Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 1
Summary
For decades, the U.S. Department of Health and Human Services (HHS)
has shown a fluctuating commitment to making oral health a national
priority. More than 10 years ago, the surgeon general’s landmark report
Oral Health in America described the poor oral health of our nation as a
“silent epidemic.” Today, oral diseases remain prevalent across the country,
especially in vulnerable and underserved populations. Oral health has been
shown to be inextricable from overall health, yet oral health care is still
largely treated as separate and distinct from broader health care in terms
of financing, education, sites of care, and workforce. While the surgeon
general’s report has been credited with raising awareness of the importance
of good oral health, oral health still remains largely ignored in health policy.
STUDY CHARGE AND APPROACH
In 2009, the Health Resources and Services Administration (HRSA)
approached the Institute of Medicine (IOM) to provide recommendations
for a potential oral health initiative (Box S-1).
The committee recognized that many important factors influence the
oral health of Americans, including settings of care, workforce, financing,
quality assessment, access, and education, and focused attention to these
areas on how they relate to possible or current HHS policies and programs.
The committee was also cognizant of the sizable role that other non-HHS
stakeholders play in the oral health care system, including those in the
private sector and at the state and local levels. Consequently, the recom-
mendations contained within this report will not on their own resolve many
1
OCR for page 2
2 ADVANCING ORAL HEALTH IN AMERICA
B OX S-1
IOM Committee on an Oral Health Initiative
Statement of Task
• Assess the current oral health care system for the entire U.S.
population.
• Examine preventive oral care interventions, their use and
promotion.
• Explore ways of improving health literacy for oral health.
• Review elements of a potential HHS oral health initiative, including
possible or current regulations, statutes, programs, research, data,
financing, and policy.
• Recommend strategic actions for HHS agencies and, if relevant and
important, other actors, as well as ways to evaluate this initiative.
of the problems that exist in the oral health care system. Instead, this report
should be viewed as a complementary piece of a larger solution that will
require efforts throughout the oral health community and beyond. This re-
port therefore uses the term oral health in its most comprehensive sense—as
the responsibility of the entire health care system.
Several major developments during the course of this study challenged
the committee. In particular, after the project had already begun, HHS
announced the launch of the Oral Health Initiative 2010 (OHI 2010), a
cross-agency effort to improve coordination within HHS toward improving
the oral health of the nation. HHS considers this current IOM study as part
of the initiative. The committee decided to acknowledge the OHI 2010 but
not to let its current structure limit their recommendations.
ORAL HEALTH TODAY
In recent decades, advances in oral health science broadened under-
standing not just of healthy teeth but of the health of the entire craniofacial-
oral-dental complex and its relation to overall health. Scientifically, we have
moved into a postgenomic era and expanded our understanding of oral
conditions to also include their often complex, multigene, and hereditary
bases. Despite these advances, Oral Health in America identified dental
caries1 as “the single most common chronic childhood disease.” While
1
The term dental caries is used in the singular and refers to the disease commonly known
as tooth decay.
OCR for page 3
3
SUMMARY
there have been notable successes, dental caries remains a common chronic
disease across the life span in the United States and around the world. There
is a measure of tragedy in this situation because dental caries is a highly, if
not entirely, preventable disease.
There are a wide range of both acute and chronic conditions that mani-
fest themselves in or near the oral cavity, including inherited, infectious,
neoplastic, and neuromuscular diseases and disorders. This report focuses
predominately on dental caries and periodontal diseases, which cause sig-
nificant morbidity.
THE ORAL-SYSTEMIC CONNECTION
The surgeon general’s report referred to the mouth as a mirror of health
and disease occurring in the rest of the body in part because a thorough oral
examination can detect signs of numerous general health problems, such as
nutritional deficiencies, systemic diseases, microbial infections, immune dis-
orders, injuries, and some cancers. In addition, there is mounting evidence
that oral health complications not only reflect general health conditions
but also exacerbate them. For example, periodontal disease may be associ-
ated with adverse pregnancy outcomes, respiratory disease, cardiovascular
disease, coronary heart disease, and diabetes.
Popular attention to the connection between oral health and overall
health increased dramatically in 2007 with the death of Deamonte Driver, a
12-year-old Maryland boy who died when bacteria from an untreated tooth
infection spread to his brain. Driver’s death transformed the oral health
discussion as more people—including members of Congress—recognized
the potential seriousness of untreated oral disease. His enduring story has
contributed to the sustained interest in oral health seen in recent years.
