Fifteen years ago Bill Clinton was president, our lives had not been changed forever by the destruction of the World Trade Center, and Dr. David Satcher issued the first-ever surgeon’s general’s report on oral health in America. The report detailed the huge unmet need for dental care across the country, a need especially acute in poor and minority communities.
Since 2000, Satcher tells ICTMN, change has come, but not quickly enough. “We’ve come a long way, but we haven’t come far enough. We have a long way to go.”
He explains, “We still have major disparities in oral health in this country and certainly in Indian country. Yet there are some hopeful signs, two major hopeful signs from my perspective.
“One is the Affordable Care Act, which made dental health care for children an essential health service. That’s a major step forward. We’ve always been concerned about children getting cavities and missing school and suffering toothaches. Those things are more common than asthma, for example, in this population. The fact that the ACA makes dental health care for children an essential health service is a very important development.”
Oral health, says Stacher, is about more than just teeth. “If you don’t have good oral health, you don’t have good health,” he says. The 2000 report says oral health “means being free of chronic oral-facial pain conditions, oral and pharyngeal (throat) cancers, oral soft tissue lesions, birth defects such as cleft lip and palate, and scores of other diseases and disorders that affect the oral, dental, and craniofacial tissues.”
Our oral health—or lack thereof—affects how we speak and smile, smell, touch, chew and swallow, express emotion and present ourselves socially. Within the American Indian and Alaska Native population, “One third of schoolchildren report missing school because of dental pain. Twenty-five percent of schoolchildren avoid laughing or smiling, and 20 percent avoid meeting other people because of the way their teeth look. As a consequence of dental pain, almost a quarter of the adults are unable to chew hard foods, almost 20 percent report difficulty sleeping, and 15 percent limit their work and leisure activities. Three quarters of the elderly experience dental symptoms, and half perceive their dental health as poor or very poor and are unable to chew hard food. Almost half the adults avoid laughing, smiling, and conversation with others because of the way their teeth look,” according to the report.
The major constraint to getting adequate health care, even if you have insurance through the Affordable Care Act or another program, is access. “What the Affordable Care Act does is to give you a way to pay for [dental care]. But we don’t have enough dentists in this country and we certainly don’t have enough in Indian country,” says Satcher.
“If you have coverage for health care and yet you don’t have access to anybody who can provide it, you still have a problem. That’s why models like the one that’s developing in some parts of Indian country—Alaska is one that comes to my mind immediately—are so important.”
Satcher’s second reason for hope is a new model for delivering oral health care. The model Satcher is advocating is training dental hygienists to practice independently of dentists. In Alaska, for example, dental hygienists travel to schools and community centers to evaluate oral health, fill cavities, perform extractions, make dentures and apply dental sealants, the first line of defense against cavities for kids. They teach children and adults the importance of brushing and flossing.
“I make the analogy to nurse practitioners because there are several states now where nurse practitioners can practice independently,” says Satcher. Studies have shown that when it comes to things like controlled hypertension and diabetes they do as good a job as physicians. Physicians are very resistant to that [concept].
“Dentists are very resistant to the independent practice of dental hygienists. Those are policy barriers that we’ve got to find a way to get over.
“We’ve got to put the health of people first. That’s where I come down. If we have people who are not able to get care because there are not enough physicians or dentists and we’re able to show that one strategy makes a positive difference, then we’ve got to get the policies in line with that,” Satcher says.
Satcher is certain that oral health care is essential to overall good health and that this care should be made available to as many people as possible. “It’s important to continue to produce people who can provide oral health services and to look at models other than traditional ones.
Jacqueline Pata, executive director of the National Congress of American Indians, says, “Our tribes should be able to exercise their sovereign rights to ensure that tribal members have access to oral health care services through mid-level providers such as dental health aide therapists. The dental health aide therapists in Alaska have been providing high quality and effective oral health care to Alaska Native communities for over 10 years. They are the solution to reducing oral health disparities and improving access to oral health care in Indian country.”
Satcher, 74, a four-star admiral in U.S. Public Health Service Commissioned Corps, is currently director of the Center for Health Leadership Institute at the Morehouse School of Medicine in Georgia.