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ANALYSIS & COMMENTARY
abstract The importance of oral health for overall well-being cannot be overstated. Yet the US dental delivery system struggles to address effectively the two most common oral diseases (caries and periodontal disease), which are among the most prevalent of all chronic diseases and are largely preventable. This article describes the evolution of contemporary US dental care policy and practice, highlighting the challenges resulting from the dental system's separation from the rest of health care, and explores the implications of this divide for the future of oral health policy and system reform. It remains unclear whether twenty-first-century dental science, information technology, interprofessional practice, and population health needs can be mounted onto the current nineteenth-century dental care delivery model. At stake is whether reform efforts will lead to a reduction in disparities and the widespread incidence of dental disease, or whether those efforts will maintain a system in which poor oral health serves as a primary marker of social inequality for the next generation of Americans.
Although medical and dental care operate in different spheres, the importance of oral health cannot be overstated for physical, emotional, psychological, and socio-economic well-being. In 2000 the landmark surgeon general's report on oral health documented impressive advances in dental science and practice, as well as oral health's connections to general health, raising national awareness about the importance of oral health to overall well-being.1 Yet the report also detailed widespread inequities in access, insurance coverage, and oral health status, and it raised concerns about the quality of dental care, the financial sustainability of dental education, and the lack of workforce diversity. A decade later, two Institute of Medicine (IOM) oral health reports further highlighted the US dental care delivery system's multiple failures to address the two most common oral diseases (caries and periodontal disease), which are among the most prevalent of all chronic diseases despite being largely preventable.2'3 As far back as 1980, the IOM expressed concerns about dental policy and financing,4 and again in 1995, the IOM addressed deficits in dental education, many of which remain.5 Yet despite long-standing and widespread calls for reform, dental care has been slow to move toward universal coverage and access, improved accountability to payers or the public, or decreased costs, while...