Oral Health Care Costs Research Articles

Patient satisfaction with e-oral health care in rural and remote settings: a systematic review

BackgroundDuring the past decade e-oral health technology has been used to address the oral health care challenges in rural and remote settings. This review systematically evaluated the literature on patient satisfaction with e-oral health care in rural and remote communities.MethodsThe systematic review included interventional and observational studies published between 1946 and 2021, in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Global Health. Patient satisfaction with received oral health care using self-reported measures, at any time after the intervention, was the main outcome of the review. The other primary outcomes were undesirable consequences of the health care (e-health or conventional) such as diagnostic error. The secondary outcomes considered were waiting time, number of visits, travel, and the cost of oral health care. Two independent researchers assessed the risk of bias using the ROBINS-I risk of bias assessment tool for non-randomized studies.ResultsAmong 898 studies, 16 studies were included in the review. In most studies reporting patient satisfaction, all patients had shown willingness for teleconsultation for a dental problem and they were mostly satisfied due to saved travel time, saved working days, and prompt treatment onset. Most of the studies acknowledged teledentistry as a cost-effective and cost-saving method. Moreover, the teledentistry consultations showed diagnostic reliability and validity values comparable to conventional dental consultations. The majority of studies were considered level 4 and 3b, due to limited sample populations, analysis based on limited alternatives or costs, non-consistent sensitivity analysis, failure to appropriately control known confounders, and/or failure to carry out an appropriate follow-up of patients.ConclusionAvailable evidence indicates that e-oral health is associated with higher patient satisfaction and has been found to be an effective and reliable method for patients in rural and remote areas. Therefore, in these areas, the use of e-oral health should be encouraged. However, methodological inconsistencies in the current evidence suggest the need for long-term cohort studies and clinical trials, as well as cost analysis on e-oral health in rural settings.Systematic review registrationThe systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42016039942.

Assessment of Oral Health Care-Related Expenditure among People of Kerala: A Cross-Sectional Study.

Background:Oral health is an effective unit of general health. Dental caries and periodontal diseases are considered to be the major diseases present in modern times. Over the decades, the idea of maintaining effective oral health and interest in oral health prevention measures has diminished; thus increasing the cost of health care.Aims and Objectives:This study aims to estimate the household expenditure on oral health care among people residing in Kerala, India.Materials and Methods:Five hundred participants were surveyed who were residents of Kerala. A self-administered questionnaire that was tested and validated was used to assess the cost of oral health care. Data collected were analyzed using software for IBM SPSS version 23 for Windows (New York, USA).Results:Of 500 people, 37% are men and 63% are women. 100% of people reported using a toothbrush as an oral hygiene aid. 65% of households reported changing toothbrush for 3 months or more, while 35% of families changed for 1 month or less. Significant statistically weak correlation was observed when education, employment, and income were compared to the annual expenditure on dental care. Furthermore, there has been a moderately strong correlation observed between the socio-economic status of families and the annual cost of dental care.Conclusion:People should be aware of preventive oral hygiene aids, and appropriate policies should be formulated which will ultimately result in decreased expenditure on a curative aspect of the dental disease.

Oral healthcare delivery in institutionalised older people: A health-economic evaluation.

This health-economic evaluation aimed to assess the cost-effectiveness of a number of alternatives for preventive and curative oral health care in institutionalised older people in Flanders. A six-state Markov model was used to compare expected costs and healthy oral years (HOYs) of four alternatives: (1) usual care; (2) on-site preventive care; (3) on-site preventive care+curative care in the community; and (4) on-site preventive care+on-site curative care. A healthcare payer perspective was adopted, and the time horizon was 10years. Deterministic and probabilistic sensitivity analyses were performed. Incremental cost-effectiveness ratios (ICERs) of alternatives 2, 3 and 4 (all compared to alternative 1) were as follows: (2) 7944 €/HOY gained; (3) 1576 €/HOY gained; and (4) 1132 €/HOY gained. Hence, alternatives 2 and 3 were not cost-effective compared to alternative 4. The probability that oral care interventions are more effective and cost-saving than usual care was <3% for all three interventions. For institutionalised older people, on-site solutions for preventive and curative oral health care might be the most cost-effective alternative. It should be kept in mind that on-site solutions require large initial investment and that the advanced age of the population and the high costs of oral health care make it unlikely that these interventions would become cost-saving, even in the long term.

