lations, groups who commonly lack access to oral health care. Vulnerable and underserved populations include but are not limited to

Racial and ethnic minorities, including immigrants and non-English speakers;

Children, especially those who are very young;

Pregnant women;

People with special needs;

Older adults;

Individuals living in rural and urban underserved areas;

Uninsured and publicly insured individuals;

Homeless individuals; and

Populations of lower socioeconomic status.

Because good overall health requires good oral health, the unmet oral health needs of millions of American cannot be neglected.

While the majority of the U.S. population is able to routinely obtain oral health care in traditional dental practice settings, a disproportionate number of vulnerable and underserved individuals cannot. An array of providers and population-based public health programs—collectively referred to as the safety net—has emerged through uncoordinated attempts to reach these individuals. However, access to oral health care continues to elude too many Americans. Fortunately, additional opportunities exist—in both the public and private sectors—to ameliorate the situation.


In the fall of 2009, with support from the Health Resources and Services Administration (HRSA) and the California HealthCare Foundation, the National Research Council and the Institute of Medicine (IOM) formed the Committee on Oral Health Access to Services to assess the current oral health care system with a focus on the delivery of oral health care to vulnerable and underserved populations (see Box S-1).

The committee’s vision is both aspirational and achievable (see Box S-2), but numerous coordinated and sustained actions will be needed to realize this vision.


To guide its deliberations, the committee began with two well-established and evidence-based principles:

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