Copyright 1999 Federal News Service, Inc.
Federal News Service
APRIL 13, 1999, TUESDAY
SECTION: IN THE NEWS
LENGTH:
4343 words
HEADLINE: PREPARED STATEMENT OF
DR.
PATRICK J. FERRILLO
DEAN
SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF
DENTISTRY
PRESIDENT
AMERICAN ASSOCIATION OF DENTAL SCHOOLS
ON BEHALF
OF THE
AMERICAN ASSOCIATION OF DENTAL SCHOOLS
BEFORE THE
HOUSE APPROPRIATIONS COMMITTEE
LABOR, HEALTH AND HUMAN
SERVICES AND EDUCATION SUBCOMMITTEE
BODY:
My
name is Patrick J. Ferillo. I am a Doctor of Dental Surgery and the Dean of the
College of Dentistry at Southern Illinois University in Alton, Illinois. I am
pleased to have the opportunity to present the views of the American Association
of Dental Schools (AADS), an organization where I currently serve as our chief
elected officer. AADS represents all of the dental schools in the United States,
as well as advanced dental education. hospital dental residency programs, and
allied dental education institutions. It is within these institutions that
future practitioners, educators, and researchers ,are waned; significant dental
care provided; and the majority of dental research conducted. AADS is the one
national organization that speaks exclusively for dental education. Our clinics
in dental schools, hospital residency programs, and other training sites play a
major role in access to oral health care reaching many underserved low-income
populations, including individuals covered by Medicaid and the State Children's
Health Insurance Program (CHIP). The cost of treatment at our clinics is
substantially less than other alternatives. We play a major role in improving
the oral health care of our community, as exemplified by a collaborative program
my school has with the public health department to allow dental students to
travel to local secondary schools and assist in the placement of dental
sealants. These sealants effectively prevent cavities for the school children we
see, who are from lower income arms and are at higher risk for childhood
carries.
There is currently more focus titan ever on oral health, and with
the U.S. Surgeon General's Report on Oral Health scheduled to be released later
this year, we hope the nation will understand that oral health is part of total
health. Our science increasingly shows this. Caries, or cavities, is an
infectious disease caused by streptococcus mutans, which is .just one of the 400
different species of microorganisms (mostly bacteria) living in the mouth. And,
preliminary research suggests that bacteria causing periodontal disease are
passed between spouses and significant others. Research has increasingly shown
that the pain and infection resulting from oral disease may not be limited to
the mouth.
New research suggests that dental infectious may be implicated in
hardening of arteries, heart attack, stroke, and spontaneous, pre-term births.
As reported in several major national newspapers, a University of Minnesota
study found that bacteria in denial plaque and infections, particularly
periodontal disease, can muse heart attack inducing blood clots. Since 1989,
about a half dozen studies have found that people with periodontal disease have
an increased risk of heart disease and stroke. Preliminary studies have also
linked oral health care with premature, low birthweight (PLBW) babies, possibly
explaining why African-American women, who are often unable to get access to
dental care, have more PLBW babies than whites. From research at the University
of North Carolina. scientists theorize flint oral pathogens release toxins that
reach the human placenta via the mother's blood circulation and interfere with
fetal growth and development, which has been shown to occur in animal studies.
While dentistry has made significant progress in preventing oral disease and
developing primary care treatments, little more than half of all Americans have
access to routine dental cam. A 1995 Centers for Disease Control (CDC) survey
revealed that nearly half (44.3 percent) of adults report having no dental
insurance. Consequently, oral diseases are still among the most prevalent and
common of all chronic health conditions. A 1996 Healthy People 2000 review
conducted by the CDC reports that in the United States, 94 percent of adults
have evidence of past or current tooth decay, and only one third of adu4 years
have all of their permanent teeth. Periodontal disease is also pervasive among
adults 18 and over. Oral cancer is more common titan leukemia, Hodgkin's
disease, melanoma of the skin, and cancers of the brain, cervix, ovary, liver,
or stomach. Each year there ,are approximately 30,000 newly diagnosed cases of
oral cancer and 8,000 deaths. Accordingly, poor oral health has a tremendous
economic imxact on our country, causing our nation's workforce to miss more than
164 million hours of work annually. The NIH reports that half of U.S. children
already have cavities by age 7, and 84 percent of all children have experienced
dental decay by age 17. Oral conditions left untreated severely impair a child's
ability to concentrate in school and result in more than 52 million hours of
time away from the classroom annually. If the nation is serious about having all
children ready to learn by the time they enter school, we must improve all
children's access to comprehensive health services, including adequate oral
health care.