THE CURRENT ROLE OF HHS
HHS’ efforts to improve oral health and oral health care have been
wide ranging, but the priority placed on these endeavors, including financial
support, has been inconsistent. Enduring areas of attention include support
for community water fluoridation, research on the etiology of oral diseases,
dental education, oral health financing, workforce demonstrations, oral
health surveillance, and recruitment of oral health care professionals2 to
work in underserved areas. For example, HHS oversees the provision of
oral health care to select populations through the Indian Health Service
2 In this report, the committee uses the term oral health care professional to refer to any
health care professional who provides oral health care. This may include, but not be limited
to, dental hygienists, dentists, nurses, physician assistants, and physicians.
OCR for page 4
4 ADVANCING ORAL HEALTH IN AMERICA
and Federally Qualified Health Centers. The Centers for Medicare and
Medicaid Services (CMS) finances oral health care through Medicaid and
Children’s Health Insurance Program (CHIP) programs. HHS supports the
oral health workforce through school loan repayment programs and dem-
onstration projects in innovative workforce models. HHS also monitors
oral health and oral health care through surveys conducted by the Centers
for Disease Control and Prevention (CDC) and the Agency for Healthcare
Research and Quality (AHRQ), and it advances the scientific evidence base
for oral and craniofacial health through the work of the National Institute
of Dental and Craniofacial Research. HHS also plays a role in the assess-
ment of evidence for preventive services, such as through AHRQ’s conven-
ing of the U.S. Preventive Services Task Force and the CDC’s convening of
the Task Force on Community Preventive Services.
Despite the breadth of these efforts, it is often assumed that HHS has
a fairly minor role in and very little leverage to influence the day-to-day
functioning of the oral health care system in America. Data indicate that
only 9 percent of dental expenditures come from public insurance (com-
pared with 34 percent for physician and clinical services and 34 percent for
prescription drugs). However, data on dental expenditures do not reflect the
financial input of HHS in the broader definition of oral health since this
calculation only reflects the services performed by dentists (as opposed to
care provided by nondental health care professionals). In addition, those
who are covered by public funds are often the most vulnerable populations;
therefore, HHS’ role is extremely important for those who cannot afford
to pay for oral health care. Finally, as described previously, HHS has sig-
nificant financial investments in other aspects of oral health beyond paying
for services. So while the government does not currently have as large a
role in financing oral health care services as for other health care services,
it does, in fact, have a great role to play in the support of the overall oral
health care system.
LEARNING FROM THE PAST
While the surgeon general’s report was highly successful in many re-
spects, it did not lead to a direct and immediate change in the government’s
approach to oral health. This may have been due to broader environmental
factors, including immediate national crises; changes in the economy that
affect state and federal budgets; competing health care priorities; a tendency
to blame individual behaviors alone for poor oral health; a lack of politi-
cal will; or simply the long-standing failure to recognize oral health as an
integral part of overall health. Within HHS, changes in administrations,
workforce turnover, lack of oral health champions, insufficient funding and
staffing, and the overall lack of oral health parity may all have contributed
OCR for page 5
5
SUMMARY
to the disappointing results. Given that HHS’ resources are currently lim-
ited, that the scope of the challenge is substantial, and that solutions will
require the involvement of multiple stakeholders, one of the most important
roles HHS can play is in providing leadership and direction for the country.
RECOMMENDATIONS
In considering a “potential HHS oral health initiative,” the committee
developed a set of organizing principles (see Box S-2) based on areas in
greatest need of attention as well as approaches that have the most poten-
tial for creating improvements. It will be HHS’ responsibility to adapt the
current structure of the OHI 2010 to these principles and the recommenda-
tions that follow.
The committee outlines seven recommendations that as a whole com-
prise what will be referred to as the new Oral Health Initiative (NOHI)
to distinguish it from and build upon the current initiative. The recom-
mendations provide advice for setting intermediate, measurable goals, but
the committee concluded that ultimately HHS should use the goals and
objectives of Healthy People 2020 as the continuing mission of the NOHI.
