This paper summarizes and analyzes a 2012 article by E. Friedman examining the dental care access crisis in the United States. It traces the historical separation of dentistry from mainstream medicine back to the mid-19th century and explains how that divide contributed to dentistry operating largely outside public insurance programs such as Medicare and Medicaid. The paper highlights the disproportionate impact on low-income Americans, noting that 150 million people lack private dental coverage. It also reviews proposed solutions, including medical homes that integrate dental services, school-based intervention programs, and national public education campaigns focused on diet and early oral hygiene habits.
There is a severe problem in the United States regarding access to dental care. A large number of children with untreated oral disease die every year because they have no way of obtaining dental treatment, and it is widely believed that timely intervention would have saved their lives in most cases. Poor oral health has a negative effect on birth outcomes and can worsen heart disease, diabetes, and other conditions. Decayed, broken, and missing teeth also affect people's self-esteem, their ability to find employment, and their communication skills. As Friedman (2012) notes, "dental caries and related conditions constitute the most common diseases among American children."
There appears to be a wide gap between oral health and other types of health care, and this division has existed from the very beginning of organized American medicine. The separation originated in the mid-19th century in Maryland, where a group of dentists attempted to establish a department at the Baltimore College of Medicine and were rejected. They consequently founded their own school. Later, organized dentistry actively opposed having its services incorporated into Medicare or Medicaid, battling determinedly against inclusion in those programs — an effort that was, by and large, very successful.
Dentistry has also been excluded from the original State Children's Health Insurance Program (CHIP), which has further widened the gap between oral health and other types of medical care (Friedman, 2012). This historical trajectory set the stage for the access inequities that persist today.
The legacy of dentistry's separation from mainstream medicine has left it, for the most part, as a cash-only operation. This arrangement makes life easier for dentists and, occasionally, for patients who can afford the expense of treatment. However, as Friedman (2012) explains, "it also means that tens of millions of Americans are uninsured for dental care. The website Brighter.com reported in August 2011 that 150 million people have no private dental coverage. The figures are worse for low-income Americans, 59 percent of whom are reported to have no dental insurance of any kind." These statistics underscore a profound public health inequity that disproportionately harms the most vulnerable populations.
"State programs and integrated medical home models"
"School-based campaigns and dietary education strategies"
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