As senators debate Medicare expansion on Capitol Hill, we find ourselves reflecting on the importance of oral health for all citizens right here in Worcester.

Poor oral health exacerbates chronic health conditions including heart disease and diabetes. Nearly 96 percent of adults 65 or older are affected by cavities and 1 in 5 have untreated tooth decay; these numbers are worse for people of color and those who are poor.

It is clear that including dental coverage in Medicare plans will improve the quality of life of our aging population. However, there is much more that has to be done to help the oral health of all people across all ages locally.

We have spent two weeks examining the oral health issues, resources, and barriers within our city. The following is a summary of what we feel would help to improve the oral health of our citizenry.

Primary prevention

If we had access to local resources to tackle this problem our first goal would be to create an Oral Health Task Force as part of Worcester’s Department of Public Health, gathering community dentists and hygienists, physicians and nurses, students, politicians, and other citizens with a shared goal of improving preventative measures and access to oral health resources, especially for our most vulnerable neighbors.

Educating the public is a crucial first step. Focusing on young children and their parents through the public school system is an optimal strategy, as consistent oral hygiene from a young age improves oral health long term.

School assemblies, classroom health lessons and school nurses can facilitate learning about the importance of oral health and self-care to establish a foundation for oral hygiene that children can carry with them through adulthood.

We also encourage local primary care providers to regularly ask their patients about oral health, get trained and apply fluoride varnish to kids 5 and under, and use well-visits as opportunities to educate patients and families on the importance of oral hygiene and proper nutrition.

Low-income individuals are at a higher risk of cavities for many reasons including a lack of access to nutritional foods. We all know that sugar is bad for our teeth, but only some of us can afford to avoid processed food and sugary drinks. Therefore, healthcare providers and community advocates should help patients access healthy food.

One way our proposed task force could address this is by implementing more community partnerships with local Community Supported Agriculture groups to distribute produce to underserved citizens, perhaps through voucher programs in doctors and dentists offices. Though such a program may not fully cover costs of a family’s need for produce, it would help improve access to healthy food to some degree.

The Worcester Family Health Center has seen success implementing such a program, and we encourage more public funding for other dental offices that serve patients with MassHealth to do so to help bridge the gap between nutrition and oral health.

Adding fluoride to tap water has been shown to be a safe and effective way to prevent dental caries, yet fluoridation remains a debated topic in our community. This would not be easy and yet we should come together to discuss the science and to address possible concerns within the community.

Community water fluoridation is a health equity issue — now more than ever is our chance to improve overall equity in Worcester by thinking about how to improve access for all to basic prevention measures like fluoride.

Improving access

Unfortunately, access to dental services is impeded for many people by the relative lack of dental providers who accept MassHealth.

One method of tackling this issue is to incentivize dentists to accept MassHealth. This could be accomplished by offering tax incentives or loan repayments to those who accept a certain proportion of MassHealth patients within their practices.

To improve patient rates of making it to appointments, we need a more robust case management system to help with transportation and reminders.

Public health dental hygienists can also play a key role in bringing dental care to underserved areas and populations constrained by a lack of resources by offering care in community centers, churches and other public places.

Currently, only 40 public health hygienists practice in Massachusetts; increasing this number would improve access to dental care. These practitioners would be ideal recipients for an incentive or startup grant program aimed at increasing their numbers.

By reducing the capital burden required for these clinicians to start their practices, we could make a key investment in the city that will benefit both our economy and overall public health.

We need creativity and innovation to improve our collective oral health in Worcester and challenge the city to consider our suggestions.

Isabella DiMare, Tan Chingfen, May Dong, Allison Holt, Lauren McKenna, Suryateja Rao and Ekaterina Skaritanov are UMass Chan Medical School students.