Healthy People 2020 is an existing and well-accepted set of benchmarks
for the country and was developed by a strong collaboration of multiple
partners. Creating a new set of goals would only contribute to the redun-
dancy and fragmentation that is often criticized regarding government
programming. The relevant goals and objectives are not just in the oral
B OX S-2
Organizing Principles for an HHS Oral Health Initiative
1. Establish high-level accountability.
2. Emphasize disease prevention and oral health promotion.
3. Improve oral health literacy and cultural competence.
4. Reduce oral health disparities.
5. Explore new models for payment and delivery of care.
Enhance the role of nondental health care professionals.a
6.
7 Expand oral health research, and improve data collection.
8. Promote collaboration among private and public stakeholders.
9. Measure progress toward short-term and long-term goals and
objectives.
10. Advance the goals and objectives of Healthy People 2020.
aNondental health care professionals includes, but is not limited to, nurses,
pharmacists, physician assistants, and physicians.
OCR for page 6
6 ADVANCING ORAL HEALTH IN AMERICA
health section; the NOHI should embrace the goals and objectives of the
health communication and health information technology section as well as
oral health-related topics in other sections. Building upon Healthy People
2020 gives the NOHI a foundation for sustainability and the ability to
change goals and objectives depending upon achievements in improving
oral health. More importantly, as better measures of quality in oral health
are developed, more sophisticated goals can be set.
Establishing and Evaluating the Oral Health Initiative
The committee concluded that HHS has the ability and opportunity
to play a vital role in the current oral health enterprise. This initiative can
succeed if it has clearly articulated goals, is coordinated effectively, is ad-
equately funded, and has high-level accountability.
RECOMMENDATION 1: The secretary of HHS should give the
leader(s) of the new Oral Health Initiative (NOHI) the authority and
resources needed to successfully integrate oral health into the plan-
ning, programming, policies, and research that occur across all HHS
programs and agencies.
• Each agency within HHS that has a role in oral health should
provide an annual plan for how it will integrate oral health into
existing programs within the first year.
• Each agency should identify specific opportunities for public-
private partnerships and collaborating with other agencies inside
and outside HHS.
• The leader(s) of the NOHI should coordinate, review, and imple-
ment these plans.
• The leaders(s) of the NOHI should incorporate patient and con-
sumer input into the design and implementation of the NOHI.
The identification of specific leadership for the NOHI is necessary to
establish accountability. Measurable objectives could focus on shorter-
term or intermediate measures of departmental performance such as
implementation of new programs and collaborations or demonstrated
impact on oral health status and access. The leader(s) of the NOHI would
be responsible for oversight of all of these plans, including looking for
overarching areas for collaboration and learning both from within HHS
and from external partners. Finally, the NOHI needs to ensure that patient
and consumer perspectives are recognized and appreciated in future oral
health planning.
OCR for page 7
7
SUMMARY
Focusing on Prevention
Among the most important contributions HHS can make to improve
oral health is to promote the use of regimens and services that have been
shown to promote oral health, prevent oral diseases, and help manage those
diseases. Too often, oral health care focuses more intently on treating dis-
ease once it has become manifest. A focus on prevention may help to reduce
the overall need for treatment, reduce costs, and improve the capacity of
the system to care for those in need.
The committee concluded that (1) preventive services have a strong
evidence base for promoting oral health and preventing disease; and (2)
HHS is a key provider of oral health care, especially for vulnerable and
underserved populations through the safety net.
RECOMMENDATION 2: All relevant HHS agencies should promote
and monitor the use of evidence-based preventive services in oral health
(both clinical and community based) and counseling across the life
span by
• Consulting with the U.S. Preventive Services Task Force and the
Task Force on Community Preventive Services to give priority to
evidentiary reviews of preventive services in oral health;
• Ensuring that HHS-administered health care systems (e.g., Fed-
erally Qualified Health Centers, Indian Health Service) provide
recommended preventive services and counseling to improve oral
health;
• Providing guidance and assistance to state and local health systems
to implement these same approaches; and
• Communicating with other federally administered health care sys-
tems to share best practices.
The committee emphasizes that preventive services should be provided
by all types of health care professionals who are competent to do so, includ-
ing nondental health care professionals. Assistance to state and local health
systems could include both financial assistance and technical assistance.
HHS will also need to evaluate the adequacy of and support needed for
the public health infrastructure to carry out these activities—both at the
federal and the state level.
Improving Oral Health Literacy
The public and health care professionals are largely unaware of the
basic risk factors and preventive approaches for many oral diseases, and
OCR for page 8
8 ADVANCING ORAL HEALTH IN AMERICA
they do not fully appreciate the connection between good oral health and
overall health and well-being. For example, the fact that dental caries is
both infectious and preventable is not well known, and despite decades of
robust evidence about the safety and efficacy of community water fluorida-
tion, segments of the population remain wary of its use.
