ADHA Access to Care Facts & Stats

The American Dental Hygienists' Association (ADHA) believes that oral health care—a fundamental component of total health care—is the right of all people. Yet 40 percent of Americans are not getting the care they need. A number of factors inhibit access to care, the most evident being the inability to pay for care.

Millions of Americans in both rural and inner-city areas are unable to obtain care because there are not enough dentists practicing in their communities. The federal government estimates that more than 31 million people live in areas designated as "dental shortage areas" where there is less than one full-time equivalent dentist for a population of 4,000 to 5,000.(1)

Lack of access to oral health care is a critical issue in the United States due to disparities in the health care delivery system. This is documented in ADHA's Access to Care 2001 Position Paper. It follows the Surgeon General's 2000 report, Oral Health in America, which called untreated poor oral health a "silent X-factor promoting the onset of life-threatening diseases which are responsible for the deaths of millions of Americans each year."

Key points of ADHA's Access to Care Position Paper:

• Dental caries (cavities) are the most common chronic disease nationally affecting 53 percent of 6-8 year olds and 84 percent of 17 year olds.
• One in four American children is born into poverty (annual income of $17,000 or less for a family of four). Children and adolescents living in poverty suffer twice as much tooth decay as their more affluent peers, while their disease is more likely to go untreated.
• Licensed dental hygienists, by virtue of their comprehensive education and clinical preparation, are well prepared to deliver preventive oral health care services to the public, safely and effectively, independent of dental supervision.
• Each year, millions of productive hours are lost due to dental diseases. Children missed nearly 52 million hours of school, or an average of 1.17 hours per child, in one year due to treatment problems, according to one survey. During that same time, workers lost more than 164 million work hours, an average of 1.48 hours per worker, due to lack of treatment for dental disease.
• From 1985-86 to 1995-96, the number of dental hygiene graduates increased by 20 percent, while the number of dentist graduates declined by 23 percent.
• Recent research identified periodontal disease as a risk factor for heart and lung disease; diabetes; premature, low birth weight babies and a number of other systemic diseases. Also, routine oral health exams can uncover symptoms of diabetes, osteoporosis and low bone mass, eating disorders and HIV.
• The cost of providing restorative treatment is more expensive than providing preventive services. For example, the Centers for Disease Control and Prevention's (CDC) 2001 recommendations for using fluoride to prevent dental caries reports that in 1991, the annual cost of water fluoridation in the U.S. was $0.72 per person. Moreover, the average cost of applying one dental sealant is less than half the cost of one silver filling.
• In addition to economic hurdles, there are bureaucratic and legal barriers that prevent dental hygienists from providing access to care. For instance, state laws and regulations limit access by imposing restrictive supervision requirements on dental hygienists.
• ADHA recommends several solutions to the access to care issue. One is to develop partnerships among health care organizations, state and federal government and other interested groups to educate the public on the importance of oral health and the integral role it plays in total health. Another solution is for state and federal government to recognize licensed dental hygienists as Medicaid providers. One more solution would be to relax state practice acts to allow more dental hygienists to provide oral health care to those who are not currently receiving it.

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