E D I T O R I A L

Bringing Oral Health Care to School-aged ChildrenJay W. Friedman, DDS, MPH

The Healthy People 2010 ’smodest goal of increasing annualoral health care utilization amongchildren from 20 to 57 percent isunlikely to be achieved without amajor change in the delivery system(1). Good intentions notwithstand-ing, the barriers that prevent manyschool-aged children, not all ofwhom are poor, from accessingdental care cannot be overcome bytraditional private practice forreasons that are well known: thehigh cost of fee-for-service and therefusal of many dentists to acceptthe lower payments of Medicaid; theincreasing shortage and geographicmaldistribution of dentists; the dis-inclination of many dentists totreat poor and minority children,or to treat children at all. No lesssignificant are the social barriersthat include ethnic/cultural attitudesand values, deficient education,single parentage, household debtsand inadequate transportation (2).

There is even underutiliza-tion when dental care is free. AsMaserejian, et al., stated, “. . . childrenfrom low-income families who areentitled to comprehensive oral healthcoverage through Medicaid [e.g., freecare] are less likely to utilize dentalcare than children from higher-income families (2).” This is not true,however, in countries that have pub-licly funded, salaried dental therapistsproviding preventive and curativecare for school-aged children whereutilization of over 90 to nearly 100percent is achieved (3). The service isusually located in school dentalclinics or mobile trailers stationed on

school grounds. Parenthetically, pre-schoolers could also be provided pre-ventive and early interceptive care inthese programs, as well as in theoffices of pediatricians and familyphysicians.

If we are content with a goal of57% utilization by children to theneglect, through no fault of their own,of millions of other mainly poor ormarginally poor children comprisingthe other 43%, then we stick with thetraditional system that requires trans-portation to health care providers. Butif we really want to care for all chil-dren in the United States, rich andpoor alike, then we have to considerbetter ways of bringing oral healthcare to children who cannot accessprivate practices, free clinics or com-munity health centers. We mustacknowledge the obvious fact that,with respect to health care, childrenare essentially non-ambulatory. Theymust have someone with the desire,time, money and means to take themto health care providers. Since manychildren lack that caregiver, they willnot receive preventive and curativehealth care, even if it is free. If there isno one to bring these children todental care, then dental care must beprovided for them in schools, prefer-ably by dental therapists whose com-petency has been well documented.

Where is the money to comefrom? School-based health programsrequire public funding, a conceptthat is anathema to private healthcare advocates but which, in theseeconomic hard times, can no longerbe ignored. Administrative costs toadminister commercial insurance

ranges from 25 to 30%, comparedto 5% for Medicare (4). If only 10percent of the nearly $2 trillion annualhealth care expenditure was savedby adopting universal single payerhealth insurance, approximately $20billion could be made available tosupport development and deploy-ment of school-based programsstaffed by dental therapists and pedi-atric nurses, as well as providing basichealth insurance for the remainder ofthe uninsured population.

How we allocate available fundsand services will determine if we failor succeed in meeting the goals ofHealthy People 2010 and beyond. Ifwe want all school-aged children tobenefit from adequate oral healthcare, it needs to be provided inschool-based programs where it canbe easily accessed.

References1. U.S. Department of Health and Human

Services. Healthy people 2010. VolumeII, Second edition. Washington (DC): USDepartment of Health and Human Ser-vices; 2000.

2. Maserejian NN, Trachtenberg F, Link C,Taveres M. Underutilization of dentalcare when it is freely available: a pro-spective study of the New England chil-dren’s amalgam trial. J Public HealthDent. 2008;68(3):139-48.

3. Nash DA, Friedman JW, Kardos TB,Schwarz E, Satur J, Berg DG, Nasruddin J,Mumghamba EG, Davenport ES, Nagel R.Dental therapists: a global perspective.Int Dental J. 2008;58(2):61-70.

4. Matthews M. Medicare’s Hidden Admin-istrative Costs: A comparison of Medicareand the private sector: executive sum-mary. The Council for Affordable HealthInsurance. January 10, 2006. Available at:http://www.pnhp.org/news/2006/january/cahis_claim_of_medi.php

Vol. 68, No. 4, Fall 2008 187

© 2008, American Association of Public Health DentistryDOI: 10.1111/j.1752-7325.2008.00114.x