Oral Health Services Research: A Rising Voice on the Silent Epidemic

Nearly 20 years after the Surgeon General’s Report on Oral Health in America characterized oral diseases as a silent epidemic “affecting our most vulnerable citizens,” poor oral health still receives relatively little attention from researchers and policymakers.

In recent years, however, oral health services research has gradually drawn more attention from the academic community. There is growing evidence strengthening the link between oral and systemic health, as well as the psychosocial effects of poor oral health on quality of life. Moreover, oral health services have direct implications for both the opioid crisis and emergency department use. The profile of oral health services research has been increasing over the last decade with the formation of the American Dental Association Health Policy Institute (HPI) and an entire issue of Health Affairs dedicated to oral health in 2016.

At the recent AcademyHealth Annual Research Meeting, I was pleasantly surprised to see several scheduled talks and a poster session centered on oral health. I attended this leading national conference for health services research as part of the Penn LDI Summer Undergraduate Minority Research (SUMR) Program. I thoroughly enjoyed one such session, titled “How states use data to improve Medicaid adult dental benefit policies.” One of the panelists, Dr. Leon Assael, who has served as the dean of several dental schools over his career, started the session by stating that a better title would be “How dentists NEED MORE data to improve Medicaid adult dental benefits.” While current dental care is very good for many Americans, he explained, more than 100 million Americans still suffer from the “silent epidemic” because of a lack of access to care. He emphasized the need for high quality health services research to better quantify oral health issues and elucidate potential policy solutions. 

Another panelist, Dr. John Dane, the state dental director for Missouri, explained the iterative process involved in expanding adult dental Medicaid benefits in his state. Because adult dental benefits were not included in the Essential Health Benefits of the Affordable Care Act, coverage is left up to state discretion. Currently, only 31 states offer some adult dental Medicaid benefits. Dr. Dane successfully convinced the Missouri legislature to offer adult dental Medicaid benefits in 2016, after demonstrating that expanded dental benefits to vulnerable populations can improve oral health outcomes while saving the state money by reducing non-traumatic dental ED usage. This case study illustrates the power of data from oral health services research to shape health policy.

While strides have been made in oral health services research, there is still a lot of work to do. Dental coverage and care in vulnerable Medicaid populations still lag far behind their medical counterparts. There is also a growing sense within the dental field that major changes may be on the horizon, as the nation moves toward value-based health care and a more holistic view of health. Therefore, it is crucial for the field of oral health to build on the recent progress and take even greater initiative in funding, conducting, and promoting oral health services research in the coming years.