May 4, 2005
Pittsburgh, Pa. 

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I’m delighted to be with all of you today.  I’m especially happy to be discussing the importance of oral health because I’ve worked hard during my four years as Administrator to make oral health a “front-burner” issue at HRSA.

HRSA has long been a source of federal financial support for oral health professionals, with ongoing grantee programs for Residencies in General and Pediatric Dentistry and Residency Training in Dental Public Health that help train several hundred dentists annually.
 
HRSA also administers a Geriatric Training Program for Physicians, Dentists, and Mental Health Professionals.  How visionary will that seem when the baby-boomer crush hits in earnest?  Additionally, dentists are eligible for loan and scholarship programs HRSA offers to health care professionals.

During my term at HRSA, I have acted to boost the impact of these fine programs by focusing on increasing access to oral health care in all of our program areas.  We all know that the United States can do a lot better in providing oral health care to those who need it.  This is one of my passions.  And I like to think that I’ve been successful in spreading this passion to others throughout the agency.

One big thing we’ve done -- with Steve Smith’s leadership and the help of oral health professionals inside and outside the agency -- is to put down on paper HRSA’s oral health mission, goals, and objectives -- and strategies to reach those objectives.   HRSA’s oral health mission is:
 
“To improve the nation’s health by assuring access to comprehensive, culturally competent, quality oral health care for all, as an integral component of comprehensive health care.”
 
We believe that oral health – along with mental health – is an integral part of comprehensive primary and preventive care.  We need to see patients in their entirety:  the brain and the mouth are inseparable from the body.  They are component parts of a single entity, and we must treat them that way.  We must treat the whole person.
 
And we have worked with Surgeon General Rich Carmona and other HHS agencies to answer his call to action on oral health – especially in the area of building partnerships to increase access to oral health care for the people we serve.
 
HRSA’s drive to improve oral health services, of course, is occurring at the same time we push to implement President Bush’s five-year initiative to expand the health center network and the number of National Health Service Corps clinicians in the field.
 
During the three years of the President’s initiative, from FY 2002 through FY 2004, HRSA has awarded 200 oral health expansion grants, worth more than $30 million.
 
Expanding access to oral health care is one big way HRSA is answering the Surgeon General’s call to action.  And by expanding oral services available at health centers we also are reducing historic disparities in accessing dental services, since about two-thirds of health center patients are members of minority populations.

At our health centers, dental encounters are up 38 percent since 2001 and in 2004 -- for the first time -- exceeded 5 million!

Additionally, HRSA is making steady progress toward meeting the Healthy People 2010 goal of providing onsite dental care at 75 percent of all health centers.

We will continue to try to keep that figure rising in FY 2005.  Seven grants totaling $1.75 million are expected to be awarded to provide new comprehensive primary oral health services.  And another 70 grants totaling $10 million are expected to be awarded to grantees to expand service delivery capacity at existing oral health service sites.
 
One of HHS’ national health care goals is to eliminate health disparities among minority populations, disparities that lead to higher rates of illness and death from heart disease, cancer, stroke and diabetes -- the four top killers -- and other illnesses. To eliminate health disparities, health care organizations must change the way they deliver care. The HRSA’s Health Disparities Collaboratives call for such a change -- a transformation in the delivery of care.
 
I am particularly proud of these efforts currently being implemented in most of the nation’s health centers.   This work has far-reaching impact and, frankly, I like to brag about them.  Collaboratives have become a national success story.
  
Collaboratives bring together multidisciplinary teams of health center professionals to study what works in treatment and follow-up, to test those best practices on site -- making adjustments as needed -- and to keep and expand what works best.  They emphasize greater teamwork among health professionals, better procedures to track treatments and reach out to local residents, and a larger role by patients themselves in monitoring their own illnesses.
 
I’m especially gratified that we made sure to include in these collaboratives training for physicians and nurses on how to screen patients for oral health problems and refer them to dentists when needed.
 
In the diabetes collaborative, periodontal screening and referral to treatment is an important element of patient care.  In the prevention collaborative, young people are screened for access to fluoride treatment and referred to dentists if fluoride access is insufficient in their communities.  Clinicians also screen children to determine their need for age-appropriate dental sealants.
 
Currently we have an oral health pilot collaborative in the planning stage.  It would aim to improve outcomes for:
 

• perinatal oral health;
• early childhood tooth decay;
• and for the prevention and treatment of periodontal disease as it relates to other chronic illnesses such as diabetes and cardiovascular disease.

We know that health centers have recruitment problems with dental professionals.  To help resolve this problem, we developed a plan we call the “Grow Your Own Health Center Dentist” initiative.  This initiative will support the training of dental students from nearby dental schools through education and training programs linked to health centers. 
 
By training dental health professionals at health centers and increasing their exposure to primary care environments, we hope to encourage them to continue to practice at a health center.  We want to build more and more links between health centers and dental schools, because we know how beneficial and productive those links are wherever they exist.
 
The School of Dentistry at the University of California at San Francisco, for example, works with 22 health centers and clinics across California to give about 80 fourth-year students the chance to gain clinical experience in a community-based setting.
 
In New York City, the Lutheran Hospital Dental Residency Program sends residents to the Sunset Park Health Center in Brooklyn to treat patients there.
 
