Conducted by the Pew Center on the States, the report gave only six of the 52 states an A grade (using Pew's benchmarks), while nine got F grades. And with one out of five children getting no dental care each year, the nation as a whole has made little progress in the decade since the U.S. surgeon general's landmark 2000 report called attention to problems with the nation's oral health, Pew noted.
"This is a solvable problem," said Shelly Gehshan, director of the Pew Children's Dental Campaign, in an ADA conference call. "Some problems in healthcare seem intractable, but this is not one of them."
The report, produced with the support of the W.K. Kellogg and DentaQuest foundations, used eight benchmarks to evaluate how well states are caring for children's oral health. Perhaps the most controversial is the state's authorization of "a new primary care dental provider."
Pew gave only one state, Minnesota, credit for meeting this objective. That state has introduced a category of oral health provider, who will be licensed to do simple extractions and restorations after a minimum of four years of education. (Dental health aide therapists now practicing in Alaska do so under federal rather than state authority.)
The other benchmarks included the following:
- Sealant programs in at least 25% of high-risk schools
- Not requiring a dentist's exam before a hygienist sees a child in a school sealant program
- Providing optimal fluoridation to at least 75% of residents on community water systems
- Meeting or exceeding the national average (38.1%) of children on Medicaid receiving dental care
- Paying dentists at least the national average (60.5%) of dentists' "median retail fees"
- Reimbursing medical care providers for preventive dentistry
- Submitting basic screening data to the National Oral Health Surveillance System
"Honestly, if you look at them, we did not set the bar all that high," Gehshan said.
In a press release, ADA President Ronald Tankersley, D.D.S., said the organization welcomed the report. But he quibbled with some of the criteria used to evaluate the nation's dental care policy.
"The report does omit some policy areas that we believe are equally important to improving children's access to care," he said. "For instance, some states have innovative programs -- like student loan forgiveness and tax incentives -- to help dentists establish practices in underserved areas or practice in community health centers. And when it comes to fixing Medicaid, money is a huge issue, but it isn't the only issue. Patients and parents need oral health education to help them take care of themselves and their families to prevent disease. Many of them need additional services, like transportation, in order to be able to get to dental appointments. If Medicaid did a better job of these things, treatment costs would decrease because we would be preventing more disease and treating less."
Making the grade
In the Pew report, states got an A for meeting six to eight benchmarks, a B for five, a C for four, a D for three, and an F for zero to two.
Six states earned A's: Connecticut, Iowa, Maryland, New Mexico, Rhode Island, and South Carolina.
Nine states earned B's: Alaska, Colorado, Idaho, Illinois, Maine, New Hampshire, Ohio, Texas, and Washington.
Twenty states got C's: Arizona, California, Georgia, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New York, North Carolina, North Dakota, Oklahoma, Oregon, South Dakota, Tennessee, Vermont, Virginia, and Wisconsin.
D's went to six states: Alabama, Indiana, Mississippi, Montana, Nevada, Utah, and the District of Columbia.
Nine states got F's: Arkansas, Delaware, Florida, Hawaii, New Jersey, Louisiana, Pennsylvania, West Virginia, and Wyoming.
Though Pew researchers chose their own benchmarks, they also relied on Healthy People 2010, a set of national objectives set by the U.S. Department of Health and Human Services, for some of them. That standard calls for at least half of the third-graders in each state to have sealants by 2010. While data was incomplete, the Pew report found that only eight states have reached that goal, and in 11 states, fewer than one in three third-graders have sealants.
Likewise, Healthy People set a goal of fluoridated water for 75% of the population by 2010. According to data from the Centers for Disease Control and Prevention, the report states, the U.S. still stands at less than 50%.
Less than 21% of the population should have untreated cavities, according to Healthy People. But among children ages 6-8 years, almost a third still have untreated cavities, Pew said.
The report aimed to call policymakers' attention to an area of health that Pew feels has been neglected. In the debate over healthcare reform last year, "there was enormous attention to the amount of people without medical insurance, but you hardly ever heard anything about the fact that twice as many people lacked dental insurance," Gehshan said. "A lot of policymakers don't know what a sealant is."
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