December 17, 2021
The Honorable Benjamin Cardin
U.S. Senate
509 Hart Senate Office Building
Washington, DC 20510

Dear Senators Cardin and Stabenow:

The Honorable Debbie Stabenow
U.S. Senate
731 Hart Senate Office Building
Washington, DC 20510

On behalf of the American Association of Oral and Maxillofacial Surgeons (AAOMS), which represents
more than 9,000 oral and maxillofacial surgeons (OMSs) in the United States, I wish to thank you foryour leadership on oral health issues in Congress, particularly given your introduction of the Medicaid
Dental Benefit Act (S. 3166). This important legislation would provide comprehensive and consistentadult dental Medicaid benefits across the country for those who cannot otherwise afford oral healthcare.

OMSs understand the important role oral health can have on a patient’s overall health. OMSs are
surgically and medically trained dental specialists who treat conditions, defects, injuries, and esthetic
aspects of the mouth, teeth, jaws, neck and face. The OMS scope of practice straddles the line between
medicine and dentistry, treating conditions that could be dental or medical in nature. In fact, AAOMS
maintains a list 1 of oral and maxillofacial surgery services it considers to be “medically necessary” or“essential” because they are integral to a patient’s overall health.

It is well-documented that those who suffer from oral disease, especially periodontitis, are more likely tohave chronic health diseases, including diabetes, heart disease and stroke. 2 Access to regular dental carecan prevent oral disease and serious health complications. For example, dental infections, if left
untreated, can lead to blood infection, deterioration of the jaw, heart complications, or death.
Unfortunately, regular oral healthcare is not accessed by many adult Medicaid eligible recipients, and it
manifests in poor dental outcomes. One study showed that “untreated dental caries were more than 2.5
times as common in those living 100% below the poverty level (41.9%) relative to those living 200%
above the federal poverty level or higher (16.66%).” 3 The data clearly show that increasing access todental care through the Medicaid program can lead to better oral health outcomes for these populations.
A study examining the causal relationship between access to adult Medicaid benefits and usage of dental
1 Essentials of Oral and Maxillofacial Surgery Services. American Association of Oral and Maxillofacial Surgeons WhitePaper. January 2021. AAOMS.org/docs/govt_affairs/advocacy_white_papers/essentials_oms.pdf.
2 2020 Leading Health Indicators: Oral Health; Office of Disease Prevention and Health Promotion. Department of Healthand Human Services. HealthyPeople.gov/2020/leading-health-indicators/2020-lhi-topics/Oral-Health. Accessed Aug. 26,
2021.
3 Beltrán-Aguilar ED, Barker LK, Canto MT, Dye BA, Gooch BF, Griffin SO, Hyman J, Jaramillo F, Kingman A, NowjackRaymer R, Selwitz RH, Wu T., Centers for Disease Control and Prevention (CDC). Surveillance for dental caries, dental
sealants, tooth retention, edentulism, and enamel fluorosis--United States, 1988-1994 and 1999-2002. MMWR Surveill
Summ. 2005 Aug 26;54(3):1-43. NCBI.nlm.nih.gov/books/NBK542165/. Accessed Dec. 9, 20201

services for low-income adults, found that that adult Medicaid benefits increases the likelihood of adental visit by up to 22 percent. 4

While nearly all states provide some level of dental Medicaid benefits for adults, only 21 states plus theDistrict of Columbia provide “extensive benefits,” defined as “including at least 100 diagnostic,preventive, and restorative procedures, and a per-enrollee annual maximum expenditure of at least$1,000.” 5 We appreciate your efforts to correct this vast disparity of care among states through yourlegislation.

AAOMS is pleased that the Medicaid Dental Benefit Act also would allocate additional financial resourcesfrom the federal government to assist states with providing enhanced dental benefits. The federal
investment will help ensure these expanded benefits are consistently offered, and not subject tointermittent cuts during state fiscal downturns, as they are now.

Finally, AAOMS believes the Medicaid Dental Benefit Act also would be a significant tool in providing
dental care for the nation’s seniors who can least afford it. We recognize that other solutions have been
discussed in Congress, such as an expanded dental benefit under the Medicare Part B program. AAOMS
disagrees that a Part B expansion is the best approach to providing affordable dental care to seniorsbecause we do not believe it targets those who need it most. We believe Congress should prioritize
access to care for those adults who can least afford it through a comprehensive and consistent adult
Medicaid dental benefit across the country which does more to advance the Biden Administration’s goalfor equity in our nation’s healthcare system and is more cost-effective. For example, providing
preventative dental care to Medicaid eligible adults throughout their life rather than just when they
become Medicare eligible – and ideally before their oral health deteriorates – helps prevent significant
and costly care later in life.

Again, thank you for your leadership on oral health issues, particularly through the introduction of theMedicaid Dental Benefit Act. AAOMS would be pleased to work with you and your colleagues to advance
this important legislation and discuss how best to expand access to affordable oral healthcare. Pleasecontact Jeanne Tuerk, AAOMS Director of Government Affairs, at 800-822-6637, ext. 4321, or
jtuerk@aaoms.org.
Sincerely,AAOMS President

4 Choi MK. The impact of Medicaid insurance coverage on dental service use. J Health Econ. 2011;30(5): 1020-31.

Accessed: Sciencedirect.com/science/article/abs/pii/S016762961100110X?via%3Dihub. Accessed Dec. 14, 2021

5 Vujicic M, Fosse C, Reusch C, Burroughs M. Making the Case for Dental Coverage for Adults in All State MedicaidPrograms. ADA Health Policy Institute, Families USA and Community Catalyst Research Brief. July 2021. ADA.org//media/project/ada-organization/ada/adaorg/files/resources/research/hpi/whitepaper_0721.pdf?rev=cf603f948e6a4dd09fb62386e3ee2083&hash=4986B3ED8
A5FD4F99A1D28F61D3C2DA1. Accessed Dec. 14, 2021