Oral health in America has improved dramatically over the last 50 years. Great progress has been made in understanding and treating common oral diseases such as tooth decay and gum disease, and we now have safe and effective measures for preventing or delaying the progression of dental health problems. These advances, however, have not occurred evenly across all sectors of our population, particularly among low-income individuals and families.
Far too many Americans today do not have access to regular oral health care. An estimated 47 million Americans live in areas lacking adequate dental services. As a consequence, effective treatment and prevention programs are not being implemented in many of our communities. Astoundingly, as many as 11 percent of our nation’s rural population has never been to a dentist.
Nowhere is this more troubling than among our nation’s children. Tooth decay is currently the single most common chronic childhood disease. It affects 50 percent of first graders and 80 percent of 17-year olds, and is five times more common than asthma and seven times more common than hay fever. According to the Surgeon General’s landmark report, Oral Health In America, dental care is “the most prevalent unmet need among American children.”
The current shortage of oral health professionals is exacerbated by the fact that our dental workforce is getting older and the overall ratio of dentists to population is declining. Nationwide, more than 20 percent of dentists are expected to retire in the next 10 years, and the number of new dental graduates may not be enough to replace these retirees.
These shortages are particularly severe in rural areas. In Maine, there is one general practice dentists for every 2,300 people in the Portland area. The numbers drop off dramatically, however, in other parts of our state. In Aroostook County, for example, there is only one dentist for every, 5,500 people. Moreover, of the 22 dentists practicing in Aroostook County, only a few are taking on any new cases.
To help address this shortage of dental professionals, I joined Senator Russ Feingold (D-WI) in introducing the Dental Health Improvement Act, which was signed into law as part of the Health Care Safety Net Act Amendments of 2002. The legislation authorized $50 million over five years for grants to States that can be used for a wide variety of programs to strengthen their dental workforce and increase access to oral health care in rural areas.
For example, States can use the funds for loan forgiveness and repayment programs for dentists practicing in underserved areas and for recruitment and retention programs. They can also use the funds to establish or expand community or school-based dental facilities or to set up mobile or portable dental clinics. To assist in their recruitment and retention efforts, States can use the funds for placement and support of dental students, residents, and advanced dentistry trainees. Or they can use the grand funds for continuing dental education, through distance-based education and practice support through teledentistry.
Maine is one of twenty-six states that has received funding through this program so far. Over the past three years, the Maine Department of Health and Human Services Oral Health program has received almost $340,000 in grant funding, and I am pleased to report that Congress recently passed legislation to extend this important program for an additional five years.
The states that have received funding through the Collins-Feingold Dental Health Improvement Act are doing great things to improve access to oral health services. Colorado, Georgia and Massachusetts are using the grant funds for loan forgiveness and repayment programs for dentists who practice in underserved areas. Maine, Arkansas, Michigan, Mississippi and a number of other states are using the funds for recruitment and retention efforts. Delaware, Rhode Island, and Vermont, which, like Maine, don’t have dental schools, are using the funds to expand dental residency programs in their states.
As we work to improve our health care system, it is important to remember that good oral health is a major contributor to good overall health. The Collins-Feingold Dental Health Improvement Act is helping states to develop innovative dental workforce development programs that are targeted to their individual needs. It is helping them to strengthen their oral health care safety nets to make sure that children and families in Maine and across the nation have access to the dental health services that they need.