under wellness culture – another list of luxury self-care items to add to cart or scroll by, depending on how inclined or able you are to treat yourself.
Just under the surface of what seems like a quick chuckle, is the stark reality of our nation’s dental health care system: one that affords some – namely, white and wealthy people – the care and coverage they need, leaving many others to withstand unnecessary pain and suffering, worsening health problems, and even death because they don’t have access to the most basic dental care. Today, almost 60 million people live in areas without enough dental providers and about a third of adults have untreated tooth decay and no yearly dental visit. Additionally, disparities are persistent: Black and brown communities, low-income populations, tribal communities, people with disabilities and LGBTQ+ people all experience greater barriers to accessing the dental care they deserve. A system that affords dental care as a luxury to the few while denying access to even the most basic care to the many will never lead to oral health equity.
One key factor compounding this inequitable access to dental care is how many of our health care policies position oral health as a luxury: adult dental benefits are an optional coverage category in state Medicaid programs, are not considered an essential health benefit in private Marketplace plans and Medicare includes no dental coverage at all. Some proposed and implemented Medicaid waivers have even positioned oral health care as a luxury that must be earned – by completing healthy behavior requirements to access benefits or avoid paying premiums – rather than an essential health care service included in a comprehensive benefits package. Our dental insurance, payment and dental records systems, and even the sites where we receive care, are completely separate from the rest of the health care system. This is why the work of advocates to underscore that oral health matters is so important.
Policy Solutions to Improve Access to Essential Dental Care
Understanding that oral health care is health care is necessary, but not sufficient. Policy solutions that move toward ensuring dental coverage and access to care is universal and equitable include:
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Key improvements to Medicaid, which serves as a critical safety net for millions of low-income children, adults and families.
- The optional nature of Medicaid adult dental benefits creates a patchwork of coverage and access based on state of residence. Access to critical dental care should not depend on where someone lives, which is why Medicaid adult dental benefits should be made mandatory at the federal level.
- In the meantime, states can choose to cover comprehensive dental benefits for all adults with Medicaid – including those who are pregnant and post-partum – authorize the program to pay for toothpaste and other oral health supplies. In particular, as the economic effects of the COVID-19 pandemic continue to disproportionately harm low-income families, providing comprehensive coverage and essential supplies is an important option for protecting the oral and economic health of families and communities.
- Congress should also increase federal Medicaid matching funds, in general with specific funding increases for adult dental services to support states in maintaining this optional benefit.
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Adding a comprehensive dental benefit to Medicare to improve access to critical oral health care for more than 56 million older adults and people with disabilities.
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Expanding the dental workforce to serve more people, in more places.
- The dental workforce already isn’t sufficient to fully meet the needs of all communities and that need is only projected to grow post-COVID due to pent up demand. Authorizing dental therapists, expanding the scope of dental hygienists and ensuring that all members of the dental team can work at the top of their licenses is critical to right-sizing the oral health care workforce and addressing existing maldistribution of providers.
Oral health affects and is affected by other health conditions, shaping wellbeing from childhood through older adulthood; good oral health can support economic and mental wellbeing, and supporting it is integral for achieving health justice. Oral health is not just about aesthetics and it’s certainly not a luxury, it’s health care.