The committee concluded that the oral health literacy of individuals,
communities, and all types of health care providers remains low. This
includes lack of understanding about (1) how to prevent and manage
oral diseases, (2) the impact of poor oral health, (3) how to navigate the
oral health care system, and (4) the best techniques in patient–provider
communication.
RECOMMENDATION 3: All relevant HHS agencies should undertake
oral health literacy and education efforts aimed at individuals, com-
munities, and health care professionals. These efforts should include,
but not be limited to:
• Community-wide public education on the causes and implications
of oral diseases and the effectiveness of preventive interventions;
o Focus areas should include
■ The infectious nature of dental caries,
■ The effectiveness of fluorides and sealants,
■ The role of diet and nutrition in oral health, and
■ How oral diseases affect other health conditions.
• Community-wide guidance on how to access oral health care; and
o Focus areas should include using and promoting websites such
as the National Oral Health Clearinghouse and www.health
care.gov.
• Professional education on best practices in patient–provider com-
munication skills that result in improved oral health behaviors.
o Focus areas should include how to communicate to an increas-
ingly diverse population about prevention of oral cancers, dental
caries, and periodontal disease.
The committee did not find enough evidence specifically in the oral
health literacy and behavioral change literature to recommend exact strat-
egies for delivering needed messages; the examples within the recommen-
dation have the most evidence supporting the need for outreach and are
therefore worthwhile areas for HHS to focus on. To be effective, literacy
and education efforts should be carried out in accordance with standards
for culturally and linguistically appropriate services.
OCR for page 9
9
SUMMARY
Enhancing the Delivery of Oral Health Care
The adequacy of the oral health workforce, in terms of its size and
capabilities, is difficult to assess. However, it is apparent that the current
system is not meeting the needs of many citizens, particularly the most vul-
nerable populations. The nondental health care workforce has little educa-
tion and training in the basics of oral health care and oral health literacy
(e.g., being able to recognize oral diseases and disorders, teaching patients
about self-care, understanding basic risk factors, applying topical fluorides).
Dental professionals3 and other health care professionals are trained sepa-
rately and often do not learn how to work in collaborative teams, including
the appropriate use of referrals in both directions. In addition, while profes-
sionals from underrepresented minority populations often care for, or are
expected to care for, a larger proportion of underserved populations, efforts
to increase the diversity of the dental professions have not had substantial
impact. These and other challenges have resulted in persistent disparities
in access to care along racial, socioeconomic, and urban and rural lines.
Oral health care is predominantly provided by dentists in the private
practice setting. Efforts to use new sites of care or types of professionals
have been controversial and polarizing. For example, the Indian Health
Service recently gained some experience with using dental therapists to
target populations that for a variety of reasons (e.g., geographic location)
have difficulty accessing oral health care. While the most recent evaluation
of these dental therapists was limited to five sites, early results have been
promising in terms of the quality of care provided, improved access, and
patient satisfaction. Concerns have been expressed about the quality of care
provided in alternative settings or by new types of professionals, but data
on the quality of care and long-term outcomes related to the provision of
care by all types of oral health care professionals are almost wholly lack-
ing. Without further research and evaluation on the delivery of oral health
care by a variety of health care professionals, including a comparison of the
quality of that care as compared to the care of dentists, better workforce
models cannot be developed.
The committee concluded that (1) nondental health care professionals
are well situated to play an increased role in oral health care, but they re-
quire additional education and training; (2) interprofessional, team-based
care has the potential to improve care-coordination, patient outcomes, and
produce cost savings, yet dental and nondental health care professionals
are rarely trained to work in this manner; (3) new dental professionals and
3 The term dental professionals is typically used to include dentists, dental hygienists, dental
assistants, and dental laboratory technicians. It may also include new and emerging profes-
sionals as they become part of the health care workforce.
OCR for page 10
10 ADVANCING ORAL HEALTH IN AMERICA
existing professionals with expanded duties may have a role to play in ex-
panding access to care; and (4) efforts to broaden the diversity of the oral
health care workforce have not produced marked changes.
