Dental safety net: current capacity and potential for expansion.

OBJECTIVES: The authors' objectives were to determine the size and characteristics of the dentally underserved U.S. population, describe the capacity of the safety net system to treat the underserved, explore policy options for expanding the system and discuss the policy implications of these findings. METHODS: The data came from published reports from health care organizations and researchers, as well as from public officials, dental educators and clinic directors. The values presented are estimates from available data. RESULTS: The underserved population consists of 82 million people from low-income families. Only 27.8 percent of this population visits a dentist each year. The primary components of the safety net are dental clinics in community health centers, hospitals, public schools and dental schools. This system has the capacity to care for about 7 to 8 million people annually. The politically feasible options for expanding the system include increasing the number of community clinics and their efficiency, requiring dental school graduates to receive one year of residency training, and requiring senior dental students and residents to work 60 days in community clinics and practices. This could increase the capacity of the system to treat about 10 million people annually. CONCLUSIONS AND CLINICAL IMPLICATIONS: The safety net system has limited capacity but could be improved to care for another 2.5 million people. Even if it is expanded, however, the majority of low-income patients would need to obtain care in private practices to reduce access disparities. The biggest challenge is convincing the American people to provide the funds needed to care for the poor in safety net clinics and private practices.

The role of safety net providers in delivering oral health services for people with special needs.

The U.S. health care system, best suited to acute care for adults, struggles to accommodate vulnerable populations (such as the elderly, disabled, and mentally ill), and struggles even more to find or put in place a system to care for special needs populations. Special needs populations require a protective and preventive system--one that helps families anticipate upcoming needs as patients transition through life cycles, and monitors problems as they arise while coordinating services. Developing such a system, using a life cycle methodology, is a critical health policy frontier.

Oral health for people with special needs: consensus statement on implications and recommendations for the dental profession.

In November 2004, the Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry, with support from the California Dental Association Foundation, hosted a conference to explore the issue of oral health for people with special needs. This conference was held in conjunction with the joint meetings of Pacific's Statewide Task Force on Oral Health for People With Special Needs and Pacific's Statewide Task Force on Oral Health and Aging. These groups of interested stakeholders meet several times a year to discuss the increasing problems faced by people with disabilities, elderly individuals, and other special populations in obtaining access to oral health services and maintaining good oral health. The purpose of this conference was to explore the changing population of people with special needs, analyze the implications for the dental profession and society, and describe systems and strategies that might lead to improved oral health for these populations. This conference also served as a forum for developing oral health recommendations as a part of the California Commission on Aging's Strategic Plan for an Aging Population. Seven nationally recognized speakers presented draft papers on various aspects of this topic. These presentations are published as the additional papers in this and the next issue of the Journal. There was time for audience reaction and discussion with the speakers. The speakers and a designated group of reactors then developed this consensus statement and recommendations for addressing these issues.