Section 1: Filling Gaps in HIV Dental Care

Introduction

Many Americans lack good dental care. Significant proportions of the population live with untreated cavities and do not get regular dental care. [ 1, 2 ] Over 100 million Americans lack dental insurance. [ 3 ] Access is even less available for people living with HIV disease (PLWH), a diverse group of individuals who are disproportionately low income and often lack health insurance of any kind.

A number of Federal initiatives have been established to address shortages in dental care for low-income and underserved populations, including PLWH. These efforts are largely being carried out under the auspices of the U.S. Department of Health and Human Services (HHS) and its agency devoted to access to primary health care, the Health Resources and Services Administration (HRSA). This report presents one such effort, the Community Based Dental Partnership Program under HRSA’s Ryan White HIV/AIDS Program, in a review of its accomplishments and strategies for delivering HIV dental care to clients who are hardest to reach.

The Dental Partnership was established in 2002 in response to well-documented gaps in oral health care for PLWH. Among the earliest such reports was the HIV Cost and Services Utilization Study, the Nation’s largest examination of health utilization patterns of PLWH. HCSUS found that 58 percent of PLWH did not receive regular dental care. [ 4 ] More recent studies covering specific areas of the country have arrived at similar findings. Among these is a report examining dental care among PLWH in North Carolina, where 64 percent were found to have unmet dental needs. [ 5 ]

Gaps in dental care have also been extensively identified in assessment studies conducted by Federally-funded Ryan White HIV/AIDS Programs, which exist to fill gaps in HIV/AIDS care to underserved populations via community and State programs throughout the nation. [ 6 ] These assessments consistently rate dental care as a top unmet need among many other health care issues faced by PLWH. Ryan White services are crucial in this respect as private dental coverage is largely not an option for many PLWH because coverage is often expensive. The public safety net, in turn, has many gaps as public insurers like Medicaid typically have limited coverage for adult oral health services.

PLWH reportedly face the added barrier of relatively few dentists trained and/or willing to serve people living with HIV, from among the 161,000 dentists in the U.S. [ 7 ] The competition that people typically face in getting a dental appointment from this limited pool of dentists is probably even greater for PLWH. Such gaps are all the more troubling because dental care is a crucial part of HIV care. (See below, Oral Care: An Essential HIV Service)