Community-based oral health prevention. Issues and opportunities.

For too long the issue of oral health has been neglected and has been separated from issues of primary care and general health. As a result of this neglect, large disparities in oral health exist by race/ ethnicity and social class. Despite scientific and technologic advancements, basic oral health prevention and care elude many Americans, particularly the uninsured and underinsured, low-income populations, and communities of color. It is within these communities that we continue to see high rates of oral disease and low rates of utilization of oral health services. Children represent a special problem. Twenty-five percent of children, namely those who are poor or are children of color, experience 80% of all dental decay occurring in permanent teeth. 1 The problems of children are not the only crisis that the nation faces as the oral health status of poor adults, and their access to any care, including restorative care at the moment, appears to defy solution or priority in policy dialogue (Figure 1). While the oral health recommendations of the Task Force on Community Preventive Services (the Task Force) do not target any specific population, they are a starting point for the concomitant task of identifying community-based interventions along the continuum of addressing oral health disparities including disparities in access to care. The next step however is to identify where the needs are, factor in the economic and social impact of the oral health disparities, and design appropriate points of intervention and service to effectively address the oral health of underserved communities. The W.K. Kellogg Foundation through its Community Voices: Healthcare for the Underserved Initiative and other funded activities has focused on improving access to oral health for vulnerable populations as a way to improve oral health for all. A basic tenet underlying Kellogg’s investments is that oral health care must be integrated within a primary healthcare system that is accessible, acceptable, and available to all. While the Task Force has focused on three disease-oriented issues— dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries—the Kelloggfunded oral health activities focus on complementary issues related to the health delivery system and health policy. The Kellogg-funded work addresses the overarching issues of accessibility, finance, education, workforce, and infrastructure/organization. The work ultimately attempts to integrate activities that remove barriers in a manner that does not leave segmented and separate answers for different communities based on, for example, service gateway, payment, and willing provider availability. Kellogg’s Community Voices Initiative involves thirteen diverse communities— or learning laboratories— across the country that serve as working centers to identify and implement strategies and interventions that address the needs of those who currently receive inadequate or no health care. The lack of any, adequate, or appropriate oral health care has been a major focus of their overall work in addressing the need for a comprehensive primary care system. These learning laboratories serve some of the hardest-to-reach populations, including those living in poor rural and urban communities, immigrants, children of the poor, communities of color, women attempting to make the transition from welfare to work, adult men, and the homeless.