at nursing home patients and homebound individuals will also grow. Medicare's lack of dental benefits (which most reform proposals would not change) and state restrictions on services provided by allied dental personnel will likely become more significant policy issues.

It now seems unlikely that public policymakers will undertake either major or incremental steps to extend coverage for oral health care. Thus, the prospects for improved access to oral health care are uncertain, particularly for those most in need.

Recommendations of Other Groups

Oral Health Status and Services

The most common dental diseases—caries and periodontal disease—are largely preventable through a combination of community, professional, and personal practices. Thus, most proposals to improve oral health status of individuals and populations over the long run focus on preventive rather than curative strategies. However, disparities in treatment across socioeconomic groups make effective access to basic dental care a major objective of some proposals.

As part of the Healthy People 2000 initiative, the federal government published in 1990 a set of comprehensive and specific objectives for improving the health of Americans (USDHHS, 1990). Oral health was one of the 22 defined priority areas for which more than 300 objectives were set. The project defined 16 primary goals for oral health, most of which included subgoals for groups with poorer than average health. (Appendix 3A lists the 16 Oral Health 2000 goals and associated data and research needs.) The 16 goals have been endorsed by most major dental groups including the American Dental Association.

A major initiative on behalf of the Healthy People 2000 objectives is Oral Health 2000, which was launched by the American Fund for Dental Health with funding from NIDR and support from an array of public and private organizations. The three broad goals of this initiative are "to reduce the occurrence and severity of oral diseases in the U.S. population; to prevent the unnecessary loss of teeth, whether resulting from oral diseases, neglect or trauma; [and] to alleviate the physical, cultural, racial, ethnic, social, educational, health care delivery system and environmental barriers that prevent individuals from achieving healthy oral functioning" (American Fund for Dental Health, 1992, p. 1).

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