RECOMMENDATION 4: HHS should invest in workforce innova-
tions to improve oral health that focus on
• Core competency development, education, and training, to allow
for the use of all health care professionals in oral health care;
• Interprofessional, team-based approaches to the prevention and
treatment of oral diseases;
• Best use of new and existing oral health care professionals; and
• Increasing the diversity and improving the cultural competence of
the workforce providing oral health care.
In addition to the training and composition of the oral health work-
force, more needs to be done to improve the delivery and financing of oral
health care. Significantly fewer Americans have dental coverage than health
coverage, which is important because dental coverage is a major predictor
of utilization. Challenges in federal financing include the almost complete
exclusion of oral health care from the Medicare program and the limited
numbers of professionals willing to care for Medicaid populations (often
due to low reimbursement rates and high administrative burden). Many
other Americans may be considered to be underinsured.
Because oral health care is integral to the overall health of individu-
als and the population, ideally it would be part of every health plan (e.g.,
Medicare); however, current political and economic barriers make this
highly unlikely. Not enough research has been done to determine if alterna-
tive payment structures might offer incentives to deliver the most effective
services efficiently, or to determine if coverage of preventive services results
in long-term cost savings. In addition, as more members of the overall
health care workforce become competent and licensed to deliver care, re-
search will be needed for how they will work and be reimbursed.
The committee concluded that (1) distinct segments of the U.S. popu-
lation have challenges with accessing care in typical settings of care; (2)
lack of dental coverage contributes to access problems; (3) newer financing
mechanisms might help contain costs and improve health outcomes; and (4)
new delivery models need to be explored to improve efficiency.
RECOMMENDATION 5: CMS should explore new delivery and pay-
ment models for Medicare, Medicaid, and CHIP to improve access,
quality, and coverage of oral health care across the life span.
OCR for page 11
11
SUMMARY
One option for this endeavor is through the Center for Medicare and
Medicaid Innovation that seeks to identify, support, and evaluate models
of care that improve quality of care while also lowering costs.
Expanding Research
While much is known about the prevention and management of oral
diseases, evidence is lacking for many important aspects of oral health. For
example, not enough is known about the best ways to decrease the signifi-
cant oral health disparities or the best ways to change oral health behaviors.
In addition, very few quality measures exist for oral health care, leading
to little evidence not only about the quality of the services themselves but
also about their ultimate relationship to long-term improvements in oral
health. Quality assessment efforts in oral health lag far behind analagous
efforts in medicine, most notably in the lack of a universally accepted and
used diagnostic coding system for dentistry.
Data sharing and surveillance activities are a central piece of what HHS
can contribute to the U.S. oral health care system. Federal agencies, both
inside and outside HHS, provide oral health services and collect data on
oral health and oral health care; consolidating the data collected by all these
sources would be useful in performing secondary research. However, much
effort would be needed to make all of these data standardized and usable.
The committee concluded that a more robust evidence base in oral
health is needed overall. Efforts are needed most toward (1) generating new
evidence on best practices; (2) improving the usefulness of existing data;
and (3) evaluating the quality of oral health care (including outcomes).
RECOMMENDATION 6: HHS should place a high priority on efforts
to improve open, actionable, and timely information to advance science
and improve oral health through research by
• Leveraging resources for research to promote a more robust evi-
dence base specific to oral health care, including, but not limited
to,
o oral health disparities, and
o best practices in oral health care and oral health behavior
change;
• Working across HHS agencies—in collaboration with other federal
departments (e.g., Department of Defense, Veterans Administra-
tion) involved in the collection of oral health data—to integrate,
standardize, and promote public availability of relevant databases;
and
OCR for page 12
12 ADVANCING ORAL HEALTH IN AMERICA
Promoting the creation and implementation of new, useful, and
•
appropriate measures of quality oral health care practices, cost and
efficiency, and oral health outcomes.
The committee supports the direction of new funding toward research,
but in a time of limited resources, HHS needs to prioritize oral health re-
search when deciding on distribution of existing resources.
Measuring Progress
Finally, the committee concluded that an effective NOHI needs an on-
going process for maintaining accountability and for measuring progress
toward achieving specific goals of improved oral health.
RECOMMENDATION 7: To evaluate the NOHI the leader(s) of the
NOHI should convene an annual public meeting of the agency heads
to report on the progress of the NOHI, including
• Progress of each agency in reaching goals;
• New innovations and data;
• Dissemination of best practices and data into the community; and
• Improvement in health outcomes of populations served by HHS
programs, especially as they relate to Healthy People 2020 goals
and specific objectives. HHS should provide a forum for public
response and comment and make the final proceedings of each
meeting available to the public.
