November 13, 2000

It has always been difficult to have a rational discussion about dentistry - the usual jokes keep getting in the way. Yet those stereotypes bear little relation to today's dentists, who benefit from important strides in biomedical research.

Once concerned solely with teeth and gums, dentists today look upon the mouth as the center of vital functions that are critical to a person's total health.

Biomedical advances in dental health might not hit like a thunderbolt, such as the decoding of the human genome. Yet persistent progress in dental health research over the past few years has already had an immediate payoff for patients.

A recent report from Surgeon General David Satcher tells us why. "A thorough oral examination can detect signs of nutritional deficiencies as well as a number of systemic diseases, including microbial infections, immune disorders, injuries, and some cancers", the report says. Some experts say that more than 90 percent of all systemic diseases have oral manifestations.

Cancer, for instance, can first appear on the tongue or soft palate. The mouth can provide some of the earliest indications of diabetes and HIV/AIDS. Radiographic or magnetic resonance imaging of oral bone can help identify the onset of osteoporosis.

The bad news? Because dental care is so often a stepchild in the nation's health care system, the benefits of this revolution have not reached enough Americans.

In all, an estimated 25 million Americans live in areas lacking adequate dental care services as defined by federal criteria under the Health Professional Shortage Area designation.

More than 108 million lack dental insurance, far outpacing the 44 million who lack health insurance. According to the American Dental Education Association, 80 percent of the nation's dental problems are in the mouths of 25 percent of the population, who, not surprisingly, tend to be poor.

Chief among the reasons for this disparity is the fact that our federal government is skimpy when it comes to covering dental care. At a time when the government pays nearly 60 percent of hospital costs and over 30 percent of physician costs, they cover less than 5 percent of total dental costs.

Connecticut is not immune to any of this. Because Medicaid payments cover less than half the cost of procedures (not even close to covering the cost of the dentist's overhead), the state's dentists in private practice are understandably discouraged from treating a large portion of Medicaid patients.

The fallout is seen first hand by University of Connecticut dental students and residents as they care for the underserved at our Farmington site as well as in programs in Hartford, New Britain, New Haven and Torrington.

We are planning to extend our reach into two additional cities. But the needs far outweigh our resources.

How can we make sure that all Americans benefit from pioneering oral health research?

The answer begins with a comprehensive and sustainable national dental health initiative that, at the start, provides everyone with access to dental care. Corrective measures must include a new and realistic fee structure for Medicaid dental procedures. And while additional money alone won't solve the problem, the existing chasm of care can only be expected to widen without it.

Peter J. Robinson

This column was first published as an op-ed in the New Haven Register on Oct. 30.