Comparing dental care coverage for older adults in eight jurisdictions

Abstract Background Oral health is an important component of general health and healthy aging, yet financial protection for the costs of oral health care is often limited. Methods We systematically compare dental care coverage in Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States. Drawing on the WHO Universal Coverage Cube, we compare breadth (who is covered), depth (share of total costs covered), and scope (services covered), with a focus on adults aged 65 and older. We populated data collection templates to provide detailed and comparable descriptions of dental care coverage in 8 jurisdictions. Results Overall there were four general types of coverage models: 1) deep public coverage for a small subset of the population based on strict eligibility criteria jurisdictions: Canada, Australia and Italy; 2) universal but shallow coverage of the population, combined with deeper coverage for a sub-set of the population meeting eligibility criteria: England, France, Sweden; 3) universal, and predominantly deep coverage for the whole population: Germany; and 4) shallow coverage available to some subgroups of the population in the United States. Conclusions While age, specifically turning 65, is an important consideration in the design of public coverage in Canada, Australia and the United States, many jurisdictions do not consider age as an eligibility criterion for public coverage. Yet all jurisdictions we include, except Sweden, provide differential coverage for those who meet a specific low-income threshold. Due to the limited availability of comparable data within and across jurisdictions, further research would benefit from standardized data collection initiatives for oral health measures. Key message Given the important role oral health plays in promoting healthy aging, the limited public coverage of oral health within statutory health systems warrants policy and research attention.

Perceptions and practices of general practitioners on providing oral health care to people with diabetes - a qualitative study

BackgroundPoorly controlled diabetes leads to multiple complications including oral health problems. General practitioners (GPs) are at the forefront of management of chronic diseases in primary health care. Diabetes guidelines encourage a proactive role for GPs in oral health complications management in people with diabetes, yet little is known about this area of care. This study aimed to explore current practices, perceptions and barriers of GPs towards oral health care for people with diabetes.MethodsWe employed a qualitative research method utilising telephone interviews. Purposive and snowball sampling were used to recruit 12 GPs from Greater Sydney region. A thematic analysis involving an inductive approach was used to identify and analyse contextual patterns and themes.ResultsA majority of participants were males (n = 10), working in group practices (n = 11) with a mean ± SD age of 55 ± 11.4 years and 25 ± 13.6 years work experience. Three major themes emerged: oral health care practices in general practice settings; barriers and enablers to oral health care; and role of diabetes care providers in promoting oral health.Most GPs acknowledged the importance of oral health care for people with diabetes, identifying their compromised immune capacity and greater risks of infections as risk factors. GPs reported 20–30% of their patients having oral health problems, however their current oral health care practices relating to education, risk assessment and referrals were reported as very limited.GPs identified several barriers including time constraints, absence of referral pathways, and limited knowledge and training in promoting oral health care. They also reported patient barriers including oral health care costs and lower oral health awareness. GPs perceived that resources such as education/training, a standardised assessment tool and patient education materials could support them in promoting oral health care. GPs also perceived that other diabetes care providers such as diabetes educators could play an important role in promoting oral health.ConclusionsDespite current recommendations, GPs’ current oral health care practices among people with diabetes are limited. Further strategies including capacity building GPs by developing appropriate oral health training programs and simple risk assessment tools along with accessible referral pathways are needed to address the current barriers.

Variations in the provision and cost of oral healthcare in 11 European countries: a case study

Aim: To compare the provision and costs at the point of delivery of dental treatments in a sample of European Union (EU) Member States. Materials and methods: A questionnaire with open-ended questions was sent to oral health policy-makers in Denmark, England, France, Germany, Hungary, Ireland, Italy, the Netherlands, Poland, Romania, Scotland and Spain. They were asked to answer questions on the probable costs and provision of treatment in their country for a vignette presented as a pre-defined case. Results: All respondents returned answers to all questions. Wide variations were reported in: who would deliver care, cost of items of care and total cost. For example, in France, only a dentist would provide the treatment. In Denmark, England, Germany, Ireland, Italy, the Netherlands and Scotland, it was likely that the treatment would be provided by a combination of dentist, dental hygienist and dental nurse. Fees ranged from €72 in England (if treated within the NHS) to €603 in Denmark. In Italy, Spain and for most patients in Romania, all treatment costs were paid by the patient. In the other nine countries, some subsidy from public funds was available. In terms of percentage of per capita Gross National Income, the cost to the patient ranged from 0.12% in France to 1.57% in Spain. Conclusions: It was apparent that there are wide variations between EU Member States in the manner in which oral healthcare is delivered, its cost and the extent to which the cost of treatment is subsidised from state funds or through private insurance.

How useful are current caries risk assessment tools in informing the oral health care decision-making process?