This meeting can be an opportunity to report both on short-term and
intermediate goals (as set by the individual agencies per Recommendation 1)
and progress on Healthy People 2020 goals and objectives (the overall
mission of the NOHI). It is also a means to share best practices and new
knowledge and to get public feedback. This meeting need not preclude ad-
ditional meetings that HHS might hold internally without a public presence.
LOOKING TO THE FUTURE
As this committee looks to the future of HHS’ involvement in oral
health, questions arise regarding long-term viability both of maintaining
oral health as a priority issue and the likelihood of the recommendations
of this report coming to fruition. In this vein, the committee has identified
three key areas that are needed for future success: strong leadership, sus-
tained interest, and the involvement of multiple stakeholders.
OCR for page 13
13
SUMMARY
The Importance of Strong Leadership
Compared to previous HHS efforts to improve oral health, the OHI
2010 involves many more HHS agencies and programs at multiple levels.
The NOHI further calls for each agency to involve individuals at the staff
level, a strategy that veterans of previous initiatives have said can be help-
ful. However, this also presents the challenge of organizing and directing
multiple agencies that are highly autonomous and may not always act in
concert. The NOHI presents an additional challenge in that it calls for the
increased involvement of and collaboration with leaders from the private
sector and other segments of the public sector. The committee believes that
the current leadership at HHS is capable of meeting these challenges.
Sustaining Interest
Regardless of how an initiative is structured, much of its long-term
viability depends on the interests and efforts of the individuals leading the
agencies and HHS, which can change in unpredictable ways over time. For
example, a key factor may be whether it can survive a change in presidential
administrations, particularly one involving a change in parties. Long-term
viability depends on HHS itself making and keeping oral health a prior-
ity issue. While the OHI 2010 reflects yet another attempt to enhance the
prominence of oral health in HHS, several warning signs have arisen that
could contribute to a loss of momentum. For example, in early 2011, the
committee learned of the proposed downgrading of the CDC’s Division
of Oral Health into a branch of the Division of Adult and Community
Health. In addition, despite the announcement of the OHI 2010, the CDC’s
Division of Adolescent and School Health does not list oral health among
the “important topics that affect the health and well-being of children and
adolescents” and the Administration on Aging does not have any specific
initiatives related to the oral health of older adults. Similar to the need for
consistent messages to patients and health care professionals about the
importance of oral health, HHS needs consistent messaging within its own
organization that oral health is a priority across the life span.
Involving Multiple Stakeholders
While HHS should look for ways to be a leader, a range of stakehold-
ers have roles in the success of the NOHI. Collaboration with and learning
from the private sector; other public sector entities at the local, state, and
national levels; and patients themselves is essential toward achieving the
goal of improving the oral health care and, ultimately, the oral health of
the entire U.S. population.
OCR for page 14
14 ADVANCING ORAL HEALTH IN AMERICA
CONCLUSION
In discussions with this committee, HRSA expressed a desire for recom-
mendations that could be acted upon quickly, but also have enough flex-
ibility to allow HHS to choose among several methods of implementation.
The approach and details of the previously outlined recommendations do
just this. Many of the recommendations are not necessarily “new”; as the
title of this report suggests, the challenges and strategies illuminated by
Oral Health in America remain the areas that have the strongest evidence
for actions by HHS to advance oral health in America.
The recommendations provided in this report align with the current
HHS Strategic Plan for Fiscal Years 2010–2015. Some of the specific objec-
tives and strategies of this plan include ensuring access to quality, cultur-
ally competent care for vulnerable populations; strengthening oral health
research; and promoting models of oral health care that use a variety of new
and existing health care professionals. The recommendations of this report
also align with the mission of HHS: “to enhance the health and well-being
of Americans by providing for effective health and human services and by
fostering sound, sustained advances in the sciences underlying medicine,
public health, and social services.”
Bringing disparate sectors together to effect significant change is a
daunting task, but it is well suited to the mission and responsibilities of
HHS. This report focuses on the role HHS can play in improving oral
health and shaping oral health care in America—in particular, on the ways
in which HHS can have the most impact. There are many reasons that
HHS should seize this opportunity. However, most important is the burden
that oral diseases are placing on the health and well-being of the American
people.
