[Congressional Record Volume 147, Number 78 (Thursday, June 7, 2001)]
[Senate]
[Pages S5977-S5979]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Mr. Feingold):
  S. 998. A bill to expand the availability of oral health services by 
strengthening the dental workforce in designated underserved areas; to 
the Committee on Health, Education, Labor, and Pensions.
  Ms. COLLINS. Mr. President, I am pleased to join my good friend and 
colleague from Wisconsin, Senator Russ Feingold, in introducing 
legislation to improve access to oral health care by strengthening the 
dental workforce in our Nation's rural and underserved communities.
  Oral and general health are inseparable, and good dental care is 
critical to our overall physical health and well-being. Dental health 
encompasses far more than cavities and gum disease. The recent U.S. 
Surgeon General report Oral Health in America states that ``the mouth 
acts as a mirror of health and disease'' that can help diagnose 
disorders such as diabetes, leukemia, heart disease, or anemia.
  While oral health in America has improved dramatically over the last 
50 years, these improvements have not occurred evenly across all 
sectors of our population, particularly among low-income individuals 
and families. Too many Americans today lack access to dental care. 
While there are clinically proven techniques to prevent or delay the 
progression of dental health problems, an estimated 25 million 
Americans live in areas lacking adequate dental services. As a 
consequence, these effective treatment and prevention programs are not 
being implemented in many of our communities. Astoundingly, as many as 
eleven percent of our Nation's rural population has never been to the 
dentist.
  This situation is exacerbated by the fact that our dental workforce 
is graying and the overall ratio of dentists to population is 
declining. In Maine, there currently are 393 active dentists, 241 of 
whom are 45 or older. More than 20 percent of dentists nationwide will 
retire in the next ten years and the number of dental graduates by 2015 
may not be enough to replace these retirees.
  As a consequence, Maine, like many States, is currently facing a 
serious shortage of dentists, particularly in rural areas. While there 
is one general practice dentist for every 2,286 people in the Portland 
area, the numbers drop off dramatically in western and northern Maine. 
In Aroostook County, where I'm from, there's only one dentist for every 
5,507 people. Moreover, at a time when tooth decay is the most 
prevalent childhood disease in America, Maine has fewer than ten 
specialists in pediatric dentistry, and most of these are located in 
the southern part of the State.
  This dental workforce shortage is exacerbated by the fact that Maine 
currently does not have a dental school or even a dental residency 
program. Dental schools can provide a critical safety net for the oral 
health needs of a state, and dental education clinics can provide the 
surrounding communities with care that otherwise would be unavailable 
to disadvantaged and underinsured populations. Maine is just one of a 
number of predominantly rural States that lacks this important 
component of a dental safety net.

  Maine, like many States, is exploring a number of innovative ideas 
for increasing access to dental care in underserved areas. In an effort 
to supplement and encourage these efforts, we

[[Page S5978]]

are introducing legislation today to establish a new State grant 
program designed to improve access to oral health services in rural and 
underserved areas. The legislation authorizes $50 million over five 
years for grants to States to help them develop innovative dental 
workforce development programs specific to their individual needs.
  States could use these grants to fund a wide variety of programs. For 
example, they could use the funds for loan forgiveness and repayment 
programs for dentists practicing in underserved ares. They could also 
use them to provide grants and low- or no-interest loans to help 
practitioners to establish or expand practices in these underserved 
areas. States, like Maine, that do not have a dental school could use 
the funds to establish a dental residency program. Other States might 
want to use the grant funding to establish or expand community or 
school-based dental facilities or to set up mobile or portable dental 
clinics.
  To assist in their recruitment and retention efforts, States could 
also use the funds for placement and support of dental students, 
residents, and advanced dentistry trainees. Or, they could use the 
grant funds for continuing dental education, including distance-based 
education, and practice support through teledentistry.
  Other programs that could be funded through the grants include: 
community-based prevention services such as water fluoridation and 
dental sealant programs; school programs to encourage children to go 
into oral health or science professions; the establishment or expansion 
of a State dental office to coordinate oral health and access issues; 
and any other activities that are determined to be appropriate by the 
Secretary of Health and Human Services.
  The National Health Service Corps is helping to meet the oral health 
needs of underserved communities by placing dentists and dental 
hygienists in some of America's most difficult-to-place inner city, 
rural, and frontier areas. Unfortunately, however, the number of 
dentists and dental hygienists with obligations to serve in the 
National Health Service Corps falls far short of meeting the total 
identified need. According to the Surgeon General, only about 6 percent 
of the dental need in America's rural and underserved communities is 
currently being met by the National Health Service Corps.