In Portland, Oregon, a health center grantee teams up in a similar manner with the University of Washington School of Dentistry.
 
Likewise in the Boston area, where the Schools of Dental Medicine from Harvard and Boston University partner with Harbor Health Services in Dorchester to provide training and services. 
 
The Boston University and University of California at San Francisco efforts were sparked by private funds from the Robert Wood Johnson Foundation.  They receive grants of up to $1.5 million to reduce gaps in care through community-based education programs that expand patient care to underserved patients.
 
Relationships like these between dental schools and health centers just scratch the surface of HRSA’s efforts to enhance the skills of the oral health workforce and build partnerships to improve access to oral health care.
 
In the western U.S., a HRSA rural health outreach grant funded an effort administered by researchers from the University of Colorado and UCLA schools of dentistry to reduce early dental decay among Native American children.  My staff tells me that Native American children on rural reservations have the highest rate and worst severity of early childhood caries in the world!  That’s a disgrace all of us must face – and try to remedy.
 
What did the researchers do with the grant?  They worked with tribal health departments to hire and train community members to provide tooth decay prevention services.  Participants learned how to do oral health screenings and refer patients to Indian Health Service dental clinics.
 
The result after 18 months?  A 50 percent reduction in tooth decay and a 50 percent reduction in untreated decay among children who were under 3 years of age when first treated.  The number of decay-free children doubled and the number of children with diseased, missing and filled teeth fell.  That’s a great return on investment and a marvelous example of partnership among HRSA, dental schools, tribal governments and the Indian Health Service.
 
Our dental reimbursement and community-based dental partnership programs, located in HRSA’s HIV/AIDS Bureau, are another prominent example of the value of collaboration.  These programs go a long way in helping HIV-positive individuals access the latest practice in dental care geared to them and their specific medical condition. 
 
Treatment supported by those grants includes the full range of oral health services: diagnostic and preventive care, oral health education, oral medicine and surgery. 
 
In 2004, 63 dental education programs received reimbursement grants worth almost $10 million for uncompensated care they provided to HIV-positive patients. The 7,500 dental students and post-doctoral dental residents these grants support provided more than 230,000 hours of direct clinical oral health care to more than 30,000 HIV-positive patients.
 
And our 12 community-based dental partnership grantees used their $3 million in 2004 grants to treat another 2,700 HIV-positive patients.  Those grants help dental schools link up with community-based organizations to provide oral health care to HIV-positive patients.
 
Besides providing vital oral health care, the reimbursement and the dental partnership grants help educate a substantial portion of the next generation of oral health professionals on the latest practice in HIV dental care.  By doing so, they raise the quality of dental care for HIV-positive patients everywhere. 

Because impaired oral health is often the earliest clinical sign of HIV infection, dentists often are the first health care providers to identify patients who are HIV-positive.  And that’s another benefit of these grants: they can help other public health professionals track the spread of HIV in a community.
 
The reimbursement and partnership programs augment dental services provided by all other CARE Act grantees, who reported providing oral health services to over 78,000 HIV-positive clients during more than 233,000 visits in 2003.
 
Other examples of public-private partnerships to promote better oral health are found in our Maternal and Child Health programs.
 
HRSA has provided support for state dental health agencies to hold state oral health summits, where interested private and public groups come together to assess needs and opportunities.  And with the $5 million in SPRANS funding [from the MCH Title V block grant] set aside for oral health projects in FY 2005, state oral health programs are increasing access to dental care for the most vulnerable low-income children.
 
These SPRANS funds will help states continue efforts [through the State Oral Health Collaborative Systems program] started during FY 2003 to integrate oral health care into existing health service networks for mothers and children.  States also use these funds to increase access to oral health services for children through Medicaid and the State Children's Health Insurance Program.

And HRSA and another HHS agency, the Administration for Children and Families, are working more closely together to make more information available on oral health care for children.  As a result of this collaboration, the HRSA-funded National Maternal and Child Oral Health Resource Center now offers an expanded collection of Head Start oral health materials to the public.
 
Another great source of information on oral health – geared to a rural audience -- is available from the HRSA-supported Rural Assistance Center.  If you go online at their site (www.raconline.org), you’ll find an information guide on dental health that archives oral health policy papers, answers Frequently Asked Questions, and provides links to topical research, dental websites, oral health events, and funding sources.
 
Let me wrap up by thanking all of you for offering me this opportunity to speak today.  I can’t think of any topic dearer to me, personally, than this effort to improve access to oral health care to more and more Americans.
 
I hope that you will leave here with the conviction that HRSA has made an irreversible commitment to improve oral health services in the entire range of primary care programs that we administer.  We have.
 
And I hope, too, that you will leave with a renewed desire to seek out and work with partners who can contribute vital pieces and resources to our efforts. 
 
As I mentioned during the course of these remarks, such partnerships can include universities and dental schools, health centers and other community-based organizations, Ryan White and rural health grantees, tribal and state governments, other federal departments and agencies, and private organizations like the Robert Wood Johnson Foundation and the American Academy of Pediatrics.
 
I invite you to join me and my colleagues at HRSA as we expand access to quality oral health care for all Americans.  Our work together can be as inclusive and innovative as our imaginations will allow.
 
Thank you.