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Dean Feldman: Pandemic Underscores Need for Accessible Oral Healthcare

With so many Americans unable to see the dentist during the pandemic, all those lapsed appointments helped draw attention to the importance of regular, accessible dental care. Dean Cecile A. Feldman discusses how we can ensure that it’s within reach for all.

Dean Cecile A. Feldman

How has COVID-19 affected Americans’ attitude toward oral health?

COVID has put a spotlight on the consequences of going without dental care. Not being able to see the dentist for months unless it was a dire emergency helped people realize how important it can be. Tooth infections that could have been caught early wound up abscessing. Patients who might have just needed a filling between visits required root canals. Dentists are often the first to detect oral cancer, and a lapse in appointments means some cases could have been caught sooner, improving the odds for early intervention and recovery. For people getting crowns or bridges, teeth shifted because they couldn’t see their dentist requiring that work be redone.There’s anecdotal evidence that indicates a rise in bruxism, the term for teeth grinding, because of the stress and anxiety caused by COVID. A lot of patients had dirty teeth because they had to put off getting cleanings.

Even before the pandemic, what have been some of the obstacles to accessing dental care?

For some Americans, geographical access is a problem. They don’t live close to a dentist. That’s not the case in New Jersey but in many other states there is a shortage of dentists. Teledentistry, which has become widely used during the pandemic, could help partially fill that need. It could be used for preventive care – a call to ensure that someone performing good oral health hygiene and maybe after that just checking in and reinforcing oral healthcare. For far too many patients, it’s a financial problem. According to the American Dentistry Association, 33.6 percent of Americans lack dental coverage. Many have trouble affording care even with dental insurance, which, compared to medical insurance, often covers only a small portion of treatment costs. Things did improve with the Affordable Care Act (ACA) after it was approved in 2010. As a result, nearly 500,000 New Jerseyans had access to care that they didn’t have before due to ACA Medicaid expansions. But even under the ACA, dental care was only listed as an “essential” benefit for children.

What would make it easier for more people to get dental insurance and for that insurance to offer more coverage?

Employer healthcare coverage started out mostly in the 1960s as a way for industries to offer workers something without raising wages. Dentistry wasn’t a part of it because we have a bi-furcated system, where the health of a person’s mouth is somehow not regarded as part of their overall health. So that needs to change. Oral healthcare needs to be seen as just another facet of physical health and wellbeing, and dentists and other oral health providers, need to be covered the same way as others specialists, like opthalmologists or cardiologists. In terms of Medicare and Medicaid, organized dentistry initially resisted expanding it to dental visits because they feared the government would force them to lower fees. Medicaid and Medicare still pay dentists extremely low rates compared to other providers. We don’t get paid much for screening or diagnosis. You mainly get paid for actual treatment measures. And there’s a big administrative burden that costs dental offices much time and energy. That must change. We should reduce the need for documentation. You’re required to have five different administrative companies credentialing dentists where we could have one universal system for everyone one who has a valid license. We need to do everything we can do make sure affordable oral healthcare is available to everyone, and make the process of providing and obtaining it as easy as possible for both patients and dentists.

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