Access to oral health care continues to be a challenge in the United States, especially for low-income people.

The Centers for Disease Control and Prevention (CDC) notes on its website (updated July 2013) that “oral health disparities are profound in the United States.” They exist for many racial and ethnic groups as well as for other demographic groups. For example, more than 70 percent of adults ages sixty-five and older have periodontal disease.

There is some good news, though. The CDC reported in November 2012 that “the prevalence of tooth decay in permanent teeth is down for all ages.” In a 2013 article in the online journal Medicare and Medicaid Research Review, Leighton Ku and coauthors found that both “the number and percent of children receiving dental services under Medicaid climbed continuously over the decade” 2000–10.

Under the Affordable Care Act, in the individual and small-group markets, dental coverage for children is an Essential Health Benefit—meaning that it must be available inside and outside of the state Marketplaces, either as part of a health plan or as a stand-alone dental plan. However, kids’ parents are not required to buy it. Unfortunately, the case is different for adults. “Insurers don’t have to offer adult dental coverage,” according to HealthCare.gov.

In a February 2014 report, Expanding the Dental Team: Studies of Two Private Practices, the Pew Charitable Trusts examines how one practice in rural Minnesota and one in Saskatchewan, Canada, employ dental therapists, a type of midlevel provider, to increase access for the underserved. (Many other countries allow providers other than dentists to do “routine preventive and restorative care, such as filling cavities,” Pew notes.) One finding from this small study is that sizeable numbers of underserved people were able to obtain care at the two practices, which “continued generating profits.” More research is needed, though, Pew cautions.

Funders Oral Health Policy Group now has twenty-four dues-paying member foundations from across the United States. Members meet three times a year to hear from outside experts and compare notes, says Tracy Garland, who helps coordinate the group. Its March 2014 meeting focused on “how graduates of the recently developed training programs for dental therapists in Minnesota are being integrated” into dental practices and their impact on access to care, she told Health Affairs. Attendees also discussed social media campaigns aimed at increasing the public’s “engagement with oral health.” The DentaQuest Foundation provides administrative support to the group.

The following is a small sampling of what foundations are funding in oral health.

National Funders

In February 2014 the Center for Health Care Strategies published an updated policy brief on states that had thus far decided to expand Medicaid. Funded by the DentaQuest Foundation and the Robert Wood Johnson Foundation (RWJF), the brief, which stems from a national scan, found that twenty-two of the states expanding Medicaid are offering dental benefits to their newly enrolled (adult) populations. Of those, ten plan to offer “extensive benefits.”

David Krol of the RWJF said in a 2013 interview on its website that “a large part” of its oral health work aims to increase “the diversity and cultural competency of a new generation of dentists.” Krol also mentioned three 2013 RWJF synthesis reports that assess twenty-five programs that use innovative “models to address clinical and community-based barriers to preventive oral health care.”

The W.K. Kellogg Foundation supports “community-led efforts for new oral health workforce models designed to expand access to underserved families” in areas with an insufficient supply of dentists or “where the cost of that care is out of reach for many,” says Kellogg’s website. Children of color have “disproportionately high rates of tooth decay.” Therefore, the funder supports models that draw people from minority communities who are likely to return there to practice. For example, the foundation has published a sixteen-page brochure on dental therapists. In November 2013 Health Affairs’ own Narrative Matters section, also funded by Kellogg, published a first-person account written by Conan Murat, a dental therapist practicing in the rural village of Aniak, Alaska.

In 2013 Kellogg awarded a two-year, $150,000 grant to the US National Oral Health Alliance to improve oral health for underserved children and families by developing a national framework for action. Priorities of the nonprofit alliance, which is also funded by the DentaQuest Foundation, include oral health literacy and medical and dental collaboration. The alliance strives to find “common ground” among diverse viewpoints.