Our funding requests for FY 2000 reflect the expanding role of
dentistry in our nation's health care system and the changing nature of the
profession. Because the Subcommittee is under severe fiscal constraints, we have
focused on dental education and research programs that are extremely
cost-effective and will yield a significant return for the federal investment in
improving access to oral health care.General Dentistry and Pediatric Dentistry
Residencies: General Dentistry Residency training programs provide dentists with
the skills and clinical experiences needed to deliver a broad arm.,,' of oral
health services to the full community of patients. Dentists who have had the
benefit of this advanced residency training consistently refer fewer patients to
specialists, which is especially important in mini and underserved urban areas
where logistical and financial barriers can make specialized care unobtainable.
The General Dentistry Residency program has been a highly effective tool in
improving access and availability of primary care services. The Bureau of Health
Professions (BHPr) in HRSA provides time-year grants to start or expand these
programs, after which time the programs must demonstrate their ability to
continue these activities via patient care revenue and other funding sources.
Eighty-seven percent of those who receive General Dentistry Residency training
through BHPr supported programs remain in primary care practice. Compared to
dentists without this training, these residents treat four times the number of
developmentally disabled, six times the number of medically compromised, and 26
times the number of HIV/AIDS patients.
Most current grantees include
off-site rotations to underserved communities or populations, such as the poor,
the developmentally disabled, and the elderly. The General Dentistry Residency
program at Southern Illinois University (SIU) was expanded through a 1992 BHPr
grant, and features community-based training experiences where residents treat
underserved, low-income populations in East Saint Louis. The program has become
self-sustaining after the federal grant funds terminated. Tiffs type of
community relationship is typical of a growing trend in dental education,
reflected in the public service patient care missions of dental education
clinics. For example, at Columbia University. BHPr grants helped expand a
General Dentistry. Residency program where care is delivered in a "DentCare"
network (at sites such as public schools, a senior center, and a community
health center) to comprehensively address oral health care needs of Central
Harlem and Washington Heights/Inwood communities where the school is located,
serving a predominately African-American and Latino population of low
socioeconomic status residing within two health professional shortage areas. A
General Dentistry grant allows Harvard University to offer a residency program
designed to train general practitioners to care for patients m underserved
communities.
The training experience includes a community health center
rotation and a curriculum in multiculturalism and diversity, dental public
health, and community dentistry. (which includes home visits and evaluation of
school children).
Program evaluations confirm the success of General
Dentistry Residency. programs in meeting federal primary care objectives. The
Bureau of Health Professions' evaluation of lifts program found that
"Considering the relatively modext investment of funds by the federal
government, the impact on the growth and scope of General Dentistry programs and
the subsequent effect on dental care has been substantial." In the last two
grant cycles, over 90 percent of BHPr- funded grantees could document that a
significant number (greater than 25 percent) of graduates from their General
Dentistry residency programs entered practice in underserved communities. Demand
for General Dentistry. training continues to outpace supply for this primary
care training. Without federal support, it would be extremely difficult to
create new programs because of the lead time needed for these programs to become
self-sufficient and because of the high cost of start-up funding for dental
equipment and instrumentation.
The 1995 Institute of Medicine (IOM) Study of
Dental Education recommended that postdoctoral education in General Dentistry
should be available for every dental graduate and that an emphasis should be
placed on creating new General Dentistry. Residency. positions.1 While progress
has been made in meeting the current and future demand for primary care training
and care, much work still needs to be done. In 1997-98, the first-year
enrollment for all accredited dental residency programs would have accommodated
only 64 percent of all U S. dental school graduates. For these reasons, we urge
the Subcommittee to support an appropriation that will permit continued progress
toward achieving the workforce training goals set forth by the IOM.
