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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		D.C. Dental Society Practice Management Breakfast, Washington, D.C.
DATE:		February 4, 2000

Charting the Course for Dentistry in the New Millennium

It's a pleasure for me to join all of you at this Practice Management Breakfast. As I was preparing my remarks for today, I was reminded of a story involving the great Oliver Wendell Holmes. Holmes once boarded a train at Union Station. In the general commotion, the great jurist promptly lost his ticket. The conductor immediately recognized him and said, "Don't worry Justice Holmes, I know that when you find your ticket you'll mail it to the company." "Mr. Conductor," Holmes replied slowly and deliberately, "the question isn't `Where's my ticket?' but `Just where am I supposed to be going?'"

I tell that story because I believe all of us here today are faced with somewhat similar questions: As we begin to chart the course for dentistry in this new millennium, in what direction must we go? And how will we reach our destination of better oral health for all Americans? I know these are questions that all of you are certainly concerned about. Since 1866, the D.C. Dental Society has been serving the needs of District residents. You understand that a person can't be truly healthy without good oral health..You know how good oral health enhances an individual's quality of life..And you realize that good oral health is a right-not a privilege.

I, too, understand the importance of good oral health-and the importance of a good dentist: Even Shakespeare seems to have understood this when he wrote, "For there was never yet a philosopher that could endure the toothache patiently." I also know that government has a critical role to play in helping Americans understand the important link between good oral health and good overall health. That's why we've made improving oral health a central part of our Department's mission, and why our outstanding Surgeon General, Dr. David Satcher, and I consider it one of our top priorities. We're engaged in a three- part strategy to improve America's oral health. We're preventing disease; promoting access; and protecting patients. This strategy builds upon current departmental initiatives.It follows a patient through the various stages of oral health care.And it's designed to meet our three most pressing oral health challenges. Allow me to elaborate.

The first part of our strategy-and our first challenge-is to prevent disease before a patient visits the dentist. That's why our "Healthy People 2010 Objectives for the Nation" includes ambitious goals to prevent and control oral and craniofacial diseases and injuries. Released in January, the ADA, the Academy of General Dentistry, the National Dental Association and the Hispanic Dental Association were among the broad array of groups that helped us set the objectives and targets for Healthy People 2010. We'll continue to work with these groups.and all of you.to meet our objectives. But that's only the beginning.

Later this year, we'll be releasing our landmark "Surgeon General's Report on Oral Health." This report details what we know, and what we must learn-and do-to help prevent oral disease and promote good oral health. I commissioned the report in 1997-at the suggestion of my own dentist-in part to explore the growing evidence that poor oral health is associated with serious health problems including diabetes, heart disease and low birth-weight babies. The report will also identify barriers to good oral health. It will attempt to place oral health in the larger context of social customs, nutrition and economic progress. It will explore our shameful racial and ethnic disparities in oral health-such as why African-Americans have the highest rates of oral cancer. It will identify specific steps that individuals, communities and all health professionals can take in partnership with businesses, non-profits and insurers to improve the nation's oral health. Finally, the report is expected to make recommendations about what Americans can do in the 21st century to create healthier-and better-lives through preventive oral care.

Among the first activities being planned to augment the report is the "Surgeon General's Conference on Children and Oral Health" in June here in Washington. The conference will highlight ways to promote oral health and prevent disease among our most valuable-and vulnerable-citizens.

Of course, while we're focusing on prevention, the second part of our strategy-and our second challenge-is to promote access, especially for minorities. After all, once a person goes to see the dentist- we must ensure that the inability to pay doesn't keep him or her from walking through the door. This is particularly important for our nation's children. Our children will be the architects of society in the new millennium. They will create, construct and define the new century. But children can't make their dreams reality without a healthy start in life-and that includes good oral health. Yet-as you're aware-untreated dental caries remains the single most common chronic childhood disease. And although cases of the disease have greatly declined in recent years, it remains a significant problem among poor and minority children. A recent article in the Journal of the American Dental Association concluded that African-American and Mexican-American children were twice as likely to experience caries than white children.

Unfortunately, while the American dental community-both dentists and dental hygienists-provides the finest care in the world, it's still inaccessible to many vulnerable and disadvantaged individuals-including our children. That's why we've recommended that states include dental care in their benefit package under our State Children's Health Insurance Program--and why we're working to increase enrollment in the program. Of the 56 states, territories and the District of Columbia that have had their plans approved, only three have no dental coverage. Along the same lines, we want to make sure that children on Medicaid have access to preventive dental care. In 1996, an HHS report showed that only 20 percent of Medicaid eligible children were receiving recommended preventive services. To improve this situation, we've been working with the ADA and other dental organizations to help state-and DC-Medicaid agencies address the dental community's concerns about the program's reimbursement levels and bureaucracy--and how they affect access.

Of course, once a person actually enters the dentist's office, we must ensure proper patient protections. That's the third part of our strategy-and our third challenge. In his State of the Union Address last week, the President once again asked Congress to pass a comprehensive, enforceable Patient's Bill of Rights.A Bill of Rights that will guarantee access, choice, privacy and recourse to shoddy care.And a Bill of Rights that ensures that everyone-regardless of the type of health insurance they have-enjoys these same rights. That's exactly what the "Bipartisan Consensus Managed Care Improvement Act" will do. Sponsored by Congressmen Charlie Norwood--a dentist himself--and John Dingel, the Act was passed by the House last year. It's a comprehensive, enforceable Patient's Bill of Rights. It will provide a giant booster shot for health care quality. And it's the right prescription for what ails our entire health care system. The Senate also passed a patient protection bill last year but, unfortunately, its version protects far fewer people and doesn't provide adequate recourse for shoddy care.

This Administration and the dental profession share an interest in legislation that ensures choice and fairness for all patients-and accountability for health plans. Americans deserve equal protection in both dental and medical care. That's why it's important that any Patient's Bill of Rights covers freestanding dental plans-not just dental coverage offered as part of a medical plan.

Protecting patients.promoting access.preventing disease, these are the three most important dental challenges we face. But government, alone, can't meet these challenges. And government, alone, can't improve the oral health of America. If we're to meet our challenges, we need all of you who are working on the frontline to be our partners. We must work together to find innovative ways to improve oral health. That's why I look forward to reading the ADA's "Future of Dentistry" report when it's released.and why I think it's an excellent idea that the D.C. government may hire a fulltime public health dentist. We must work together to ensure that the dental professions are ready for the 21st century-and that includes increasing the number of African-American and Hispanic dentists, who remain underrepresented when compared with the general population. Finally--as we chart our course and strive to reach our destination of a healthier America--we must work together to ensure that oral health is always viewed as an essential component of both health care and good health.

When we speak about oral health, I'm reminded of the story of the great French mathematician, Blaise Pascal. On one occasion, Pascal was suffering with a terrible toothache. He endured the agonizing pain for many hours-and when it finally stopped, the idea of "cycloid geometry"-suddenly occurred to him. So relieved to be pain free, Pascal worked incessantly for eight days on his new theory. Eventually, his findings would form a necessary bridge between geometry and calculus. It's true that this is probably history's most exceptional oral health care story. But it does illustrate one fact: Creativity, productivity and overall quality of life require a foundation of good oral health. Together, let's help ensure that every American has that foundation in order to build a life of hope and happiness; of option and opportunity; of promise and possibility.

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