  In my state, approximately 173,000 Mainers live in designated dental 
health professional shortage areas. While the National Health Service 
Corps estimates that it will take 33 dental clinicians to meet this 
need, it currently has only three serving in my State.
  The bill we are introducing today would make some needed improvements 
in this critically important program so that it can better respond to 
our nation's oral health needs.
  First, it would direct the Secretary of Health and Human Services to 
develop and implement a plan for increasing the participation of 
dentists and dental hygienists in the National Health Service Corps 
scholarship and loan repayment programs.
  It would also allow National Health Service Corps scholarship and 
loan repayment program recipients to fulfill their commitment on a 
part-time basis. Many small rural communities may not have sufficient 
populations to support a full-time dentist or dental hygienist. This 
would give the National Health Service Corps additional flexibility to 
meet the needs of these communities. Moreover, some practitioners may 
find part-time service more attractive, which in turn could improve 
both recruitment and retention in these communities.
  Last year, after a six-year hiatus, the National Health Service Corps 
began a two-year pilot program to award scholarships to dental 
students. While this is a step in the right direction, these 
scholarships are only being awarded to students attending certain 
dental schools, none of which are in New England. Moreover, the pilot 
project requires the participating dental schools to encourage Corps 
dental scholars to practice in communities near their educational 
institutions. As a consequence, this program will do nothing to help 
relieve the dental shortage in Maine and other areas of New England.
  The bill we are introducing today would address this problem by 
expanding the National Health Service Corps Pilot Scholarship Program 
so that dental students attending any of the 55 U.S. dental schools can 
apply and require that placements for these scholars be based strictly 
on community need.
  It would also improve the process for designating dental health 
professional shortage areas and ensure that the criteria for making 
such designations provides a more accurate reflection of oral health 
need, particularly in rural areas.
  Mr. President, the Dental Health Improvement Act will make critically 
important oral health care services more accessible in our Nation's 
rural and underserved communities, and I urge all of my colleagues to 
sign on as cosponsors. I also ask unanimous consent that letters 
endorsing the bill from the American Dental Association and the 
American Dental Education Association be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


                                  American Dental Association,

                                     Washington, DC, May 25, 2001.
     Hon. Susan Collins,
     Russell Senate Office Building,
     Washingtion, DC.
       Dear Senator Collins: On behalf of the American Dental 
     Association and our 144,000 member dentists, I am delighted 
     to endorse the ``Dental Health Improvement Act,'' which you 
     introduced today. The Association is proud that the oral 
     health of Americans continues to improve, and that Americans 
     have access to the best oral health care in the world.
       Having said that, we agree that dental care has not reached 
     every corner of American society to the extent it has reached 
     the majority of Americans. For those Americans who are unable 
     to pay for care, and those with special needs, such as 
     disabled individuals, those with congenital conditions, and 
     non-ambulatory patients, obtaining dental care can be 
     difficult.
       Your legislation recognizes several of these problems and 
     goes a long way towards addressing them in a targeted and 
     meaningful way. The section on grant proposals offers states 
     the opportunity to be innovative in their approaches to 
     address specific geographical dental workforce issues. You 
     recognize the need to provide incentives to increase faculty 
     recruitment in accredited dental training institutions, and 
     your support for increasing loan repayment and scholarship 
     programs will provide the appropriate incentives to increase 
     the dental workforce in ``safety net'' organizations.
       The ADA is very grateful for your leadership on these 
     issues. Thank you for introducing this legislation. We want 
     to continue to work with you on dental access issues in 
     general and on this legislation as it moves through the 
     Congress.
           Sincerely,
                                               Robert M. Anderton,
     President.
                                  ____

