Oregon's Task Force on Access to
Oral Health Services
Margie Tattersfield, MPH, Health Specialist, Region X Head Start Support Center,
Portland, Oregon
As in the case in many other parts of the country, Oregon's Head Start children have limited access to oral health services. Concern for the oral health of vulnerable populations in our State prompted the recent formation of a state-wide task force to address the issues contributing to this problem.
A state-wide oral health needs assessment began this process in 1991, jointly funded by the Oregon Health Division (OHD), Oregon Health Sciences University, Multnomah County Health Department, and the Oregon Dental Foundation. The assessment evaluated oral health among Head Start children, school-age children, and "special population" groups such as nursing home residents, physically and/or mentally disabled adults, minority population groups, and low-in come adults.
The needs assessment concluded that not only is access to restorative care limited in Oregon, but also access to basic preventive services. The report also noted that access to oral health services was especially limited in rural areas and for special needs groups outside of the Portland metro area. Limited financial resources, low reimbursement rates from Medicaid, and lack of dental
insurance coverage for a large percentage of the low-income population contributed to the significant amount of untreated oral disease. To resolve some of these issues, the Oregon Health Plan now covers dental services for children under 6 and pregnant women with an income up to 133% of the Federal poverty level. This is accompanied through a new managed care service delivery system. The OHD recommended that the task force study the issues of access to services and recommend strategies to improve access to oral health services for all Oregonians.The task force mission encompassed areas such as scope of practice, licensure, availability, and distribution of dentists and dental hygienists; education programs; financing; and barriers due to geographic location, institutionalization, cultural differences, languages, and poverty.
Some conclusions reached by the task force were that there were considerable existing barriers for low-income individuals, including Head Start children and families, to receiving oral health care services, and that there is an obvious urban and rural difference: those in rural counties were less likely to have an over abundance of general or specialist dentists. In fact, three small rural counties have no dentists and a fourth has only one dentist to serve a population of over 8,000 people.
The task force recommendations may dramatically increase access to services and significantly improve the oral health of all Oregonians, including Head Start children and families. The recommendations include having the OHD work with public and private entities to advocate for an increase in the number of fluoridated water systems throughout the State, having the legislature explore the feasibility of providing targeted incentives (such as income tax credits, assistance with start-up costs, or expansion of the State loan repayment program) to encourage oral health providers to work with under served populations/areas in the State, and encouraging the Board of Dentistry to expand the definition of "limited access client" to include geographic location, cultural barriers, and poverty, in addition to the currently used criteria of age, infirmity, and handicap.
Oregon's report, "Improving Access to Oral Health Services in Oregon," calls for local and State agencies to work together to improve the oral health of some of the State's most vulnerable populations.