1998
legislation reauthorizing the Title VII and Title VIII Health Professions
Education and Training programs expanded the primary, care dental program to
include both General Dentistry Residency training and Pediatric Dentistry
Residency training. Many applicants to Pediatric Dentistry training positions
are turned away due to lack of positions. Pediatric Dentistry training positions
have not expanded in the last 20 years, despite increased societal needs.
Pediatric Dentistry is the dental counterpart to general pediatrics. While
preventive dental care for children is one of the great successes in public
health, there is still a significant unmet need: 20 percent of the pediatric
population experiences 80 percent of the dental disease, and this is
concentrated in low-income, minority populations. With the establishment of the
new State Children's Health Insurance Program (CHIP) we expect the need for
trained pediatric dentists to increase. Residents trained in General Dentistry
and Pediatric Dentistry are the cadre of professionals essential to meeting the
needs of Medicaid and CHIP children and are also the essential training
components of the current oral health initiative at HRSA aimed at improving
access to or,d health care. Because the FY 1999 appropriation provided $3.9
million for General Dentistry alone, the addition of Pediatric Dentistry to the
authorization requires additional funding to ensure that critical training needs
in both areas are met. We urge the committee to provide sufficient funding
($132.4 million) in the Primary Care Cluster to ensure that $8 million is
available for these two dental programs.
Ryan White HIV/AIDS Dental
Reimbursement Program (Part F. Ryan White CARE Act): Federal
support for rids program increases access to oral health services for people
living with HIV/AIDS and, at the stone time, provides dental students and
residents the education and training necessary to deliver oral health care to
HIV/AIDS patients. Thus, two major federal objectives--service to patients of
limited means and education of future practitioners--are accomplished with this
important but very. modest federal program.
As a result of immune system
breakdown, HIV/AIDS patients ,are more susceptible to oral diseases such as oral
lesions that cause significant pain and oral infection leading to fevers, weight
loss, and difficulty in eating, speaking, or taking medication. Extreme pain in
the mouth is frequently the symptom that motivates patients to seek care. In
fact, many of the first physical manifestations of HIV infection are found in
fire oral cavity, and a dentist is often the first health care professional to
diagnose these patients. Moreover, the development of some oral problems may
signify flint HIV infection is progressing. Oral health care Ires continued to
be a major need of HIV/AIDS patients and consistently ranks high in surveys of
health needs of HIV/AIDS patients. HIV positive patients generally have a
greater incidence of complications from minor dental problems turn those without
HIV, and some dental conditions are sufficiently serious to interfere with
health-related necessities of eating and taking medication.
Private
insurance and Medicaid coverage for dental services is very limited or simply
unavailable for adults. This lack of sufficient reimbursement particularly
affects those dental education clinics flint serve as the safety net for a
significant number of Medicaid and HIV/AIDS individuals. The Ryan White HIV/AIDS
Dental Reimbursement program facilitates treatment of patients by alleviating
some of the financial burden faced by dental education institutions. This
program represents a partnership between the federal government and dental
education programs. in which the government partially offsets the costs dental
education programs incur by serving a disproportionate share of HIV/AIDS
patients. Denial education institutions accept tiffs partnership because it
helps us to continue to deliver and expand care for people living with HIV/AIDS
while simultaneously broadening the training experience and sensitivity of
future dental practitioners. The program has also enhanced relationships of
dental education institutions with state and local AIDS care programs.
In
1998, the program provided retrospective reimbursement to 101 dental education
programs that treated over 66,000 patients that could not pay for their
services. The $7.3 million paid to these institutions represented approximately
45 percent of the direct costs incurred from providing dental services to
low-income HIV and KIDS patients. By facilitating treatment to underserved HIV
patients, the program helps train practitioners to effectively deliver the
carefully coordinated health care needed by patients with HIV/AIDS, who often
are taking a variety of medications that impact any type of health care
treatment, including dental treatment. A preliminary evaluation of program
participants found that this program had a positive impact in the following
areas: integrating oral health care with other services, increasing the support
and commitment among providers to HIV/AIDS education and provision of care,
increasing the providers' knowledge about infection control and treatment, and
increasing patient access to oral health. Recent preliminary results from the
final program evaluation confirm that the program has accomplished much good in
expanding access to care and improving training opportunities. For example, Dr.
