COVID-19 has demonstrated the crucial role the federal government plays in Americans’ health. Yet one key area of health care has been neglected for years, across multiple administrations: oral health. While policymakers on both sides of the aisle acknowledge the importance of oral health, federal agencies have not sufficiently prioritized it. This longstanding pattern needs to end with the next administration.
Despite the fact that federal agencies oversee critical dental programs and budgets, there is a concerning lack of oral health expertise within those same agencies — especially at senior levels. In fact, according to our review of agency staffing, just one agency currently has a chief dental officer. President-elect Joe Biden recently announced several key nominees, including Xavier Becerra for secretary of the Health and Human Services Department and Rochelle Walensky for director of the Centers for Disease Control and Prevention, with more to come in the weeks ahead. As the incoming administration’s appointees prepare for their potential roles, it is critical they keep hiring oral health experts top of mind.
Oral health is critical to overall health, and it shouldn’t be an afterthought when it comes to federal agency priorities or high-level staffing decisions. Poor oral health can have dangerous consequences. Oral disease is associated with cardiovascular disease, respiratory disease and adverse pregnancy outcomes. Periodontal, or gum, disease is strongly associated with increased risk of cancer and chronic diseases such as diabetes.
Untreated, often preventable, oral diseases send 2.1 million Americans to the emergency room each year. Moreover, there is a lot of work left to do to ensure all Americans have affordable access to the oral health care they need. Millions of Americans lack dental insurance, and racial inequities have created stark gaps in oral health outcomes for communities of color.
Recent polling from our organization, the Delta Dental Institute, shows Americans overwhelmingly agree that oral health is critical to overall health. In fact, more than two-thirds agree the benefits of a routine dentist appointment during COVID-19 outweigh the potential risks of delaying preventive care. Furthermore, Americans want the federal government to take action to expand oral health access and affordability. Another Delta Dental Institute poll found 87 percent of Americans support legislation at the federal level that expands dental benefits for children, and 89 percent think dental benefits should be included in programs like Medicare and Medicaid — policies that can’t be effectively evaluated, let alone implemented, without oral health experts in positions of authority.
While policymakers across political parties have long acknowledged the importance of oral health, federal agencies have not sufficiently prioritized it. In a review of agency staffing between 2012 and 2020, we found only two federal agencies had a chief dental officer or equivalent at any point: the Centers for Medicare and Medicaid Services and the Office of the Surgeon General. In contrast, eight federal agencies had a chief medical officer or equivalent.
Oral health is underrepresented in other areas of federal agency work as well. Federal agency funding for oral health initiatives is disproportionately low; from 2012 to 2020, the Health Resources and Services Administration dedicated on average less than 5 percent of its health workforce funding to oral health initiatives. Many other agencies don’t report a breakdown of their oral health funding at all.
It’s time federal agencies started taking oral health more seriously and dedicating the resources necessary. Agencies like CMS, HRSA, the CDC and the Department of Veterans Affairs have a substantial impact on Americans’ oral health, overseeing programs like Medicaid and making decisions about how dental offices operate during COVID-19. Yet they have no chief dental officer or equivalent on staff. While oral health is intimately connected to overall health, it is a specialized area that requires expertise. To ensure the effectiveness of executive, legislative or regulatory action related to oral health, we need oral health experts in government. The American Dental Association agrees, recently calling for the appointment of oral health experts to key advisory positions, including a chief dental officer at CMS.
Oral health is too important to Americans’ overall health to take a back seat. We need greater focus on oral health at the federal level, and agencies can start by ensuring oral health experts have a seat at the table. Most crucially, as the incoming administration prepares to take office, it is essential oral health experts are installed in positions of leadership.
Joseph Dill is the Head of Dental Science for the Delta Dental Institute and Vivian Vasallo is the Executive Director of the Delta Dental Institute.
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