By Jane S. Grover, D.D.S., M.P.H., Director, Council on Advocacy for Access and Prevention, American Dental Association (ADA)

While Congress continues the seemingly endless debate over healthcare reform, we need to remember that community-based solutions are addressing our health equity crisis right now. The Community Dental Health Coordinator (CDHC), along with improved Medicaid dental benefits, are proven, complementary solutions to a complex problem.

First, consider the challenge. 2.2 million people visit hospital emergency departments (ED) each year for dental pain, according to the ADA's Health Policy Institute. 91% of adults aged 20-64 have caries, the disease that causes tooth decay and cavities, and nearly a third (27%) go untreated, according to the CDC. Almost half (47%) of people over age 30 have some form of gum disease.

These statistics aren't just numbers. If unchecked, infection from severe tooth decay may develop bacteria-filled abscesses with potential to spread to other parts of the body. Severe gum disease has been associated with increased risk of several other chronic diseases like diabetes and heart disease.

But many Americans face barriers to care such as low income, lack of awareness of available public health resources, low health literacy, and transportation and childcare challenges. Compounding these challenges is that while Medicaid includes dental coverage for children, “dental benefits for Medicaid-eligible adults are optional. States have considerable flexibility in determining the scope of dental services covered. As a result, Medicaid adult dental coverage varies tremendously across states, and is [sometimes] limited to emergency services such as tooth extractions, or to specific populations such as pregnant women,” according to the Center for Health Strategies. In Maryland for example, adult Medicaid enrollees are more likely to visit the hospital to treat chronic dental conditions than any other adult group, according to DentaQuest. Many people across the country without a dental benefit often turn to the ED for non-emergency dental pain instead of a dentist, which can cost the health system $400 - $1,500 per ED visit compared to $90 - $200 for a dentist appointment.

A Proven Solution: A new member of the oral health team – the CDHC – combined with Medicaid dental benefits.

The CDHC is a liaison between patients, providers and social service agencies. With a strong connection to the communities they serve, CDHCs improve the cultural competency of dental healthcare to connect patients to public health resources and improve healthcare cost efficiencies.

This program's success is rising and is even reducing the cost of Medicaid. A Western Maryland program works with dental case managers as CDHCs to triage ED patients with dental pain and helps them navigate their public health benefits. Over a five-year period, this program led to a 26% reduction in ED visits for dental pain and 2,400 patients received the dental care they needed. The ADA Health Policy Institute estimates that the Maryland Medicaid program could save up to $4 million per year by referring ED dental pain visits to dental offices.

There are 17 community colleges currently training CDHCs. Recent graduates work in settings including community health clinics, Federally Qualified Health Centers (FQHC), private dental practices, schools and nursing homes. Currently, there are more than 135 graduates working in 21 states. Soon there will be over 200 additional new graduates connecting people to existing care in their area.

MiQuel McRae pursued the CDHC certification at Rio Salado College in Tempe, Arizona after working as a dental hygienist for 16 years. She recognized the grave need to improve dental public health in her very underserved rural region, so with her CDHC certification, she started a non-profit called Tooth B.U.D.D.S. (Bringing Understanding of Dental Disease to Schools) to connect nearby school children to free dental care. She credits the CDHC program with motivating her to try an alternative approach to care saying, “The program completely transformed my thinking about dental hygiene. There were so many people not coming into the office and getting dental care. The CDHC program taught me there was an unmet need and I could be their connector to a permanent dental home while educating the community about oral health.”

MiQuel plans to treat over 500 children this year by coordinating educational programming in Arizona schools. MiQuel connects with her patients and their families because she lives in same area where she treats patients, so she can better serve entire families – not just the children she treats – understand how to manage their own health. “Parents call and talk about [their children]. A lot of times, parents are just unaware of the issue[s], but by going into the schools […], the parents become aware,” she says.

The demand for CDHCs and the community college investments illustrates the need for community-based approaches. National and local health organizations, community colleges, social service agencies and dentists can work together and alongside the ADA to understand local patient challenges and develop effective strategies like the CDHC program, which would amplify improvements to Medicaid benefits. Think of the progress we could make in achieving a more equitable healthcare system by doing what we know already works while connecting people to underused dental delivery sites.

For more information about the CDHC program visit the American Dental Association's website.

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