Expand Role of New Oral Health Professionals: IOM Report

An Institute of Medicine report released yesterday calls on the US government to explore an expanded role for nondentists and new ways of paying for dentistry.

The report, "Advancing Oral Health in America," faults the government for inconsistent efforts to address oral health. "For decades, the U.S. Department of Health and Human Services (HHS) has shown a fluctuating commitment to making oral health a national priority," the report says. "Today, oral diseases remain prevalent across the country, especially in vulnerable and underserved populations."
The committee, tasked with designing a new oral health initiative within the HHS, warns that a current oral health initiative in HHS risks losing momentum. It cites a proposal to downgrade the Centers for Disease Control and Prevention's Division of Oral Health into a branch of the Division of Adult and Community Health, and a letter from HHS Secretary Kathleen Sebelius suggesting that states can save Medicaid money by cutting adult dental benefits.

The report seeks more attention for oral health in general, new programs to educate the public about oral health, and a shift of research dollars toward reducing disparities in oral health among various populations.

"The goal is to make sure access is improved and oral health is paid attention to," committee member Robert Weyant, DMD, MPH, DrPH, from the University of Pittsburgh, told Medscape Medical News. But the report stops short of saying how these changes could be achieved.

"We did not get down to that level of specificity," said Dr. Weyant. "Those kinds of details need to be worked out within the agency." He noted that another Institute of Medicine committee is expected to issue a report soon focused on access to oral healthcare.

An American Dental Association (ADA) analysis of the current report praises many of its findings but flags 2 of the report's goals: "Explore new models for payment and delivery of care," and "Enhance the role of nondental health care professionals."

The report gives few details on these recommendations. Stepping lightly around the sensitive issue of midlevel providers, the report says, "new dental professionals and existing professionals with expanded duties may have a role to play in expanding access to care."

"We will of course pay particular attention to these recommendations and how the federal agencies interpret them," the ADA said in its brief.

Much of the 211-page report is devoted to documenting problems of oral health in the United States, particularly among underserved populations.

"It's an excellent review of all the evidence of the past couple of years," Steven Silverstein, DMD, MPH, director of the graduate program in dental public health at the University of California San Francisco told Medscape Medical News. But, he added, "This report is not earthshaking," since it largely reiterates the findings of the landmark surgeon general's report on oral health issued in 2000.

He predicted that one of the most likely results of the report could be a new position within the HHS to coordinate dental services. "I think they will do that, but they might not give the person authority and resources," he said. He also expected to see more efforts toward oral health literacy and more efforts to integrate oral health into overall health.

The report divided its findings into the following recommendations:

* A new oral health leader for an oral health initiative;
* More evidence-based preventive services;
* More public education about oral health, especially preventing disease;
* More training for oral health professionals, especially about cultural issues;
* Research into compensation for oral healthcare through Medicare, Medicaid, and the Children's Health Insurance Program;
* Better sharing of data about oral healthcare among agencies; and
* Annual reporting on the progress of the new oral health initiative by HHS agency heads.

Burton Edelstein, DDS, MPH, a Columbia University professor who led a similar initiative in the Clinton administration, called the report "substantial."

"I anticipate that the report will be of terrific value to all who work toward improving oral health across America," he said in an email.

But Dr. Edelstein added that it won't be easy to put the recommendations in place. "The substantive challenge now confronting DHHS, particularly in these tumultuous budgetary times that are exacerbated by political debates over the roles of government in health and healthcare overall, are all about implementation."

Dr. Weyant, Dr. Silverstein, and Dr. Edelstein have disclosed no relevant financial relationships.

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