United Health Foundation and UnitedHealthcare together awarded $1.75 million to Temple University’s dental school for Project ENGAGE, which launched in February 2013 and aims to improve oral health in young children enrolled in Medicaid in Philadelphia, Pennsylvania. The university is creating an oral health registry that will use medical claims information for children ages five and under who have had no dental care, as well as histories of any oral health procedures done in emergency departments. Its goal is to identify kids most at risk of developing any dental conditions stemming from tooth decay. In spring 2014 community health workers will begin providing information about oral health care to families of such children and helping them to schedule dental appointments. The project will also make available public health dental hygienists for in-home care. Another component of the initiative will encourage dentists at community health centers to detect decay in kids’ teeth early on and apply fluoride varnishes to teeth. Dentists will also be asked to motivate parents to improve their children’s oral health practices at home. The grantors hope to expand this effort to other parts of the state and country.

State And Local Funders

Improving the oral health of West Virginians is one aim of the Pittsburgh, Pennsylvania–based Claude Worthington Benedum Foundation’s health and human services program. The foundation cofunded and was directly involved in creating and implementing the first oral health plan in the Mountain State. And because of that plan and Benedum’s advocacy, West Virginia hired a dentist to be its first full-time oral health director. Other foundation activities have included cofunding the gathering of oral health “surveillance data on all age groups (from babies to seniors),” program officer Kim Tieman told Health Affairs. Also, Benedum is considering a proposal to fund the West Virginia Association of Free Clinics to develop a model for expanding dental services to uninsured adults at ten clinics. The Highmark Foundation, also in Pittsburgh, has already awarded a grant for this effort.

Oral health is among the Caring for Colorado Foundation’s funding priorities. Areas funded are access to care and prevention of oral disease in children. The funder is also working with partners on determining future workforce needs for the state. In early 2014 it awarded a $75,000 grant to Oral Health Colorado, a statewide coalition advocating for optimal dental health in the state. In the 2014 legislative session, the coalition helped advocate—successfully—for a pediatric dental benefit that is required to be purchased in Colorado’s state-based insurance Marketplace. The Delta Dental of Colorado and DentaQuest Foundations are among the group’s current cofunders.

The grantee also received funding from Caring for Colorado and others in 2013. Because of the collaboration of many advocates, bills adding a dental benefit for all adult Medicaid enrollees and increasing Medicaid reimbursement for providers of dental services were passed during the 2013 Colorado legislative session, noted a grantee press release.

The Delta Dental Foundation awarded $2 million to the University of Michigan’s School of Dentistry for a clinic “where patients with special needs will receive dental and health care services in the same facility from providers representing multiple disciplines,” according to a March 2014 press release. (The foundation is the philanthropy arm of Delta Dental operations in Indiana, Michigan, North Carolina, and Ohio.) The clinic’s target population includes patients with cognitive impairments, those with developmental disabilities, veterans with post-traumatic stress disorder, and vulnerable elderly people. Dental, dental hygiene, and graduate students will learn how to assess and manage these patients’ treatment needs. Carol Anne Murdoch-Kinch, associate dean and clinical professor of dentistry, notes in the release that the Council on Dental Accreditation now requires graduates to be competent in assessing the needs of, and effectively managing the oral health care of, special-needs patients, while collaborating effectively with other types of providers.

The Missouri Foundation for Health’s Oral Health Initiative addresses the lack of access to high-quality, affordable oral health care for the underserved in St. Louis and eighty-four counties in the state. The funder focuses on increasing the number of places where care is available for the underserved and the number of dental providers, as well as expanding insurance coverage for oral health care—specifically for adult Medicaid enrollees. From 2011 to 2013 the foundation awarded funding to help staff and equip the new A.T. Still University’s Missouri School of Dentistry and Oral Health, in Kirksville, which welcomed its initial class in October 2013. The foundation has also made a grant to help the school build a dental clinic in St. Louis, where students will spend their third year providing care to underserved people.

In April 2014 the foundation authorized $1.9 million for its new Community Oral Health Innovation program, which is to launch in June 2014. The program aims “to give communities the opportunity to develop creative strategies to address the oral health needs” in their local areas, says the foundation’s program director, Web Brown. Potential grantees include faith-based groups, Head Start programs, local health departments, and women’s shelters.

Key Personnel Changes