Dental Public Health and Research

Chapter 3: Dental Care Delivery in the United States

Dental Care Delivery in the U.S

• Dental care delivery in the U.S. involves private and government entities

• Oral health is a major unmet need in this country

• Untreated dental disease is more prevalent in individuals from lower-income households and ethnic minorities

• Oral health is integral to total health and well-being

• Mostly in private dental practices

• Impacted by many federal and state governmental entities

• Providers:

• Dental hygienists

• Dentists

• Dental assistants

• Denturists (in some states)

• Expanded function dental personnel

• Dental technicians

• Trends are suggestive more public funding for dental care

Federal Influence

• Department of Health and Human Services (HHS)

• Largest grant-making agency in the federal government

• Works closely with state and local governments

• United States Public Health Services (PHS)

• Improve and advance the health of all Americans

• U.S. Surgeon General directs the PHS

• RDH can work as a PHS commissioned officer

• National Institutes of Health (NIH)

• The federal government’s medical research institution

• Research conducted within the Bethesda, Maryland facilities and coordinates other research projects across the nation

• National Institutes of Dental and Craniofacial Research (NIDCR)

• Food and Drug Administration (FDA)

• Established in 1906 and headquartered in Rockville, Maryland

• Regulates:

• Dental materials

• Dental equipment

• Dental medicine

• Over-the-counter dental care products

• Centers for Disease Control and Prevention (CDC)

• Health surveillance

• Prevent and monitor outbreaks

• Oral health division

• Focus on prevention

• Community water fluoridation

• Indian Health Services (IHS)

• Dental care for Native Americans

• Health Resources and Services Administration (HRSA)

• National Health Services Corps

• Ryan White

• CARE Act

• Organ transplants

• Infant and children health

• Agency for Healthcare Research and Quality (AHRQ)

• Research quality, costs, access, and effectiveness

• Administration of Aging

• Older Americans Act of 1965

• Administration of Children and Families

• Early Head Start and Head Start Programs

• Centers for Medicare and Medicaid

• Medicare: Federal insurance program for senior citizens

• Medicaid: Publicly-funded insurance program for low-income and populations with disabilities, includes dental for children and adults in some states

• Department of Justice (DOJ)

• Responsible for the Federal Bureau of Prisons and the dental care provided to inmates incarcerated in this system

• Department of Veterans Affairs (VA)

• Dental care for veterans with service-connected disabilities

• Bureau of Labor Statistics

• Labor, economics, and statistics, which impact dental care delivery

• Department of Agriculture

• Women, Infant, and Children Program (WIC)

• Nutrition focused

• Department of Treasury

• Department of Education

• Agencies:

• Federal Trade Commission (FTC)

• Peace Corps

Strategic Plan of the U.S. Department of Health and Human Services

• Strategic Goal #1: Strengthen health care

• Strategic Goal #2: Advance scientific knowledge and innovation

• Strategic Goal #3: Advance the health, safety, and well-being of the American people

• Strategic Goal #4: Ensure efficiency, transparency, accountability, and effectiveness of HHS programs

State Influence

• State dental departments work as dental consultants within the state environment and strive to promote dental health

• They also work to implement water fluoridation within communities, school-based prevention programs, school sealant programs, and fluoride mouthrinse programs

Dental Health Care Workforce

• Mixture of organizations, practitioners, financing mechanisms, and innovative approaches to health services planning

• Need

• Demand

• Utilization

• Supply

• Models of care

• Direct access to dental hygienist

• Increasing access to dental care

• Dentist workforce

• Trends

• Demand for dental hygienists

• Demand

• Trends

• Denturists

• Dental therapists

• Proposed providers

• Mid-level models

• Advanced dental hygiene practitioner

• Community dental health coordinator