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Dental Public Health: The “Big Picture” Branch of Dentistry

Dental public health is a dental specialty focused on prevention and control of dental diseases, and promotion of dental health through organized, community-based efforts. Rather than addressing individual patient needs, dental public health concentrates on the overall dental health needs of local, state and national communities in order to provide optimal oral health for all individuals, including patients with special needs and underserved populations. Dental public health emphasizes the environment, human behavior and lifestyle, and medical care, and encompasses dental health education, dental research and the administration of group dental care programs as factors affecting the prevention and control of dental diseases on a communal level.

Dental Public Health Specialist Education

Dental public health specialists must possess broad knowledge and skills in public health administration, research methodology, prevention and control of oral diseases, and the delivery and financing of dental health care.

Dental public health specialists also must meet certain requirements for eligibility to the American Board of Dental Public Health (ABDPH), specifically graduation from an accredited dental school, and good moral and ethical standing. They also must possess professional experience and complete advanced education in public health. This entails: two years of advanced educational preparation, such as a Master or Doctorate degree, in dental public health. Courses must include biostatistics (the science of biologic or medical data statistics); epidemiology (the study of the distribution and causes of health-related states or events in specific populations) and its application to controlling health problems; health care policy/management (the study of public health administration skills, practices and applications); environmental health (the study of protecting against environmental hazards and helping the community in recovery, epidemic prevention and contaminant containment); and behavioral sciences (the study of human behavior and lifestyle as it relates to public health concerns).

Dental public health specialists then must complete at least one full year of an accredited residency in the field of public health. This may involve two or more years of full-time experience in administration, teaching, research or clinical practice related to dental public health. After completing these education requirements, candidates can take an examination and, upon passing, receive a 10-year certification as a dental public health specialist.

Focus of Dental Public Health Specialists

The primary functions of dental public health specialists include the following:

Oral Health Assessment: Monitor community oral health status, community health needs and epidemiologic issues to diagnose and investigate dental health problems and hazards in the community. This is accomplished by regularly collecting and distributing information (registries, vital statistics, clinical surveys, screening surveys, non-clinical data and health department data, such as water fluoridation reports).

Oral Health Assurance: Dental public health specialists assure the quality and accessibility of oral health services through community oral health education that informs, educates and empowers patients about dental health issues; promoting and enforcing laws to protect and improve oral health; linking people to needed oral health services and providing dental health care when otherwise unavailable; ensuring an adequate public health workforce; implementing/supporting prevention programs; evaluating the effectiveness of services; and conducting research to solve oral health problems.

Oral Health Policy Development/Implementation: This includes maintaining oral health units within state or local health agencies; mobilizing community partnerships and developing policies and plans to identify and solve community oral health needs and problems; enforcing laws and regulations that protect the dental health and safety of the community; and evaluating effectiveness, accessibility and quality of personal/population-based dental health services.

Other functions of dental public health include seeking to eliminate disparities, fostering and facilitating social justice and dental care access, and researching innovative solutions to dental health problems.

Prevention and Patient Education

Programs developed by associations such as the American Academy of Pediatric Dentistry (AAPD) aim to provide comprehensive developmental services for low-income families and communities. This involves educating children and parents. The overall goal is to create a network of pediatric and general dentists who base their practices on educating patients about tooth decay prevention and a life of good oral health habits. The plan is to start at the regional level, then move to state and local levels to build an ever-widening network of community outreach initiatives that serve targeted patient populations.

Dental public health initiatives and associations seek to educate and empower patients, starting at a young age, so they develop habits conducive to a lifetime of oral health. Programs such as Head Start (HS) and Early Head Start (EHS) are comprehensive early childhood health programs (including oral health) that use education and prevention to improve the welfare of low-income, at-risk children, pregnant women and their families.

Dental Insurance

Although improved, there remains a lack of access and provision for those who are uninsured, and dental plans still present excessive costs to patients. There now are advocacy groups that include members from commercial insurance carriers, regional and single-state companies, and companies organized as Delta Dental and Blue Cross Blue Shield Plans (non-profit dental benefits corporations organized as community-based entities that accept all individuals regardless of health status at low-cost coverage and open enrollment).

Serving as a voice to government officials, the media and other organizations (such as the American Dental Association), these advocacy organizations attempt to promote and advance the dental benefits industry to improve consumer access to affordable quality dental care for those with and without dental insurance coverage. For instance, the National Association of Dental Plans (NADP), the industry voice and representative for dental benefits plans, advocates for the dental industry’s best practices when working with policymakers and stakeholders via its core services of government relations, including health care reform initiatives and industry representation.

The Children’s Health Insurance Program (CHIP), a state and federal partnership program working closely with Medicaid, provides low-cost health insurance coverage for children in families that earn too much to qualify for Medicaid coverage but can’t afford private health insurance. Eligibility rules vary by state. In most states, children up to age 19 in families with annual incomes at or below $45,000 are eligible for coverage through CHIP. CHIP covers U.S. citizens and certain legal immigrants; undocumented immigrants are not eligible for CHIP. Benefits covered through CHIP vary by state, but all states are required to cover certain important health services — including dental care — free of charge or for low-cost co-payments.

The Future of Dental Public Health

While much has been done to improve the access to and quality of dental health care, preventing and controlling oral diseases and making dental care more available and affordable remain big challenges for dental public health specialists.

In 2009, President Obama signed the Children’s Health Insurance Program Reauthorization Act (CHIPRA), which provides additional funding to renew CHIP and help make CHIP and Medicaid coverage available to more families. Every state currently operates a CHIP.

Under the new health care bill, essential health benefits, such as pregnancy and newborn care, along with dental and vision care for children, will be covered in all new individual, small business and Exchange plans starting in 2014. Exchange plans are central marketplaces for individuals and small businesses to compare and purchase competitively priced health insurance plans.

However, in the wake of the nation’s challenging economic reality, many dental public health programs are facing devastating proposed budget cuts from Congress. Congress’ proposed cuts would eliminate 218,000 children and 55,000 jobs nationwide from Head Start, a national educational program for economically disadvantaged children, especially those 3 to 5 years old, and their families.

Now more than ever, it is crucial for groups such as the American Association of Public Health Dentistry (AAPHD), the Association of State and Territorial Dental Directors (ASTDD) and Oral Health America to vigorously advocate that health reform — including oral health — be a top national domestic policy priority.

Federal, state and local dental public health programs must receive adequate funding to ensure they can continue working toward the primary goal of oral health reform — optimal health and the elimination of oral health disparities through high quality and affordable personal oral health services for all Americans.

According to the Surgeon General, all Americans can benefit from the development of a National Oral Health Plan to improve quality of life and eliminate health disparities by facilitating collaborations among individual health care providers, communities and policy makers at all levels of society, and by taking advantage of existing initiatives.

Now and in the future, dental public health coalitions and collaborative partnerships must continue to unite and work together in order to make possible a tomorrow where preventive, diagnostic and treatment measures for oral diseases are available to all Americans.