June 10, 2004
Milwaukee, Wis.

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Good afternoon and thank you for inviting me to be with you today.
 
I’m especially happy to be discussing the importance of oral health because we’ve worked hard during my three years as HRSA Administrator to make oral health a “front-burner” issue at HRSA.

We know that, as a nation, we can do a lot better in the area of providing oral health care to all who need it, and during my term at HRSA we have taken concrete steps to increase the focus on access to oral health care.  This is one of my passions.   And I like to think that I’ve been successful in spreading my passion to many 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.  This is our oral health mission:
 
“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, because that is how they come to us.  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 these are our oral health goals within that mission:
 

• First, to improve the health infrastructure and systems of care for all, especially underserved, vulnerable and special needs populations, to assure access to comprehensive, quality oral health services.
• Second, to improve oral health status and outcomes to eliminate health disparities, and ways to measure it.
• Third, to improve the quality of oral health services (preventive and curative) for all, especially underserved, vulnerable and special needs populations.
• And fourth, to promote oral health through building public-private partnerships, including strengthening the dental public health infrastructure.
  
  

Each of these goals comes with objectives that set targets for improvement and strategies to implement the objectives.
 
The dilemma of providing sufficient dental care to seniors is well-known to all of you.  Medicare doesn’t cover routine dental services.  Older Americans who have no private dental insurance have to pay out of their own pockets.  Unfortunately, many spend their limited income on other necessities and let their teeth go until they need to be pulled.  Even those with funds sometimes forget the lessons of a lifetime and skip regular check-ups.
 
HRSA-supported community health centers are available to offer dental care to older Americans, but even the expansion we’re implementing won’t solve the national problem of insufficient access to oral health care.
 
It would be bad enough if poor dental care limited a person to just having problems with his teeth.  But increasing evidence points to links between poor oral health and cardiovascular disease and other chronic illnesses.
 
The importance of geriatric oral health care in the context of the overall health of seniors has traditionally been overlooked.  Health professionals receive too little training on how to work collaboratively with dental professionals to improve the quality of life for older Americans.  And on the other hand, even dentists seldom have any formal training in gerontology.  Often they find themselves trying to keep up or catch up with evolving standards of care for older patients.
 
That’s why this conference is so important and such a breath of fresh air.  Let me say thanks to the Wisconsin Geriatric Education Center -- which I can proudly say is funded by HRSA -- and to its director, Dr. Anthony Iacopino, for all that he and his staff have done to make this two-day conference a reality.
 
The conference alone is very impressive, and it is even more impressive that it is set in a broader context of continuing education efforts.  First, you have assembled a talented group of experts to discuss the latest information on dental disease in the elderly, clinical dental approaches to older patients, and ways that dentists and other health professionals can work together to deliver comprehensive, interdisciplinary care.
 
But what really wows me is the web site component of the program – with its wealth of information, its interactive nature, and its 24/7 accessibility.  It is a very creative use of the latest technology to reach dentists and other health professionals and I congratulate the Geriatric Education Center and their partners at the Marquette University School of Dentistry for putting it together.
 
Dr. Iacopino tells me that the Geriatric Center and the faculty at the School of Dentistry also are partners in integrating geriatric dentistry curriculum into the complete four-year dental educational program.
 
And I understand that they have produced the first "virtual aging patient" on CD-ROM for use by both medical and dental students.  The CD-ROM takes the virtual patient through 40 years of aging, illustrating the various medical and dental problems that develop over time.   Instructors use the patient to emphasize the ways dental and medical professionals can work together to provide the range of care an elderly patient needs.
 
Let me now take a few minutes to tell you about where we are in the health center expansion and how oral health care fits into our efforts there. 
 
Health centers today are serving more patients at more sites than ever before!  We’ve successfully integrated more services -- like oral health care – into hundreds of centers where patients can now get everything they need in one setting. We’ve encouraged good business practices and embraced new technologies that make it possible for all of us to work better and smarter as we expand to serve more people.
 
In the first two years of President Bush’s health center growth initiative, HRSA has funded more than 550 new or expanded health center access points, bringing the total to almost 3,700 health center sites nationwide.
 
In 2003, health centers treated about half a million more dental patients than in 2001, bringing the total to nearly 1.9 million patients.  Dental encounters increased over that two-year span by close to 1.2 million, to nearly 4.4 million patient visits in 2003.
 
One thing we’re particularly proud of is the fact that in 2003, 82 percent of health centers offered dental care either on site or through contracts.   This exceeds our Healthy People 2010 goal six years early – 7 percentage points above the target.
 
President Bush thinks we’re making great strides on the expansion, and in February asked Congress for an additional $219 million for health centers in fiscal year 2005.  If approved, it will set the appropriation at more than $1.8 billion, an increase of 57 percent over the last four years.
 
