The Robert Wood Johnson Foundation's Response to Improving the Nation's Oral Health

This supplement to the American Journal of Preventive Medicine on oral health preventive measures is an important addition to the literature and will be welcomed by health planners, community organizations, researchers, grantmakers, and others who are concerned about the “silent epidemic”1 of oral diseases. The Surgeon General’s Report (2000)1 on oral health disparities has helped to raise the level of public concern that tens of millions of Americans—the poor and near poor, ethnic and racial minorities, the disabled, and those in rural areas—suffer from oral diseases but do not have access to basic preventive and restorative dental services. Unfortunately, access and oral health disparities are likely to increase in the coming years as the population grows faster than the number of dentists.2 Under these conditions, effective community-level preventive measures offer the best hope for reducing oral health disparities. Brown et al.3 compared the number of decayed and filled tooth surfaces in children aged 6 to 18 years by family income from 1971 and 1994. Tooth decay declined for all income groups—associated with the use of ingested and topical fluorides—and especially for children from low-income families. The three papers in this supplement provide a useful compendium on the current state of scientific knowledge on the impact and cost-benefit ratios of community-level programs to prevent three important oral diseases: caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. The authors’ reports provide convincing scientific evidence about the effectiveness of different community preventive interventions. They use this body of research as the basis for making their recommendations. The reports are organized for readers with different levels of knowledge and interest in the subject. Thus, health planners will find a concise set of recommendations, and academicians will have access to a comprehensive and detailed summary of the literature on which the recommendations are based. Philanthropic organizations can use this information to develop intervention strategies, turning research into action and focusing on the systemic problems that lead to disparities in oral health status and care. Several foundations have supported a range of activities to improve dental access among vulnerable populations. The W. K. Kellogg Foundation has made oral health a focus in all 13 sites of its national initiative to improve health care access and quality for the underserved, Community Voices. The California Endowment has expanded the capacity of grantees to deliver oral health services. The Sierra Foundation has supported several oral health projects in schools and rural communities. The United Methodist Health Ministry Fund has invested in a multi-level campaign to prevent dental disease in Kansas. The Washington Dental Service Foundation funds a public awareness and advocacy initiative to improve oral health in Washington. Some local funders have supported efforts to raise the visibility of oral health status and the disparities in access. Other foundations have focused on promoting water fluoridation, expanding prevention and treatment services, building the field of research, and exploring ways to broaden the dental workforce. Grantmakers in Health’s Issue Brief Filling The Gap: Strategies for Improving Oral Health (2001)4 provides a detailed description of public and private sector initiatives to address the oral health needs of the nation. The Robert Wood Johnson Foundation (RWJF) has supported projects to improve health and health care for all Americans for over 30 years, and has recently reinvigorated its commitment to oral health. Throughout the 1970s and 1980s, the Foundation supported a variety of dental health programs. In 1972, its initial year as a national philanthropy, the Foundation launched a $4.1 million Dental Student Aid Program. Four-year scholarships and loans were offered to underrepresented minority students, women, and applicants from rural areas to encourage graduates to practice in underserved communities. RWJF’s Dental Training for Care of the Handicapped (1973–1978) supported 11 dental schools in their efforts to develop course curricula instructing dental students in the care of disabled patients. The program’s goal was to increase the number of community dentists who had the skills and competence to treat specialneeds children and adults. Today, these types of trainFrom the Robert Wood Johnson Foundation, Princeton, New Jersey Address correspondence to: Judy Stavisky, MHPH, MEd, Robert Wood Johnson Foundation, Route 1 and College Road East, Princeton NJ 08543-2316. E-mail: jstavis@rwjf.org.