                                                   American Dental


                                        Education Association,

                                     Washington, DC, May 23, 2001.
     Hon. Susan Collins,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Collins, I am writing on behalf of the dental 
     education community to commend you for developing and 
     introducing the Dental Health Improvement Act. This 
     legislation, when enacted into law, will expand the 
     availability of oral health care services for the nation's 
     underserved populations, strengthen the dental workforce, as 
     well as maintain the ability of dental schools to produce the 
     necessary manpower to provide oral health care to all 
     Americans.
       The American Dental Education Association (ADEA) represents 
     the nation's 55 dental schools, as well as hospital-based 
     dental and advanced dental education programs, allied dental 
     programs and schools, dental research institutions, and the 
     faculty and students at these institutions. ADEA's member 
     schools are dedicated to providing the highest quality 
     education to their students, conducting research and 
     providing oral health care services to Americans from 
     medically unserved and underserved areas, the majority of 
     whom are uninsured or who are from low-income families. 
     Recent downward trends in student enrollment and a growing 
     shortage in dental faculty have caused ADEA serious concern 
     about our ability to fully and competently address these 
     responsibilities.
       Therefore, I was delighted to see that the Dental Health 
     Improvement Act directly responds to many of these concerns. 
     If implemented, the Act would expand access to oral health 
     care to thousands of Americans for the first time. When 
     enacted, the provisions of the bill can be instrumental in 
     helping the more than 31 million Americans living in areas 
     that lack access to adequate oral health care services. It 
     can provide much needed help to dental education institutions 
     as we seek to address faculty shortages.
       As you know, dental education institutions face a major 
     crisis in the graying of its faculty which threatens the 
     quality of dental education, oral, dental and craniofacial 
     research, and ultimately will adversely impact the health of 
     all Americans. Currently, there are approximately 400 faculty 
     vacancies. Retirements are expected to accelerate in both

[[Page S5979]]

     private practice as well as teaching faculties in the 
     nation's 55 dental schools. There is a significant decrease 
     in the number of men and women choosing careers in dentistry, 
     teaching and research. Your personal experience in Maine is a 
     perfect example.
       Educational debt has increased, affecting both career 
     choices and practice location. Your bill will provide funds 
     to help with recruitment and retention efforts and helps 
     expand dental residency training programs to the 27 states 
     that do not currently have dental schools.
       Also important are the incentives you have proposed to 
     expand or establish community-based dental facilities linked 
     with dental education institutions. The need for this is 
     obvious. More than two-thirds of patients visiting dental 
     school clinics are members of families whose annual income is 
     estimated to be $15,000 or below. About half of these 
     patients are on Medicare or Medicaid, while more than a third 
     have no insurance coverage or government assistance program 
     to help them pay for their dental care.
       Dental academic institutions are committed to their patient 
     care mission, not only by improving the management and 
     efficiency of patient centered care delivery at the dental 
     school, but through increasing affiliations with and use of 
     satellite clinics. All dental schools maintain at least one 
     dental clinic on-site, and approximately 70% of U.S. dental 
     schools have school sponsored satellite clinics. Delivering 
     patient care in diverse settings demonstrates professional 
     responsibility to the oral health of the public.
       Dental schools and other academic dental institutions 
     provide oral health care to underserved and disadvantaged 
     populations. Yet more than 11 percent of the nation's rural 
     population has never been to see a dentist. This bill can 
     have a positive impact on the population by establishing 
     access to oral health care at community based dental 
     facilities and consolidated health center that are linked to 
     dental schools. 100 million Americans presently do not have 
     access to fluoridated water. The bill provides for community-
     based prevention services such as fluoride and sealants that 
     can cause a dramatic change for nearly a third of the 
     nations's population.
       Thank you again for taking such a leadership role in the 
     area of oral health. Please be assured that ADEA looks 
     forward to working closely with you to bring the far-reaching 
     potential of the Dental Health improvement Act to fruition.
           Sincerely,
                                            Richard W. Valachovic,
                                               Executive Director.
                                 ______