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dental coverage through the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Under the Patient Protection and Affordable Care Act, over 5 million more children will have dental coverage by the year 2014. The bad news is that coverage alone, especially Medicaid coverage, in no way guarantees access to a dentist. Many dentists do not accept Medicaid, and those who do often have an unreasonably long wait for services. In fact, a 2011 study published in Pediatrics found that dentists, including those participating in Medicaid, were less likely to see a child needing urgent dental care if the child had public insurance as compared to private coverage.26 In Vermont, 57% of children with Medicaid received any dental service in 2009. While this is Shawn Jones, Brattleboro, Vermont: “Last year, I had a toothache that was so painful, I had trouble eating and sleeping. My girlfriend is also covered by Medicaid so I called her dentist, but they wouldn’t see me. So I called 12 more dentists in the area, but they all said the same thing: they weren’t taking new Medicaid patients. A few said to call back in three months, which seems like a long time to live with a bad toothache. Finally, someone from OVHA [Office of Vermont Health Access] helped me get an emergency voucher to get my tooth pulled. I’m just grateful that my girlfriend had a car to get me there.” 4 considerably higher than the 38% of children with Medicaid nationally who received any dental service that year, it is still unacceptably low.27 The Costs of Untreated Oral Health Problems Untreated dental problems result in missed work and school, poor nutrition, and a decline in overall well-being. The U.S. Surgeon General’s report, Oral Health in America, published in 2000, noted that students miss more than 51 million hours of school and employed adults lose more than 164 million hours of work each year due to dental disease or dental visits.28 A more recent study published in 2009 found that 504,000 children age 5 to 17 missed at least one day of school due to a toothache or other oral health problem in California alone.29 The Emergency Room as Safety Net Because no real dental safety net exists in the United States, many people turn to the emergency room for care. This is costly to hospitals and taxpayers. The Pew Center on the States estimates that there were over 830,000 visits to ERs nationwide for preventable dental conditions in 2009 - a 16% increase from 2006.30 In 2007, more than 10,000 visits to Iowa emergency rooms were related to dental issues with a cost to Medicaid and other public programs of nearly $5 million.31 In Florida, there were more than 115,000 hospital ER visits for dental problems in 2010 with costs of more than $88 million.32 These numbers would not be nearly as high if people had access to the basic and preventive care they need. POTENTIAL SOLUTIONS FOR INCREASING ACCESS TO DENTAL SERVICES There are many things we can do to improve access to dental services for those who need them most. Options include expanding the oral health workforce, integrating dental services, and promoting prevention and education. Expanding the Oral Health Workforce In order to address access issues we must increase the number of providers. Specifically, we need more oral health professionals who treat low-income individuals and other populations that face barriers to care and understand what should be done to eliminate these barriers. After a period from 1986-2001 when several private, not-forprofit dental schools closed their doors, a number of new dental schools have been established.33 There should be a continued effort to increase the number of dentists, and in particular, dentists from diverse backgrounds. Dental schools should encourage students to gain experience in community-based programs as a component of their education and continuing dental education should focus on ways to address disparities in access to oral health services. The Institute of Medicine report, Improving Access to Oral Health Services for