Part F: Continued
A Growing Role for Dental Care
The Dental Reimbursement Program was first authorized in 1991, but it was not funded until 1994. It was then incorporated into the Ryan White Program in the 1996 reauthorization.
The idea for a Federal program to support dental care for people living with HIV/AIDS germinated in conversations between Henry Cherrick, dean of the UCLA School of Dentistry, and Jay Gershen, who was chair of the school’s Public Health Dentistry Department and active in the American Association of Dental Schools (AADS, now the American Dental Education Association).4 The school was providing a substantial amount of unreimbursed care for people living with HIV/AIDS. Cherrick also saw that many of the patients had soft-tissue lesions in their mouths and realized that dentists could play a key role in AIDS diagnosis and treatment, if trained appropriately.
Recognizing that other dental schools also needed funding to support the uncompensated care they were providing, Gershen worked closely with Martha Liggett at AADS to build congressional support for a Federal funding stream to support dental care provided in academic settings for people living with HIV/AIDS. Key allies included Representatives Henry Waxman (D-CA), Barbara Boxer (D-CA), and Edward Roybal (D-CA), all Californians who had assignments on important congressional committees.
“Early on, policymakers asked us why they should fund fillings for people who were dying, but once we explained the need and the important role dentists could play in diagnosing and treating people with HIV, they came on board,” says Gershen.4
Dental Partnerships Extend Care Into the Community
The Dental Reimbursement Program provides resources to cover some of the costs of uncompensated care for people living with HIV/AIDS provided by academic dental institutions (dental schools, hospitals with postdoctoral dental residency programs and, since the 2000 reauthorization, dental hygiene programs). In 2010, the program awarded funding to 57 grantees.
Congress added a second component to the program in the 2000 reauthorization. The Community-Based Dental Partnership Program, first funded in FY 2002, supports collaborations between dental education programs and community-based dentists and dental clinics. Designed to further expand the reach of services into communities that lack academic dental institutions, the program proved to be a valuable training tool through clinical rotations for students and residents in community-based settings.
COMMUNITY-BASED DENTAL PARTNERSHIPS
- Twelve Dental Partnerships in 11 States have formed networks of community-based HIV dental care, comprising university-based dental schools and community agencies to extend access to oral health care.
- Dental care was provided to more than 5,300 people living with HIV in 2008.
“Students go out to [the] community health center, and they are not just treating a mouth, they are treating the whole person,” says David Reznik, director of the Oral Health Center at Grady Health System’s Infectious Disease Program in Atlanta and the founder of HIVdent. “They learn that as opposed to just treating a person with HIV, you have to treat other factors that influence their lives. You have to ask the right questions and listen.”6
According to Reznik, who started treating people living with HIV/AIDS in 1987, there was substantial unmet need for training in those early days to help dentists overcome ignorance and fear, and the training supported by these programs has been an incredible service. Gershen echoed that sentiment along with the program’s role in fostering a more central role for the dental profession in HIV/AIDS care and treatment.