To make sure access to oral health services at health centers improves even as we expand the system, HRSA has implemented three strategies:

• The first is that all new access points must provide patients ready access to primary, preventive and supplemental health services, and that includes primary oral health care.  When we talk about primary oral health care, the range of services should include preventive care and education, emergency services, basic restorative services and periodontal services – all but the most specialized oral health care.
  
  
• The second is that existing health centers that currently offer some form of dental care must expand it.
  
  
• And the third is this:   we will improve the quality of oral health care programs at health centers.

That’s what HRSA is doing to improve access to dental care at health centers.  But there are other things health centers and states can do, too.  Dr. Steve Geiermann, HRSA’s dental consultant in Region V, told me about one such arrangement along the Wisconsin-Michigan border.
 
Florence County, north of Green Bay, presents one of Wisconsin’s biggest challenges in terms of accessing oral health services.  The town of Florence has one private practice dentist and very few options for area senior citizens who rely primarily on Medicare and state programs for care.  Dr. Geiermann says that lack of access to oral health care has been a continuing frustration for low-income elderly there.
 
But in Crystal Falls, Michigan, just 15 miles across the border, there is a dental clinic, part of the Upper Peninsula Association of Rural Health Services, a HRSA-funded community health center headquartered in Marquette, Michigan. 
 
Now, thanks to the support of legislators on both sides of the state line, the Crystal Falls clinic is accepting and billing eligible Medicaid clients from Florence County under Medicaid’s “close to the border” option.  That takes creativity at both the state and federal levels.
 
Dr. Geiermann tells me this type of interstate cooperation is being used up and down the Michigan-Wisconsin border as a model that can be replicated to extend primary care services to many underserved “border” populations.

We’re also doing a lot to promote better oral health care in HRSA’s other bureaus.  Our Maternal and Child Health Bureau has one great tool, a web site that contains "Best Practices” and other useful information on oral health care.  You can access it at the web site for the National Maternal and Child Oral Health Resource Center at www.mchoralhealth.org/.  The site holds an incredible range of papers and presentation from community-based oral health providers, and it’s not limited to the MCH population.  The site also has all the presentations and abstracts from the 2001, 2002 and 2003 National Primary Oral Health Care conferences, which HRSA proudly sponsors each year. 

Also in MCHB, the Community Integrated Services Systems program promotes the goals of the Children’s Health Insurance Program: to support states in developing community health programs that provide comprehensive systems of care for children.  Often grandparents are keys to helping children achieve good health and well-being.  We can save both ages!
 
We funded the CHIP/CISS program because we realize the importance of comprehensive primary health care, especially for children under 5.  As I said before: comprehensive care must include oral health and mental health services.  The health care we provide through federal dollars should reflect that unity and that essential “connectedness.”

Last fall, HRSA’s HIV/AIDS Bureau awarded almost $10 million to 64 dental schools and dental education programs to help them cover the rising costs of providing oral health services for underserved and uninsured Americans living with HIV/AIDS.
 
Treatment supported by those grants, awarded under the Ryan White CARE Act’s Dental Reimbursement Program, includes the full range of oral health services: diagnostic and preventive care, oral health education, oral medicine and oral surgery.  And by funding access to these services at dental schools and teaching hospitals, the grants also train new generations of dentists and dental hygienists now to provide oral health care for people with HIV.
 
Impaired oral health is often the earliest clinical sign of HIV infection and may indicate the disease’s progression.  As a result, dentists are often the first health care providers to identify patients who are HIV-positive.  So that’s another benefit of these grants: they help public health professionals track the spread of HIV in a community.
 
We also have oral health components in our rural health grants.  Last year our Office of Rural Health Policy awarded 14 grants worth $2 million to coalitions of rural health care organizations to improve access to oral health services.  As many of you probably know very well, many rural residents find it difficult to access oral health care because local dentists are few and even those who are available are often far away.  Many folks end up in rural emergency rooms seeking dental care, where doctors treat them for pain and infection but can’t provide restorative care.  These grants create innovative partnerships among rural institutions to try and resolve those problems.
 
At HRSA’s Bureau of Health Professions, three programs improve the training of dental residents in the practices of General Dentistry, Pediatric Dentistry, and Dental Public Health.  And the Bureau’s National Health Service Corps’ loan repayment program places oral health professionals in communities that most need them.  The President plans to continue his ongoing expansion of the NHSC in line with the health center expansion, so that will put more dentists and oral health professionals in service to the underserved across America.  And dentists are part of our Ready Responders as well.
 
That’s a quick summary of our oral health care programs and initiatives at HRSA.  I thank you for inviting me to this important conference, and I thank you for listening.