American Dental Association President-Elect Testifies Before Institute of Medicine Committee on an Oral Health Initiative
WASHINGTON, March 31, 2010 -- American Dental Association President-Elect Dr. Raymond Gist testified today before an Institute of Medicine Committee, examining the various aspects of a proposed federal “oral health initiative” as a way to advance the government’s overall strategy for improving the nation’s dental care.
Dr. Gist emphasized the importance of maintaining a dental presence in all federal agencies responsible for improving and maintaining the nation’s health. This would include ensuring that each federal agency that has a dental component have a chief dental officer with an identifiable budget, he said.
He also stressed that private-public partnerships can help the Department of Health and Human Services in enhancing projects to reduce oral disease and increase access to care.
This is Dr. Gist’s oral testimony.
Good afternoon, I am Dr. Raymond Gist, president-elect of the American Dental Association, which has over 157 thousand members and represents more than 69 percent of the profession. The ADA understands the tasks facing this committee and its charge to advise the Department of Health and Human Services. My testimony today briefly addresses this charge. We also have submitted a longer written statement for your consideration.
The ADA believes that before HHS can take any action to improve oral health in America it must establish a strong dental presence in all of its agencies. The various federal dental divisions have unique roles that allow them to focus on their specific missions. But as we have seen over the past two decades, if these divisions do not have dentists in leadership and advisory positions they can be neither sustainable nor effective.
For example, the CDC Division of Oral Health was established in 1995 with a budget of $3 million. Today, the division has a budget of $15 million and currently funds 16 states with grants that allow them to provide a variety of oral health activities. The division could not fulfill its mission without a chief dental officer.
Recognizing dental leadership and expertise within every HHS federal agency would allow that agency to look at all of its programs within the context of oral health. For example, the National Institute of Dental and Craniofacial Research (NIDCR), like other institutes in the 1980s and 90s, was seeking a cure for or vaccine to prevent HIV infection. Scientists knowledgeable about the mouth and its functions were instrumental in understanding the oral manifestations of this virus. That knowledge led to the discovery of the unique anti-infective properties of saliva, which led to even greater findings. For instance, scientists now believe that saliva can one day be used to diagnose breast, prostate, oral, and pancreatic cancer and acute myocardial infarction.
The Indian Health Service established its dental division as a separate entity dedicated to improving the oral health of American Indians and Alaska Natives. The division has demonstrated that adequate funding leads to progress in preventing oral disease. Last year, the number of dental sealants placed increased by 12 percent and the number of patients receiving topical fluorides increased by 19 percent. These are proven methods of preventing oral disease that cost dramatically less than treating the disease that would occur in their absence.
Dedicated funding allows the IHS Division of Oral Health to run its own recruitment activities, a summer extern initiative and a dental residency program. Dedicated funding also allows the division to address oral health issues as identified by the American Indian/Alaska Native communities. The ADA views the division as a model for all federal oral health agencies.
On the other hand are three federal agencies whose dental divisions have suffered for lack of a clearly identified oral health division. They are:
The Agency for Health Research and Quality (AHRQ),
The Centers for Medicare and Medicaid Services (CMS) and
The Health Resources and Services Administration (HRSA).
The number of dentists at AHRQ has declined over the past decade from four in 1992 to none today. Last year, the ADA nominated several dentists to serve on AHRQ’s National Advisory Council, but none was appointed. As a result, there is no one to call attention to oral health needs when the Advisory Council reviews study proposals
The Bush Administration left the CMS Chief Dental Officer position vacant for two years. Partly in response to ADA appeals, President Bush named a dental director in 2003, but not in the capacity of his predecessor. Currently, the CMS chief dental officer reports to the chief medical officer within the Office of Clinical Standards and Quality. The ADA believes a better placement would be in the Center for Medicaid and State Operations, where the chief dental officer would have a more prominent role in policy that affects Medicaid and the Children’s Health Insurance Program.
In 2000, then-HRSA Administrator Dr. Earl Fox, a member of this committee, proposed a sweeping oral health initiative for the agency. Not only did he call for highlighting and boosting HRSA’s oral health programs, he also recognized that the agency needed to forge a closer relationship with CMS and programs like Head Start. The ADA actively supported this new direction and appealed to Congress to do the same. Unfortunately, leadership changes at HRSA under the new Administration resulted in the proposal’s abandonment.
The ADA, however, did not stop advocating for changes at HRSA. From 2000 to 2008, through Congress, we have called attention to the lack of a HRSA dental division, a drastically decreasing dental workforce, and the lack of a chief dental officer. On several occasions, HRSA ignored directives from Congress to address these issues.
Consequently, as of last November, there are no dentists actively serving within HRSA regional dental consultant billets. This prevents the agency from providing valuable full-time assistance to health centers. The ADA continues to question who is currently providing oral health guidance to the ever-growing number of fledgling dental programs.
In 2008, in response to congressional urgings, HRSA appointed a chief dental officer. But unlike his counterparts at CDC, IHS or NIDCR, the HRSA chief dental officer does not receive a separate budget and therefore, cannot address program or staffing needs.
As we look at the nation’s oral health needs, the ADA believes that addressing the unique concerns of the elderly and disabled populations has been overlooked. Statistics show this is a growing need. There should be a coordinated effort across all federal dental divisions to focus on advocacy, education and research for vulnerable older Americans and those living with special health care needs.
This should be accomplished through public-private partnerships. The ADA already is pursuing this. In 2006 we developed the Oral Longevity Initiative, a three-phase education program that focuses on dentists, 14.2 million adults and caregivers, and dental students.
To sum up, we believe that each federal agency that has a dental component should have a chief dental officer with an identifiable budget. There should also be coordination of activities by these officers, to make maximum use of limited resources and prevent duplication. We also recommend that HHS encourage all dental divisions to establish public-private collaborations to enhance projects to reduce oral disease, and increase access to care.
On behalf of the American Dental Association, I thank you for the opportunity to speak here today, and I will gladly answer any questions you may have.
About the American Dental Association
The not-for-profit ADA is the nation's largest dental association, representing more than 157,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly Journal of the American Dental Association (JADA) is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit the Association's Web site at www.ada.org