Ivan Lugo gained such experience while participating in a General Dentistry
Residency program at Temple University: this subsequently influenced Iris
decision to become a faculty member at Temple and focus much of his efforts on
coordinating clinical oral health care for persons living with HIV/AIDS, as well
as developing extensive collaborations with other Ryan White CARE providers in
fire city of Philadelphia.Early in the epidemic, the majority of patients
seeking dental care were severely immunocompromised. Thus, dental intervention
was directed toward eliminating infection and pain with definitive procedures
which had the least likelihood of exacerbating the patient's already fragile
condition. With the advent of multi-drug therapies. many patients are living
longer and more stable lives. Therefore. dental intervention has increased in
scope from palliative care to the full range of denial treatment, including
periodontal procedures, root canals, and advanced restorative procedures such as
crowns, bridges, and partial dentures. Restoring oral health function is. of
course. directly related to nutrition, which is so critical for
immunocompromised patients. For these reasons, AADS urges a modest increase of
$1.2 million over the FY 1999 levels for this important program, resulting in an
FY 2000 budget of $9 million for the Ryan White HIV/AIDS Dental Reimbursement
program.
National Health Service Corps (NHSC) Scholarship and Loan
Forgiveness Programs: AADS strongly supports the NHSC Scholarship and Loan
Forgiveness Programs, which assist students with the rising costs of financing
their health professions education while pro, noting primary care access to
underserved areas. Over the last several years, and most recently in FY 1999
appropriations report language, Congress has instructed the NHSC to increase
dental participation in the loan repayment and scholarship awards programs. The
number of dental loan repayment awards has increased slowly in recent years:
currently approximately 20 percent of new loan repayment awards are provided to
dentists.
However. problems continue to exist in the scholarship program,
which Ires completely abandoned dental scholarships (the last dental scholarship
was issued in 1994). We believe it is critical that the NHSC commitment to
dentistry be maintained and strengthened as the need for dental providers is
becoming more pronounced in underserved areas throughout the nation.
According to a Department of Health and Human Services survey, as of
June 30, 1998. 3,458 dentists are needed to service 1.1)98 designated Dental
Health Professions Shortage Areas (of which 602 are geographic areas, 434 are
population groups, and 62 are facilities).
AADS also believes the NHSC
should work with dental education institutions, dental organizations, and state
and local public health departments to determine dental site readiness,
especially in rural and border areas. NHSC should also pursue educational
partnership arrangements with dental schools to better identify dental students
interested in working in the Corps. There are many wonderful examples of
collaborative efforts between dental schools, community health centers, and
state and local health departments that can be expanded via the involvement of
NHSC participants. Accordingly, AADS requests the Subcommittee encourage NHSC to
reactivate the dental scholarship program, increase dental participation in the
NHSC loan repayment program, and pursue educational partnerships with dental
schools. Further, because of the decline in commissioned Corps dental personnel
who historically have provided more continuity in local planning efforts, the
NHSC should be encouraged to strategically place an increased number of such
personnel in areas that would benefit from their involvement.
Health
Professions Education and Training Programs for Minority and Disadvantaged
Students: AADS wants to express our strong support for the various programs that
play a critical role in the recruitment and retention of disadvantaged students
and the recruitment of disadvantaged faculty. We request funding increases for
the minority and disadvantaged assistance programs within the context of the FY
2000 budget request of $316 million for all Title VII and Title VIII Health
Professions programs recommended by the Health Professions and Nursing Education
Coalition (HPNEC). The funding levels advanced for the following programs as
part of HPNEC's FY 2000 budget request will maintain our nation's strong
commitment to diversity and opportunity m the hearth professions: Scholarships
for Disadvantaged Students, Loans for Disadvantaged Students, the Centers of
Excellence program, the Health Careers Opportunity Program, and the Faculty Loan
Repayment (FLRP) program. The FLRP, in particular, should be expanded. We
currently have a faculty recruitment crisis in dental education due to excellent
private practice options combined with high student loan debt. if we cannot
recruit the best and brightest to academia and research, many of the oral health
care concerns discussed in this testimony cannot be addressed. Underrepresented
minority recruitment into dental education also remains a problem. Thus, an
increased investment in the FLRP would hey address both of these concerns.
