For two physicians, proper access to oral healthcare is about more than just having a nice smile.
Myechia Minter-Jordan, MD, and Lisa Simon, MD, DMD, recently joined two dentists to testify before the U.S. Senate Committee on Health, Education, Labor and Pensions about how to improve dental care affordability and accessibility.
The May 16 hearing came on the heels of Sen. Bernie Sanders' introduction of the Comprehensive Dental Care Reform Act of 2024. This bill aims to expand dental care coverage for veterans and low-income individuals, and increase the oral healthcare workforce. It would also work to bring more dental care services to community health centers, schools, nursing homes and mobile units.
Dr. Minter-Jordan is an internal medicine physician and the president and CEO of the CareQuest Institute for Oral Health. Dr. Simon is an associate physician at Brigham and Women’s Hospital and a fellow in oral health and medicine integration at the Harvard School of Dental Medicine in Boston. Both doctors recently spoke with Becker's about their Senate committee testimonies, the consequences of dental care inequities and the importance of medical-dental integration.
Editor's note: Responses were lightly edited for clarity and length.
Question: What inspired you to testify during the Senate committee hearing?
Dr. Lisa Simon: I'm so supportive of Senator Sanders' Comprehensive Dental Reform Act bill, so the opportunity to do anything to advance that was really thrilling. A lot of my work has centered on either talking about some of these policy changes and why things should happen or doing research that uses numbers and large datasets to evaluate these health policy changes. So those two things are probably the reason I was invited to testify, having both the research or quantitative background, and then also the clinical experience of being both a physician and dentist.
Dr. Myechia Minter-Jordan: It was an honor to represent the CareQuest Institute and the incredible work of so many experts within our organization. It was timely in the sense that Congressman Sanders' office reached out to our team to, first, get data, and one of the things I'm most appreciative and proud of is that we are viewed as a source of truth for oral health data, particularly on the topic of healthcare integration and the inclusion of oral health in Medicare and the expansion and retention of benefits under Medicaid. I was inspired to do it because it was an opportunity to bring the data that CareQuest has culminated over the years as well as the incredible research and publications we've been a part of that underscores the importance of medical-dental integration and highlights the importance of oral health and its impact on overall health and correlation with chronic disease.
Q: Dr. Simon, in your testimony you mentioned an "invisible form of health inequity." What did you mean by this?
LS: I was talking about the fact that so few people who aren't within our world appreciate how important oral healthcare can be and how challenging it is to get it when you need it. My patients who don't have good access to healthcare, they get it. They know how hard they've worked to try and find a dentist and they know how much their teeth hurt and they know how frustrated they are that it's been so hard. The separation of medicine and dentistry isn't that terrible if you're someone who has the resources to pay for a dental visit and to go to your hygienist every six months. Those barriers can be cleared by privilege, and it makes it easier to forget about this form of inequity unless you're one of the people who's experiencing it.
Q: Dr. Minter-Jordan, you mentioned in your testimony that our healthcare system and insurance policies largely treat the mouth as separate from the rest of the body, which leads to accessibility issues. Why do you think these things have historically been treated as separate?
MMJ: It is historical in nature, in terms of the siloing of the medical and dental fields. It goes back to the time of the trades and has been underscored over time by the separation in coverage by insurance carriers. In addition, I think [it's] the lack of recognition of the impact of oral health on overall health and on chronic disease. What we do at CareQuest Institute is we consistently back up with data the importance of oral health as it pertains to systemic health and we make those links between oral health and systemic health increasingly clear. Our healthcare system needs to recognize those connections as well as support the reimbursement structure for them and the training for medical and dental providers.
Q: In your experience, does it seem like more medical doctors are becoming more interested in how oral health affects overall wellbeing?
MMJ: I truly hope so. I was really proud of the fact that both Dr. Simon and I were able to testify in front of the Senate together, which I think underscores the growing body of knowledge medical doctors have around the importance of oral health. I would say there's significant advances that need to be made in terms of training in both medical and dental curricula to reinforce the level of integration we know needs to happen to make sure we are improving outcomes for patients or reducing overall costs. I am inspired and excited by the number of medical providers that we at CareQuest Institute have been able to engage on this topic and who are becoming more aware of this topic more broadly, but again, much more work to be done.
Q: What needs to happen for this bill to have a meaningful impact on communities?
LS: I think the fact that it includes several really large federal policy levers will mean that the bill has an impact. For example, with the Medicare dental benefit, that means 65 million people on Medicare will all of a sudden have a dental benefit. The other piece is that we know from medicine that Medicare has been able to drive the way medicine is practiced to advance health for people. An example might be that instead of paying for someone's hip replacement in Medicare and then paying for all of the complications of a hip replacement if they have them, Medicare pays for things based on quality. It basically says to a hospital, you can have this bundle of money for the procedure and your job is to prevent complications from happening. If you have to put someone back in the hospital or whatever else, you're gonna lose money on that. It basically maintains the level of quality for the procedure. You can imagine that doing something like that in dentistry would not only affect the people who are newly eligible for the Medicare dental benefit, but also everyone else because it might change how dentists practice or how they think about providing care to people. So it has an impact not just on those who are eligible, but on more people by changing practice. In addition, there are so many other pieces like the Medicaid dental benefit, which would also be a big federal-level change.
These policy changes require people on the ground who are willing to put them into practice. That means getting dentists on board and training a whole generation of new dentists who are eager to practice in new ways. I think all of that is really important too, and that may take years to happen, but I do think the additional funding to reduce dental student debt and to provide new places for people to practice, like in rural areas, all of those things are part of the way we can transform what it means to be a dentist to make sure dentists look like the rest of our population and care for people who need care and see themselves as healthcare providers. So it might be slow, but I think it'll work.
Q: What is the most important takeaway from this conversation?
LS: Dentistry and medicine have been separate for a really long time and the people who are most hurt by it are the people in America who most need our help and are also harmed by other forms of structural injustice. If we're able to bring dentistry into medicine, we're going to make a big difference in a lot of people's lives, and it's also just the right thing to do.
MMJ: Dental health is more than a nice smile. We want people to understand it has incredibly significant impacts on overall health and wellbeing. We want people to understand that chronic diseases like hypertension, diabetes, heart disease, dementia and adverse birth outcomes all have a direct correlation with oral health. We want them to also understand that dental disease can threaten family financial stability. It can keep children home from school and adults from being able to work. It can cause pain that is incredibly debilitating that people cannot activate in terms of their own activities of daily living. We want our healthcare system to be holistic and integrated so that we as patients and as people in this country can have improved overall health outcomes and we can continue to reduce the cost of care in this country.