## The Dental Care Crisis: A Focus on the Hispanic Population## The Dental Care Crisis: A Focus on the Hispanic Population ### Causes of the Dental Care Crisis The dental care crisis is a complex issue with multiple contributing factors. A significant shortage of dentists in rural areas, socioeconomic disparities, and the rising cost of oral care have created barriers to accessing essential dental care. The Hispanic population faces additional challenges, including language barriers, cultural beliefs, and a lack of transportation. ### Legislative Efforts to Address the Crisis To address the dental care crisis, Senator Bernie Sanders introduced the “Comprehensive Dental Reform Act of 2024.” This bill aims to expand Medicaid coverage for dental care and increase the autonomy of dental hygienists. ### Role of Dental Hygienists Dental hygienists play a critical role in providing affordable and accessible dental care. By advocating for increased autonomy and scope of practice, dental hygienists can reach underserved populations, such as the Hispanic community. Direct Medicaid reimbursement for dental hygienists would also increase the availability of dental services. ### Barriers to Optimal Dental Care The current dental healthcare system presents significant barriers to optimal dental care. The limited number of Medicaid providers restricts access to care for low-income individuals. Additionally, the requirement for specific dental supervision over dental hygienists hinders their ability to practice independently. ### Recommendations for Improving Dental Care To improve dental care, key stakeholders must collaborate to remove these barriers. This includes expanding the legal scope of practice for dental hygienists, eliminating the requirement for dental supervision, and embracing new technologies. By empowering dental hygienists, we can improve access to care, reduce disparities, and promote oral health equity.
What is causing these problems?
A significant shortage of dentists in rural areas poses a major challenge to effective patient care. This scarcity is exacerbated by demographic and socioeconomic factors that shape the health experiences of these individuals, often leading to suboptimal health outcomes.
For oral emergencies, many patients are forced to seek care in hospitals, and this does not address the root cause of the problem. As the cost of oral care continues to rise, more people are experiencing barriers to accessing essential care. According to a 2021 report from the National Institutes of Health (NIH), dental costs have surpassed prescriptions as the leading financial barrier.4
This issue is particularly pronounced in the Hispanic population. Navigating the healthcare system, let alone the dental care system, poses a significant challenge for this community. First-generation families face numerous obstacles, including language barriers. Many parents in these families do not have access to transportation, which raises the question of how they are expected to travel for these services.
The CDC states, “To achieve health equity, we must change the systems and policies that have led to the generational inequities that lead to racial and ethnic health disparities.”5 This statement underscores the urgent need for system and policy changes to address inequities and promote health equity.
What is being done for the Spanish-speaking population?
On May 17, 2024, Senator Bernie Sanders held a committee hearing titled, “Investigating America’s Dental Care Crisis: How Can We Make Dental Care More Affordable and Accessible?” During his speech, Senator Sanders highlighted the plight of tens of millions of Americans who cannot afford or access necessary dental care. In response to this crisis, he introduced the “Comprehensive Dental Reform Act of 2024.”6 While this is a step in the right direction, the solution goes beyond expanding Medicaid.
Dental hygienists need more autonomy, which will require updates and expansions to state practice laws. Additionally, more states need to join the Dentists and Dental Hygienist Compact, which allows for portability of dental hygienist licenses, allowing hygienists in rural areas to practice in multiple states without facing significant barriers.7
What dental hygienists can do about this problem
According to the Occupational Outlook Handbook, 93% of dental hygienists work in dental practices.8 This statistic begs the question: How can we, as dental health professionals, reach and improve the oral and general health of the population from a private practice? Under “29-1000, Healthcare Practitioners and Technical Occupations,” dental hygienists are classified as “healthcare diagnosing or treating practitioners,” placing them in the same group as dentists.8.9 We are not just employees; we are suppliers. There is a huge conflict of interest right now because of the supervision of one profession over another.10 We must advocate that we be regulated by members of our own profession.
The biggest problem with Medicaid is the limited number of providers.11 We must advocate for changes such as direct Medicaid reimbursement and utilize dental hygienists who are currently underutilized due to existing licensing restrictions and government policies.11,12 We must advocate for state laws that increase autonomy and enable dental hygienists to work among this underprivileged population.
Key stakeholders and dental health professionals must work together to remove the barriers that prevent dental hygienists from practising as they wish, and to reduce the barriers to delivering essential dental care.11,12 To realize this vision, we must expand the legal scope of practice for dental hygienists, eliminate the requirement for specific dental supervision, and embrace current technology.10
This transition would allow us to move beyond traditional brick-and-mortar settings and engage in interprofessional collaboration across settings with a broad range of healthcare professionals. This would increase population understanding of the critical link between oral and systemic health and lead to improved health outcomes.
References
- Mertz E, Wides C, Calvo J, Gates P. The Hispanic and Latino dental workforce in the United States. J Publ Health Dent. 2017;77(2):163-173. doi.10.1111/jphd.12194
- Explore oral health data by location. Centers for Disease Control and Prevention. 2024. https://www.cdc.gov/oralhealthdata/
- Ricks T. Oral health of Hispanics in America. J Hispanic Dent Assn. 2021;1(1):13-17.
- Oral Health in America: Progress and Challenges. National Institute of Health. 2021. https://www.nidcr.nih.gov/research/oralhealthinamerica
- What is Health Equity? Social Determinants of Health. Centers for Disease Control and Prevention. 2024. https://www.cdc.gov/healthequity/whatis/
- Sanders B. Comprehensive Dental Reform Act of 2024. Sanders Senate. Accessed June 22, 2024. https://www.sanders.senate.gov/wp-content/uploads/Comprehensive-Dental-Reform-Act-of-2024.pdf
- Dentist and Dental Hygienists Compact. Ministry of Defence. 2024. https://ddhcompact.org/wp-content/uploads/sites/31/2024/06/Dentist_Dental-Hygienist-Compact-Model-Language_Final.pdf
- 2018 Standard Occupational Classification System. Bureau of Labor Statistics. 2010. Accessed June 22, 2024. https://www.bls.gov/soc/2010/2010_major_groups.htm
- Standard Occupational Classification. American Dental Hygienists Association. 2018. https://www.adha.org/hypac/self-regulation/standard-occupational-classification/
- Addressing the Oral Health Needs of Hispanics in the US: An Exploration of Oral Health Status, Dental Needs, Dental Service Utilization, and Workforce. Hispanic Dental Association. CareQuest Institute for Oral Health. 2023. https://www.carequest.org/system/files/HDA-CareQuest-Institute_Addressing-Oral-Health-Needs-of-Hispanics-in-US_4.26.23.pdf
- Oral Health Gap Assessment. Virginia Health Catalyst. 2023. https://vahealthcatalyst.org/wp-content/uploads/2023/12/FINAL_Oral-Health-Gap-Assessment-Report-Digital-Version.pdf
- Otto M. Teeth: The Story of Beauty, Inequality, and the Fight for Oral Health in America. The New Press. 2017.
