Agency for Healthcare Research and Quality • www.ahrq.gov
Issue #13 July 2003
Dental Care: Improving Access and Quality
The oral health of Americans has improved in recent years, yet considerable gaps in the provision of dental care remain, according to a recent report by the Surgeon General.1 This Research in Action highlights dental care research sponsored by the Agency for Healthcare Research and Quality (AHRQ). Studies look at the impact of factors such as reimbursement, race, income, and age on access to and use of care. Research suggests that educating families about how to enroll in and access the Medicaid system, streamlining Medicaid administrative procedures, and adjusting provider reimbursement could facilitate broader access to dental care. Studies show that specific treatments such as dental sealants for children may have a positive impact on both health outcomes and costs. The quality of dental care can be further improved by developing and using performance measures for specific treatments. Finally, the production of evidence reports evaluating research on various aspects of care helps to advance evidence-based dental practice and thereby improve the quality of care. leading types of dental disease: tooth decay (dental caries) and periodontal disease. Dental care can be either preventive or restorative. Preventive care, such as tooth cleaning and dental sealants, is aimed at avoiding dental problems. Restorative care Making a Difference Poor children receive fewer preventive health care visits than those with higher incomes…Page 3 Dental sealants can reduce the number of cavities and decrease the cost of care in the Medicaid program… Page 4 Minority elderly receive less dental care because of financial barriers to care…Page 5 Unexplained variations in dentists’ clinical decisions are widespread…Page 6 Relative cost-effectiveness of dental crowns and their alternatives has not been established…Page 7 Use of performance measures by dental plans could improve quality of care…Page 8 Evidence-based practice is advanced by evidence reports evaluating various interventions….Page 9
The Surgeon General’s recent report states that oral health is essential to the general health and well-being of all Americans.1 Although oral health extends beyond dental health, the report clearly stresses the importance of the two
Author: Mark W. Stanton, M.A. Managing Editor: Margaret K. Rutherford Design and Production: Joel Boches Suggested Citation: Stanton MW, Rutherford MK. Dental care: improving access and quality. Rockville (MD): Agency for Healthcare Research and Quality; 2003. Research in Action Issue #13. AHRQ Pub No. 03-0040.
repairs problems such as those caused by tooth decay and periodontal disease.
year, even though Medicaid provides dental coverage for enrolled children. In addition to the considerable access problems faced by poor and Medicaid-eligible children, poor elderly people and minorities have their own problems with access. • In the 50-69 age group, non-Hispanic blacks (31.2 percent) are more likely than Mexican Americans (28.2 percent) or non-Hispanic whites (16.9 percent) to have at least one tooth site with periodontal disease. • In the age category 70 years and over, the percentages rise to 47.1 percent, 32.0 percent, and 24.1 percent for the three groups. With more elderly people having discretionary income and retaining their natural teeth, demand for dental services among the elderly has grown. But this demand can be substantially influenced by financial barriers and other health concerns. Studies show that the elderly typically underuse needed dental services. The underuse of cost-effective preventive services such as dental sealants, plastic coating applied to protect the chewing surface of teeth, also illustrates that dental care in the United States has room for improvement.
Oral health improves overall but gaps exist
Over the past several...