In the United States we have traditionally distinguished dental health from medical health. This divide dates back to the creation of two, distinct educational models and tracks. It continues as dental care and medical care are paid under different insurance mechanisms. Dental care seems to be financially treated and viewed as a luxury versus a medical necessity.
This latter issue has created large financial barriers to the receiving of dental care. This barrier is seen, for example, in the fact that Medicare does not cover such care and only 12 percent of Medicare beneficiaries have dental insurance coverage.
As we move to a value-based approach to care, we must begin to address the dental and oral needs of those we serve. It is well known that poor oral hygiene and health is associated with increased medical costs, increased emergency room visits, and increased disease burden. What is even more interesting is that one of the greatest public health policies in the United States is the fluoridation of our water supply. The return on investment has been 20 to 1, but unfortunately, 27 percent of the population does not live in an area that has such a water supply. There are also programs that have shown school-based dental sealant programs, which prevent cavities in molars, are cost effective.
We need to return our focus to oral care. There are many models that can be implemented, but we must first start by accepting the fact that dental and oral care is a medical issue. It should be treated and financed in the same manner. Of note, those organizations whose financial models take total cost of care into consideration understand this fact and focus on improving the dental and oral care of their members.
Many dental and oral issues are preventable, and we need to shift our focus to creating better prevention models and early treatment. We need to address dental and oral care in the same manner we address other medical problems. Dental and oral coverage should be provided in all federal programs in a manner similar to other prevention services.
We also need to look at our training programs and where services are needed. Workforce diversity needs to be addressed, as well as the understanding of the value of proper oral and dental hygiene. Expanded scopes of practice will also help create the work force needed to address this health determinant. All these issues should be addressed simultaneously in a comprehensive manner for the greatest impact to occur.
Value-based care must incorporate treating the entire person. This treatment should include all their medical needs, including dental and oral care. As we continue down this path to value, we will need to put our resources and focus where our mouth is. A pretty smile will then become not only heartwarming, but also a sign of overall health and well-being.