[Congressional Record Volume 145, Number 69 (Thursday, May 13, 1999)]
[Senate]
[Pages S5275-S5276]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FEINGOLD (for himself and Mr. Bingaman):
  S. 1035. A bill to establish a program to provide grants to expand 
the availability of public health dentistry programs in medically 
underserved areas, health professional shortage areas, and other 
Federally-defined areas that lack

[[Page S5276]]

primary dental services; to the Committee on Health, Education, Labor, 
and Pensions.


                   DENTAL HEALTH ACCESS EXPANSION ACT

  Mr. FEINGOLD. Mr. President, I rise today to introduce legislation to 
address a troubling--but little recognized--public health problem in 
this country, and that's access to dental health.
  Unlike many public health problems, there are clinically proven 
techniques to prevent or delay the progression of dental health 
problems. These proven techniques are not only more cost-effective, but 
also are relatively simple if done early. I'm specifically referring to 
the use of fluoride and dental sealants. The combination of fluoride 
and sealants is so effective against tooth decay that it has been 
likened to a ``magic potion.'' In fact, an article in Public Health 
Reports called the ``one-two combination of fluoride and sealants . . . 
similar to that of vaccinations.''
  With such an effective prevention method in place, one might assume 
that dental disease is becoming increasingly rare in this country. But 
that's not the case, Mr. President, because, in order to receive these 
preventive treatments--this ``magic potion'' against dental disease--
you need to see a dentist, and there simply are not enough dentists to 
provide these basic services to everyone who needs them. As of 
September 30 of last year, the United States had 1,116 dental health 
professions shortage areas, or Dental HPSA's according to the Health 
Resources and Services Administration. The chart I have here shows the 
counties in Wisconsin that have areas designated as shortage areas, but 
every single state in our Nation has a portion designated as a dental 
shortage area.
  There are proven methods for preventing dental disease, yet 1,116 
communities across our country--particularly underserved rural and 
inner-city communties--do not have enough dentists to provide simple 
preventive services. Barriers to dental care are particularly acute 
among lower income families, Medicaid enrollees, and the uninsured. 
Studies indicate that the prevalence of dental disease increases as 
income decreases. In many areas, there simply are not enough dentists 
to provide basic treatment to all who need them, and although there is 
a federal method for designating such areas as dental health 
professional shortage areas (DHPSA's) to become eligible for additional 
funding, the designation process can be so tedious that State dental 
directors simply lack the resources to complete the necessary 
documentation.
  To illustrate this problem of undercounting shortage areas, as of 
September 30 of last year, only eight counties in Wisconsin had 
portions designated as DHPSA's according to the Health Resources and 
Services Administration (HRSA), but statewide only 23 percent of 
Medicaid enrollees had received dental care. As you can see from this 
chart, in 13 Wisconsin counties, fewer than 10 percent of Medicaid 
enrollees received dental care. According to Wisconsin's state dental 
director, Dr. Warren LeMay, 80 percent of tooth decay is found in the 
poorest 25 percent of children. Given the effectiveness of dental 
health care in preventing dental disease--particularly the combination 
of check-ups, fluoride, and sealants--the access problems are simply 
unacceptable.
  And the impact of so many people going without dental care is 
devastating. Those of us who have ever had a toothache remember how 
excruciating that pain can be, making it difficult if not impossible to 
work, go to school or otherwise go about our business. For those 
Americans who lack access to dental services, however, the toothache is 
more than a bad memory--it is the here and now.
  Mr. President, imagine you had a child, a daughter, in need of dental 
services. But you lack insurance, and cannot afford to pay out-of-
pocket to see a dentist. Or you may have Medicaid, but the nearest 
dentist is more than 2 hours away, and you don't own a car. Since your 
child hasn't received the preventive care treatments, she has a lot of 
untreated tooth decay--decay that leads to infection, fevers, stomach 
aches, and, worst of all, debilitating pain, making it almost 
impossible for her to concentrate in school. She may also develop 
speech difficulties, since she may lack the teeth necessary to form 
certain words and sounds. When you try to get her emergency dental 
services, you find that the few dentists in the area have waiting lists 
of two months or more.

  Mr. President, one mother, from Rhinelander, WI--which is in Oneida 
County in the northern part of my state--called me to tell me about her 
8-year-old daughter in just that situation. He daughter was in 
excruciating pain because of a severe toothache, but the one dental 
provider in the area had a waiting list of several weeks, so that 
mother had no choice but to take her child to the nearest hospital 
emergency room, where the child was given painkillers to use until she 
could be seen by a dentist. Whereas routine primary dental care could 
have prevented this decay altogether, this mother had to take her young 
child to the hospital emergency room for prescription painkillers in 
order to make the wait before seeing the dentist bearable.
  Mr. President, the unfortunate reality is that I hear such stories 
from my constituents on a regular basis, and I have heard enough to 
know that it's time to stop this needless suffering from dental disease 
by increasing access to dental care.
  The legislation I am introducing today, the Dental Health Access 
Expansion Act, will establish take three important steps to promote 
access to dental health services:
  First, the bill creates a federal grant program to be administered by 
the Health Resources and Services Administration through which 
community health centers and local health departments in designated 
dental health professionals shortage areas can apply for funding to 
assist in the hiring of primary care dentists. Strengthening locally 
run dental access programs ensures a safety net for these vitally 
important services.
  The bill also creates a grant program to give bonus payments to 
dentists in shortage areas who devote at least 25 percent of their 
practice to Medicaid patients. More than 90 percent of America's 
dentists are in private practice, and incentive payments for dentists 
to increase their Medicaid practice helps to bring needy patients into 
the dental care mainstream.
  Finally, the bill requires that HRSA work with the Association of 
State and Territorial Dental Directors and other organizations 
interested in expanding dental health access to simplify the process 
for designating dental shortage areas. Right now the system is so 
complicated that states simply don't have the resources to fill out the 
paperwork needed to get the designation.
  Mr. President, the Dental Health Access Expansion Act is meant to 
complement existing initiatives--such as Health Professions Training 
Program expansions of general dentistry residencies, and the National 
Health Service Corps scholarship program--to increase access to primary 
care dental services in underserved communities. I have supported these 
and other programs in the past, and will continue to do so. My 
legislation is also meant to complement the excellent oral health 
initiatives proposed by my colleague, Senator Bingaman of New Mexico. I 
am thankful for the good work he has done in increasing awareness about 
this issue, and look forward to working with him to increase access to 
dental health services.
  Through the legislation I am proposing, we can increase the number of 
dentists providing care to underserved communities, and in doing so 
strengthen our nation's existing network of Community Health Centers 
and local health departments.
  Advances in dentistry have given us the tools to eradicate most 
dental diseases--what we need now is to provide people with access to 
dental care so that they can receive the simple preventive treatments 
they need, and that's what my legislation can help us achieve.
                                 ______