Other Health Professions Programs Under Title VII of the Public Health
Service Act: AADS also urges the Subcommittee to fund the following programs at
the level requested by the HPNEC coalition because of their importance in
promoting access to health care for special populations: Geriatric Initiatives
(including Geriatric Dental Training Fellowships) Rural Health Training. Health
Education and Training Centers. Area HealthEducation Centers, and Allied Health
Special Projects. Special consideration should be provided to support of Dental
Public Health Residency training under the Public Health Workforce Development
section of Title VII.
National Institutes of Health (NIH)/National Institute
of Dental and Craniofacial Research (NIDCR): AADS wishes to strongly commend and
thank Chairman Porter for his leadership in the area of biomedical research,
proven by the significant increases in the funding levels for NIH during his
chairmanship. Support for the NIDCR has yielded results applicable not only to
oral health but to health in general. NIDCR's objective is to promote the
advancement of research in all sciences pertaining to the mouth and facial
structures, to seek ways of treating and preventing or a diseases, and to
facilitate the transfer of knowledge into practical help for the public.
Scientific areas providing great research opportunities on which NIDCR will
focus in coming years include pain research, dental and craniofacial genetics,
oral and pharyngeal cancer, gene therapy using salivary, glands, and biomimetics
(an interdisciplinary, study leading to the replication of the process of new
cell growth and repair which occurs in living organisms). AADS is particularly
pleased that the NIDCR plans to pursue strategics strengthening its commitment
to recruiting and retaining young health professionals in the field of
biomedical clinical research. The recent decline in young men and women entering
tiffs field threatens our clinical research infrastructure and the ability of
our nation to fully benefit from increased investments and discoveries in the
area of biomedical research. AADS endorses the testimony of the American
Association for Dental Research regarding research priorities and the request
for a 15 percent increase over FY 1999 funding levels for NIH and an 18 percent
increase for NIDCR, resulting in a budget of $276.5 million for NIDCR in FY
2000. The Subcommittee should 'also encourage NIDCR to expand loan forgiveness
programs for re,marchers and encourage NIH to fully integrate oral health care
into the Centers of Excellence in Women's Health.
Agency for Health Care
Policy Research (AHCPR): AADS joins the Friends of AHCPR in supporting a budget
of $225 million in FY 2000. A particularly important AHCPR activity is the
Dental Scholar-in- Residence program, which is now moving into its fourth year.
This program was established in 1997 to assist the Agency in conducting research
to improve the delivery of effective oral health services and to facilitate
collaborative relationships among professional, educational, research and other
health industry sectors involved with oral health care. 1998-99 recipients
focused on projects related to evidence-based care and the promotion of closer
AHCPR collaboration with NIDCR as well as fire development of future dental
health services research agendas for the two agencies. This type of work will
help improve the knowledge base for informed oral health care policy.
Student Loan Programs: AADS is concerned about the ability of students
pursuing a health professions education to access affordable federal financial
aid due to file phase-out of the Health Education Assistance Loan (HEAL)
program. We welcomed the Secretary of Education's earlier action in raising the
annual and aggregate unsubsidized Stafford Loan limits to address this problem.
However, this action does not meet the full need of the health professions
community due to the limitations accompanying this policy. Currently, only
students attending schools which disbursed HEAL loans in FY 1995 are eligible.
Many dental schools which did not borrow under the HEAL program in FY 1995 now
have students who need to access additional loan funds; indeed, my school is
ineligible for tiffs reason. We believe that using this eligibility time frame
is arbitrary and creates a two-tiered system, thus locking out many deserving
health professions students from the lower cost federal student loan. AADS is
urging the Department of Education to broaden the pool of students eligible for
the "additional" annual and aggregate Stafford Loan limits to accommodate all
health professions students seeking assistance. We request the Subcommittee's
support for this effort.
Conclusion: Mr. Chairman, I thank you again, on
behalf of AADS and its membership, for this opportunity to present our views and
our budget requests for dental education programs in FY 2000. We believe these
programs are important public health activities essential to maintaining a
highly skilled, well-trained health professions workforce and achieving
important national oral health goals. 1 Field, Marilyn J., Ph.D., Editor, Dental
Education at the Crossroads, Challenges and Change, National Academy Press,
Washington, D.C., 1995, p. 14.
END
LOAD-DATE:
April 20, 1999 