BackgroundCaries risk assessment (CRA) tools could address oral health disparities and enhance the efficiency of the oral health care system. The authors aimed to explore the feasibility and limitations of using clinical CRA tools in informing oral health care policy-making processes. MethodsThe authors used the National Health and Nutrition Examination Survey to construct 10 CRA models from a sample of clinical CRA tools identified from the literature. They used these models to estimate the proportion of publicly insured people aged 1 through 20 years categorized as at low, moderate, and high risk, and they projected their oral health care costs. ResultsThe authors found substantial variation among the selected models in assigning risk levels. The weighted average proportions (range) of people categorized as at low, moderate, and high risk were 25% (0%-66%), 14% (0%-50%), and 61% (11%-100%), respectively. Depending on the CRA model, the projected annual cost of covering this population ranged from $18 billion to $127 billion. Conclusions and Practical ImplicationsDeveloping a valid, evidence-based, accurate, and reliable population-based CRA model could address the variability among clinical CRA tools, improve estimates of dental disease burden, help design targeted oral public health programs, and enable comparative effectiveness analyses among oral health care interventions.

The role of health insurance in the coverage of oral health care in Senegal.

Oral diseases costs are among the most expensive health care benefits. In Senegal, households contribute up to 37.6% of the national health spending through direct payments. The aim of this work was to study the role of health insurance in the coverage of oral health care in Senegal. The study was based on health insurance agents and policyholders. The study reveals that oral health care coverage through health insurance still does not meet requirements for treatment of oral infections. In financial terms, oral health care costs health insurance too much. As a result, carriers cover them partially. On top of that, the majority of the population’s lack of knowledge about mutual, because they have a little background on oral health care, the latter weighs heavily on health insurance leading to the use of self-medication, traditional medicine and handicraft prosthetists. The analysis reveals an unequal access to oral health care through the health insurance system. To bring under control the expenditure for oral health care, carriers and dental surgeons must work together to raise the populations’ awareness on community solidarity.

Point-of-Care/Chairside aMMP-8 Analytics of Periodontal Diseases' Activity and Episodic Progression.

Traditional periodontal disease diagnostics are based mainly on clinical examination and radiographs. They assess only past tissue destruction and provide no information on the current disease status or its future progression. The objective is to find out if an active matrix metalloproteinase-8 (aMMP-8) point-of-care (PoC) test could provide a cost-effective way to get around this limitation. This cross-sectional study used 47 adolescents and 70 adults, who were clinically examined and their aMMP-8 PoC tested. The aMMP-8 PoC test results and patients’ treatment need, based on the community periodontal index of treatment needs (CPITN), were compared and analyzed using Fisher’s exact test. In terms of CPITN, the aMMP-8 PoC test gave no false positives for both adolescents and adults. All healthy patients got a negative test result, while a positive test result indicated periodontal treatment need correctly. Finally, there was a significant association between a patient’s aMMP-8 PoC test result and his/her treatment need (p = 0.001 for adolescents, p = 0.001 for adults). In conclusion, more accurate diagnostics of periodontal diseases’ activity and progression using an aMMP-8 PoC test may help to reduce oral health care costs by reducing patient overtreatment, improving patient outcome, and reducing the need for complex periodontal therapy.

Assessment of oral health and cost of care for a group of refugees in Germany: a cross-sectional study

BackgroundThere is a research gap concerning the evaluation of the oral healthcare of refugees. Therefore, the aim of this study was to evaluate the oral health of refugees and to estimate the costs of oral care.MethodsThe study was conceptualized as a pilot study. The study participants were refugees who lived either in collective living quarters or at a reception center in a region of the federal state of Schleswig-Holstein, Germany. The cross-sectional design was complemented by dental screening. Data were collected from August 2016 until July 2017. The basic condition of the teeth was evaluated using a convenience sample by a single dentist. The assessment of caries was carried out visually in accordance with the International Caries Detection and Assessment System from code 3 and higher. The DMF-T (decayed, (D), missing, (M), filled (F), teeth (T)) index was calculated. The costs of oral care were analyzed for conservative treatment (filling or extraction) and for prosthetic treatment (missing teeth) in the form of a bridge or crown.ResultsThe dental screening was attended by 102 refugees, with a mean age of 28 years. A total of 49% of the study sample suffered from toothache, and the DMF-T index had a mean of 6.89. For 92% of the study sample, treatment was indicated, and a cost estimate of the treatment could be calculated. The average cost of conservative treatment was estimated to be 205.86 EUR, and the average cost of prosthetic treatment was estimated to be 588.0 EUR. The oral healthcare costs of the different treatment procedures were higher for refugees that presented with toothache than for those without toothache, with the exception of prosthetic treatment procedures.ConclusionsThere is a lack of population-based data that survey the oral health status of refugees. Therefore, the current study presents an initial overview regarding the oral health status and the potential costs of oral healthcare of refugees.

