Efforts to expand the population coverage of water fluoridation in communities that target counties with high concentrations of lower-income families could bring about greater benefits by reducing both tooth decay and income disparities in tooth decay. In the United States, private practice has been and continues to be the main setting in which most Americans receive dental care. Since the release of the Surgeon General's last report on oral health in 2000, the current patchwork of funding for dental care continues to create significant gaps in access to affordable dental care for many vulnerable groups. This implies that, in addition to the importance of addressing poverty, improving social and built environments can generate resilience as a response to the harmful effects of poverty on health itself.
A study by RAND Corporation on dental preparation observed the high cost of staff time and, therefore, combat effectiveness, resulting from dental emergencies in a combat zone (Brauner et al.). The results showed that living in a predominantly fluoridated county reduced the magnitude of income disparities related to tooth decay. In addition, dental services may not be readily available in areas where many people of color live, because the payment structure for services offers lower incentives for providers who would be located in those areas. The expansion of dental therapy is another promising model, given the evidence of improvements in dental outcomes in rural areas where dentists practice their profession (Koppelman et al.).
The severity of tooth decay in children's permanent teeth has been reduced to historically low levels, and long-standing inequalities in relation to untreated cavities appear to be diminishing. Virginia dentistry has responded to that challenge with a similar increase in dentists and a 33% increase in dental hygienists. Since older adults are much more dependent on a fixed income, the continued increase in out-of-pocket dental expenses, together with rising overall dental care costs, will result in an increase in the deferral of dental care, as there are substantial improvements in dental retention in an aging population that is increasing in number in the United States. The triple objective of healthcare, articulated by Berwick and colleagues (200): improving the health of populations, improving patients' experience with care and reducing costs, laid the foundation for the value proposition in healthcare.
A culture of patient safety in dentistry involves not only making oral health information clear and accessible, but also contextualizing that information within patients' lives. This delay in the adoption or promotion of effective but minimally invasive preventive interventions, such as silver diamine fluoride or fluoride varnish, limits the provision of dental services in non-traditional settings (care provided outside a traditional dental office) by public health dental hygienists, dental therapists, or others who may be more available than dentists. While interest has grown in the role that non-dental healthcare providers and environments could play in improving oral health, the provision of dental care in medical settings requires that providers have knowledge beyond what has traditionally been provided to them during their training. The fundamental skills on which health literacy is based, such as reading and mathematics, are often developed within the context of regular education.
