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Appendix D
Summary of
Advancing Oral Health in America:
A Report of the IOM Committee
on an Oral Health Initiative
I
n February 2010, with support from the Health Resources and Services
Administration (HRSA), the Institute of Medicine (IOM) formed the
Committee on an Oral Health Initiative to assess the current oral health
care system and to advise the Department of Health and Human Services
(HHS) on actions that should be taken for an HHS oral health initiative
(see Box D-1). This study was conducted at the same time that the IOM’s
Committee on Oral Health Access to Services study was under way. While
B OX D-1
The Committee on an Oral Health
I nitiative Statement of Task
The IOM Board on Health Care Services, in collaboration with the
Board on Children, Youth, and Families, will undertake a study to
• ssess the current oral health care system for the entire U.S.
A
population;
• xamine preventive oral care interventions, their use and promotion;
E
• xplore ways of improving health literacy for oral health;
E
• eview elements of a potential HHS oral health initiative, including
R
possible or current regulations, statutes, programs, research, data,
financing, and policy; and
• ecommend strategic actions for HHS agencies and, if relevant and
R
important, other actors, as well as ways to evaluate this initiative.
265
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266 IMPROVING ACCESS TO ORAL HEALTH CARE
the two studies had related statements of task, the two projects had separate
committees, meetings, and report review processes. The two committees
were not made aware of the other’s conclusions or recommendations.
The IOM Committee on an Oral Health Initiative’s report, Advanc-
ing Oral Health in America, released in April 2011, summarizes the state
of oral health today, underscores the important oral-systemic connection,
describes the current role of HHS, and provides lessons learned from previ-
ous related efforts. The committee made seven recommendations in six key
areas, including establishing and evaluating an oral health initiative; focus-
ing on prevention; improving oral health literacy; enhancing the delivery
of oral health care; expanding research; and measuring progress. Finally,
the committee identified three key areas needed to ensure success: strong
leadership, sustained interest, and the involvement of multiple stakeholders.
This appendix provides an overview of the report, Advancing Oral Health
in America. Full text of the report can be found online at http://www.iom.
edu/oralhealthinitiative.
ORGANIZING PRINCIPLES FOR AN HHS
ORAL HEALTH INITIATIVE
The Committee on an Oral Health Initiative developed a set of orga-
nizing principles based on the areas in greatest need of attention as well as
approaches that have the most potential for creating improvements:
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.1
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.
RECOMMENDATIONS
Based on these principles, the Committee on an Oral Health Initiative
recommended several approaches that HHS could take to help improve the
1Nondental health care professionals includes, but is not limited to, nurses, pharmacists,
physician assistants, and physicians.
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267
APPENDIX D
oral health of the nation. The committee referred to this set of recommen-
dations as the New Oral Health Initiative (NOHI), to distinguish it from
and build upon HHS’ existing Oral Health Initiative.
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 planning, 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.
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.
RECOMMENDATION 3: All relevant HHS agencies should undertake
oral health literacy and education efforts aimed at individuals, communi-
ties, 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;
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268 IMPROVING ACCESS TO ORAL HEALTH CARE
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.
RECOMMENDATION 4: HHS should invest in workforce innovations 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.
RECOMMENDATION 5: CMS should explore new delivery and payment
models for Medicare, Medicaid, and CHIP to improve access, quality, and
coverage of oral health care across the life span.
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,
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269
APPENDIX D
standardize, and promote public availability of relevant databases;
and
• Promoting the creation and implementation of new, useful, and
appropriate measures of quality oral health care practices, cost and
efficiency, and oral health outcomes.
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.
The recommendations in Advancing Oral Health in America highlight
the vital role that HHS can play in improving oral health and oral health
care in the United States. The committee concluded that an HHS oral health
initiative could be successful if it had clearly articulated goals, effective
coordination, and adequate funding. The committee stressed that three key
areas were needed to successfully maintain oral health as a priority issue for
HHS: strong leadership, sustained interest, and the involvement of multiple
stakeholders.
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