Programs and Policies Targeted to Improve Access to Dental Care for Low Income Adults and Children in the US: An Integrative Literature Review

Abstract

Objective: The authors conducted an integrative literature review of recent studies that explored the impact of interventions implemented in the U.S. that focused on improving access to dental care for low-income and vulnerable populations. Methods: The authors conducted an integrative literature review of studies published between 2012-2018 that addressed six oral health policy spheres. 1) Community-based dental access programs; (2) Medicaid reimbursement and expansion; (3) Student loan support; (4) Oral health services in non-traditional settings and dental residency programs; (5) Programs to improve oral health literacy; and (6) Use of dental therapists. Results: The authors included 39 articles for qualitative synthesis. Numerous public health initiatives and programs exist in the US aimed at increasing access to quality oral health care. Medicaid expansion, increased Medicaid fee-for-service reimbursement rates, and state loan repayment programs have demonstrated some success in improving access among underserved populations. A diversified dental workforce, with community dental health workers and mid-level providers like dental therapists, as well as interprofessional training of nurses and primary-care physicians in oral health have also shown positive impacts in advancing health equity. Further studies are needed to understand how oral health literacy programs can affect access and utilization of dental services. Conclusions: Improvements to the oral health care safety net will require a holistic and multifaceted approach in order to reduce oral health disparities. Policy levers should work, not in isolation, but rather in complementary fashion to one another.