IOM releases second report on oral health

On July 13, the Institute of Medicine (IOM) released a second report on oral health, Improving Access to Oral Health Care for Vulnerable and Underserved Populations. The report, which acknowledges barriers to access to care, makes several proposals to improve dental education that the American Dental Education Association (ADEA) will work with collaborating organizations to address.

"The report offers viable opportunities that, if implemented, would bring our nation closer to breaking down the barriers that restrict access to oral health care for too many children, older adults, people living with disabilities, and residents of isolated rural and urban communities," ADEA President Leo E. Rouse, D.D.S., said. "Ensuring access to oral health is a responsibility shared by a multitude of stakeholders. Engagement of the oral health community, as well as the broader health professions community, is therefore essential." He pledged, "ADEA will respond to the report's call to work with a myriad of stakeholders to address this societal problem."

"Dental disease can have sometimes fatal and often costly consequences for those without access to care, the same as any other medical condition," ADEA Executive Director Richard W. Valachovic, D.M.D., M.P.H., said. "Consequently, it must be given equal priority and public resources. This effort will require the engagement of accrediting agencies, national testing agencies, state boards, and state dental and allied dental associations to review and modify, where appropriate, policies, regulations, and attitudes. Most importantly, responding to the access to oral health challenge will require the commitment of federal and state lawmakers who must make appropriate and needed investments in oral health."

Improving Access to Oral Health Care for Vulnerable and Underserved Populations is organized on a set of domains that include: 1) integrating oral health care into overall health care; 2) creating optimal laws and regulations that maximize access to oral health care; 3) improving dental education and training; 4) reducing financial and administrative barriers; 5) promoting research; and 6) expanding the capacity of states to provide core dental public health functions.

Under each domain, the IOM report makes recommendations, several of which follow:

• Dental professional education programs should: a) increase recruitment and support for enrollment of students from underrepresented minority, lower-income, and rural populations; b) require all students to participate in community-based education rotations with opportunities to work with interprofessional teams; and c) recruit faculty with experience and expertise in caring for underserved and vulnerable populations.
• State legislatures should require a minimum of one year of dental residency before a dentist can be licensed to practice.
• Accrediting bodies for undergraduate and graduate-level "non-dental" health professional education programs should integrate these core competencies into their requirements for accreditation.
• All certification and maintenance of certification for health care professionals should include demonstration of competence in oral health care as a criterion.
• The Health Resources and Services Administration (HRSA) should convene key stakeholders from both the public and private sectors to develop a core set of oral health competencies for "non-dental" health care professionals.
• HRSA should dedicate Title VII funding to: a) support the development, implementation, and maintenance of substantial community-based education rotations; b) increase funding for recruitment and scholarships for underrepresented minorities, lower-income, and rural populations to attend dental professional schools; c) support and expand opportunities for dental residencies in community-based settings.
• State legislatures should amend existing state laws, including practice acts, to maximize access to oral health care that: a) allow allied dental professionals to practice to the full extent of their education and training; b) work in a variety of settings under evidence-supported supervision levels; and c) permit technology-supported remote collaboration and supervision.