Good oral health is a critical, but often overlooked, component of overall health and well-being.  Oral disease restricts activities in school, work, and home and can significantly diminish the quality of life for many children and adults, especially those who are low-income or uninsured. Dental caries (tooth decay) is the most common chronic childhood disease. There is increasing evidence of associations between oral infections and other health problems, such as preterm or low birth weight babies, heart disease, lung disease, diabetes and stroke. Effects of oral diseases include pain, disability, and difficulty eating and speaking and can lead to missed work and school, emergency room visits, and depression and self-esteem issues.

While oral health status has improved for many Americans, oral diseases still cause pain and disability for many adults and children. Disparities in oral health status still exist among minority racial/ethnic groups, people of low socioeconomic status, and those who are underinsured or uninsured. Beyond these demographic risk factors, special healthcare needs, diabetes, pregnancy, and age are additional risk factors for oral diseases and their health complications.

Dental safety net providers bridge an important healthcare gap for vulnerable groups. They are a critical component of the current and future health care delivery system in the U.S.  Although they are designed to serve the most vulnerable populations, dental safety net programs’ total capacity unfortunately cannot meet the needs of all who need care.  Access barriers include lack of dental specialists willing to accept referrals for FQHC patients, inadequate Medicaid reimbursement rates, insufficient funding, limited numbers and limited language capacity of staff, old and/or limited equipment, high no-show rates, and large numbers of uninsured patients.

The Affordable Care Act presents many opportunities and challenges to improve access to health care, including oral health services. A large number of previously uninsured Americans will become eligible for Medicaid starting in 2014. Many of these previously
uninsured patients will have received oral health services, but many will be new to the system. This will place demands on existing sites to provide services to more patients, some of whom may have untreated dental disease and other health problems that have developed due to their lack of access to affordable dental and medical care. The ACA also will provide substantial new funding to community health centers for construction, capital investments and service expansions.

The following suggestions will help ensure that FQHC dental clinics will remain strong and grow to meet the changing needs of the children, adults and elderly who seek their services:

• Regularly collect utilization, staffing, and financing data in order to measure success, improve programs, identify areas for improvement, and inform program change;

• Identify data-driven critical success factors, such as cost per patient visit, revenue
  per patient visit, efficiency, productivity, patient flow, appointment system, quality of care, and patient satisfaction;

• Consider employing best practice strategies to minimize no-show rates including
  consistently applying strong no-show policies, using scheduling software, designating and training staff that are responsible for scheduling, and
  minimizing double-booking/overbooking;

• Build capacity in specialty dental services by hiring directly and/or contracting
  with private dental specialists; and

• Pursue additional funding to further expand dental services in underserved communities through fixed site locations and mobile, school-based and community-based programs; and

• Be alert and get ready for changes related to health reform and how the ACA will
  impact your state.