Uphill Battle: How Some Foundations Are Tackling America’s Dental Health Crisis
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PHOTO: Lucian Coman/SHUTTERSTOCK
America has been in the midst of a dental health crisis for years. A third of Americans lack access to the most basic dental care. That’s partly because at least 74 million Americans have no form of dental coverage, forcing many to pay out of pocket, rely on charity and emergency care, or—all too often—to leave their teeth and gums to decay.
And while tooth and gum health are important enough on their own, oral health is directly connected to a range of issues throughout the body, including heart health. Neglect oral health and overall health suffers. Poor teeth can also have consequences for social and economic well-being. As Austin Frakt wrote last year in the New York Times: “People with bad teeth can be stigmatized, both in social settings and in finding employment. Studies document that we make judgments about one another—including about intelligence— according to the aesthetics of teeth and mouth.”
Dental coverage is just the beginning. Even those who are insured are often only covered for routine cleanings, so if you need a crown, fillings or other costly treatments, you must pay a sizable chunk out of pocket. On top of the dearth of coverage, around 50 million Americans live in areas with shortages of dental health professionals.
This is what makes the work of the Delta Dental Community Care Foundation so significant.
The foundation is among a number of funders working in the often overlooked area of oral health. Since September, the foundation has awarded seven grants totaling over $2 million to outfits in Louisiana, California, Florida, Pennsylvania, Washington and Texas. Grants included funds for the purchase of dental vans, new dental chairs, dental assistant stools, dental instruments, upgrading of dental operatories and a new X-ray system, free dental screening exams and X-rays for children and veterans and scholarships to dental students who will work in underserved areas after graduation.
All these grants aim to shore up the dental safety net in the communities they serve. According TO the American Dental Education Association, the dental safety net includes practitioners, payment programs and facilities that provide clinical, nonclinical and support services. Involved are Medicaid, CHIP, federally qualified health centers (FQHCs), school-based health centers and academic dental institutions, among other entities. If not for dental safety net providers, millions more Americans would be without any access to dental care.
As with other large-scale human needs like housing, where government and markets fall short, oral health is challenging terrain for philanthropy. Private funders don’t have the resources to make much of a dent in a problem this big through funding direct services. Many foundations steer clear of the area altogether, including health funders who believe they can have more impact elsewhere. The nation’s biggest health foundation—Robert Wood Johnson—engages in only limited funding related to oral health.
The W.K. Kellogg Foundation is among the most notable national funders in this space, as we’ve reported before, with a big focus on expanding the oral health workforce in underserved areas. Another bright spot is the growing work of regional health conversion foundations on dental care. For example, the Colorado Health Foundation has teamed up with the Caring for Colorado Foundation to back SMILES, a five-year, $4.7 million effort that brings dental services to low-income Coloradans. A big Texas health conversion foundation, St. David’s, supports the largest mobile dental charity program in the nation, with a fleet of nine mobile dental clinics that operate across Central Texas.
While St. David’s effort is focused on direct services, the foundations that operate in the oral health space often look for leverage points where philanthropy can make a larger impact. Finding creative approaches to improving access is a paramount priority. Much like the Delta Dental Community Care Foundation’s latest awards, many funders are focusing on delivery systems support and workforce development, which includes specialty training for populations with unique care needs, and developing, expanding and changing the traditional dental provider delivery system to include mid-level providers. Funders have also backed policy advocacy to improve dental healthcare coverage as part of Medicaid and Medicare. Currently, only a small minority of state Medicaid programs offer comprehensive adult dental benefits.
Meanwhile, charities with a singular focus on oral healthcare are doing some heavy lifting to expand access.
Take, for example, the nation’s largest private oral healthcare funder, the DentaQuest Foundation. In 2011, the foundation launched Oral Health 2020, which it describes as a multiyear effort to strengthen and unify the network of dental healthcare players, build upon current foundation initiative strategies, and expand its impact. Since that time, DentaQuest Foundation investments have funded a large, interconnected network of national, state and community-based change agents dedicated to oral health for all. Today, the network is working to “transform the national dialogue and reshaping the landscape of action with regard to oral health.”
Oral health is definitely one area where philanthropy could step up more, especially given its connection to overall health. Bacteria from the mouth and gums can cause infection in other parts of the body, wreaking extra havoc when the immune system has been compromised by disease or medical treatments. According the surgeon general, recent research is pointing to associations between chronic oral infections and heart and lung diseases, stroke, low birth weight, premature births; additionally, associations between periodontal disease and diabetes have long been noted. Oral bacteria is a well-recognized cause of infective endocarditis—infections of the heart and its valves that can lead to damage, heart failure or death.
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