By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management

Across the globe, millions of people lack oral health care. Others are going to great lengths to access it. Imagine traveling thousands of miles for a routine dental appointment, leaving the country to get an implant, or—unfathomably—extracting your own teeth! These things are happening to residents in the present-day United Kingdom, and they are not alone. Almost half of the world’s population experiences oral diseases, and health systems are struggling to keep up. Worse, the prevalence of disease is compounded by unequal oral health status and access, where issues such as poor service distribution hinder access to care for those individuals who most need it.

The United States is not immune to these global issues, so our next generation of leaders must look beyond their own backyards if they hope to bring the best and most innovative ideas to bear on the world’s oral health care challenges. Lessons from abroad can also help leaders see the pitfalls and limitations of seemingly promising approaches and avoid repeating others’ mistakes.

One Lesson From Abroad: The NHS

We saw the transformative power of a global outlook in real-time when students in NYU’s Global Health Care Leaders program traveled to Italy. Each fall, interested NYU D4 students apply to visit one of NYU’s Global Academic Centers where they can explore complex health policy issues with government leaders and oral health advocates.

In November 2023, students in this program met with European oral health leaders at the NYU campus in Florence, Italy. We provided educational sessions in which students learned about European oral health policy priorities and opportunities for advocacy. It was during these discussions that we learned about what’s happening in the UK, where the National Health Service (NHS) is in turmoil.

If you’re not familiar, the NHS is the UK’s public health care system. Established in 1948, it aimed to provide all medical care to all residents free of charge and has long been revered as a beacon for those who believe health care is a human right. But in recent years, the NHS has hit hard times. A combination of underfunding, privatization, and a failure to adequately grow the budget and maintain a provider pipeline have all led to what can only be described as a disaster.

The current NHS is beleaguered by strikes, long wait times, provider shortages, and debt, while private care options remain out of reach for many budgets. The failure to systematically invest in the workforce, in particular, has produced devastating results. It takes six to seven years to educate a dentist in the UK, so the problem cannot be fixed overnight. In the meantime, UK residents are left without health care.

 A Similar Challenge at Home: Medicaid  and Children’s Oral Health

This tragedy can serve as a cautionary tale for health care providers in the United States. Of course, the two health care systems differ significantly—and most U.S. dental care is delivered through private practice—but we have encountered a not-so-different issue with the provision of dental care to children on Medicaid, where insufficient investment has also undermined access.

In 1967, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit mandated comprehensive oral health care benefits for children enrolled in Medicaid. On paper, the program had extraordinary potential for addressing the needs of children living in poverty, but deeming children’s oral health care an essential benefit doesn’t equate to their having access to care. In 2020, the American Dental Association reported that only 50% of children aged 3 to 17 on Medicaid had a dental appointment in the past year.  Considering what we learned about the NHS while in Florence, our mid-20th-century legislative victory followed by a failure to follow through rings familiar. We’re left wondering: How did this happen here in the United States?

A number of factors appear to have contributed, among them a lack of awareness among Medicaid beneficiaries of the available benefits. Additionally, Medicaid’s low reimbursement rates and cumbersome paperwork requirements dissuade dentists from participating. With fewer than half of dentists in many states accepting Medicaid patients, there aren’t enough appointments to go around.

A Future Imperative: Adopting a Global Mindset

In its Global Oral Health Status Report (2022), which I wrote about last year, the World Health Organization (WHO) called for universal oral health coverage. This means all individuals across the globe should have access to affordable providers who can deliver the care they need wherever they are in the world.

While in Florence, our students felt the enormous impact of adopting a global mindset as exposure to European oral health leaders shifted and enhanced their perspectives. After hearing about other ways of delivering care, one of our students called the experience “mind-blowing” and “life changing.” Another put it better than I could when she said, “Being able to hear the other person and then create your own understanding based on their perspective is so important, because it’s not just us, it’s all of us.”

As we strive to remedy the barriers to universal access to dental care in the United States—such as those experienced by Medicaid beneficiaries—we can learn from the early successes and later missteps at the NHS. Over time, we may also see our overseas colleagues solve their current problems in ways we want to emulate in the future.

Likewise, our friends in the UK can learn from us. Together, we can expand our ability to envision solutions to oral health challenges and actively contribute to meeting the goals laid out by the WHO.