Where the Mind Meets the Mouth – an integrated and collaborative health care approach

Background: The majority of the cost of oral health care in Australia is borne by individuals, hence many miss out on early, cost-effective care. 63,000 Australians are hospitalised annually for preventable oral conditions. Current approaches separate the provision of oral from general health care. Australia’s National Oral Health Plan recognises oral health as everyone’s business and a role for health care workers and carers to intervene early in oral disease. Objectives: To present an innovative approach to primary oral health care focussed on patient centred care, workforce reorientation, health promotion and prevention and the integration of oral and general health. Methods: North Richmond Community Health (NRCH), an inner urban community health service, in Victoria, Australia, through developing an innovative oral health program, has also developed a conference series Where the Mind Meets the Mouth WMMM (www.wheremindmeetsmouth.com.au) to inform the integration of oral health and general health. In 2015 the inaugural conference explored significant social determinants in oral and general health, such as substance use, mental illness and family violence. In 2016, the second conference, Putting the Mouth back into the Body, examined common risk factors for oral and general diseases, and working with other health professionals (eg. doctors, pharmacists, nurses). Results: WMMM has raised awareness amongst health professionals of the impact of oral health on general health and vice versa. A national research network committed to integration of oral and general health has been established, and a model of diabetes management that includes oral health has been proposed for trial. Conversations about Care, 2018, places the consumer at the centre of informing integrated health care provision. Conclusion: By responding to community needs, encouraging dialogue and sharing between consumers, health professionals and carers, we can truly collaborate in the delivery of primary preventive integrated health care, bringing the mind, body and mouth together.

Costs of a school-based dental mobile service in South Africa

BackgroundThe burden of untreated tooth decay remains high and oral healthcare utilisation is low for the majority of children in South Africa. There is need for alternative methods of improving access to low cost oral healthcare. The mobile dental unit of the University of the Witwatersrand (Wits) has been operational for over 25 years, providing alternative oral healthcare to children and adults who otherwise would not have access. The aim of this study was to conduct a cost-analysis of a school based oral healthcare program in the Wits mobile dental unit. The objectives were to estimate the general costs of the school based program, costs of oral healthcare per patient and the economic implications of providing services at scale.MethodsIn 2012, the Wits mobile dental unit embarked on a 5 month project to provide oral healthcare in four schools located around Johannesburg. Cost and service use data were retrospectively collected from the program records for the cost analysis, which was undertaken from a provider perspective. The costs considered included both financial and economic costs. Capital costs were annualised and discounted at 6 %. One way sensitivity tests were conducted for uncertain parameters.ResultsThe total economic costs were R813.701 (US$76,048). The cost of screening and treatment per patient were R331 (US$31) and R743 (US$69) respectively. Furthermore, fissure sealants cost the least out of the treatments provided. The sensitivity analysis indicated that the Wits mobile dental unit was cost efficient at 25 % allocation of staff time and that a Dental Therapy led service could save costs by 9.1 %.ConclusionsExpanding the services to a wider population of children and utilising Dental Therapists as key personnel could improve the efficiency of mobile dental healthcare provision.

The healthcare system and the provision of oral healthcare in European Union member states: Part 5: Romania.

Romania is one of the newest member states of the European Union (EU). It has 13 dental schools, 14,841 dentists and 2,935 dental technicians providing oral health care for a population, at 31 December 2014, of 21.3 million. The shift from a communist system to a democratic or capitalist society has contributed to an enormous change in the proportion of public and private sector oral health services. The lack of public funds during the post-communist years has contributed to a dependency on private oral healthcare rather than the government financed public provision. Affordability and social awareness have together established a mixed economy for oral health care costs and oral healthcare is growing slowly compared with other developed EU member states. At the same time, there has been overproduction of new dentists (currently 1500 graduate annually). This has led to un and under-employment and emigration of dentists to other EU member states. This paper explains the current oral healthcare system in Romania and changes in recent years.

Investments and costs of oral health care for Family Health Care.

ABSTRACTOBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy.METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described.RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%.CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the team’s operational cost.

Patient Stratification for Preventive Care in Dentistry

Prevention reduces tooth loss, but little evidence supports biannual preventive care for all adults. We used risk-based approaches to test tooth loss association with 1 vs. 2 annual preventive visits in high-risk (HiR) and low-risk (LoR) patients. Insurance claims for 16 years for 5,117 adults were evaluated retrospectively for tooth extraction events. Patients were classified as HiR for progressive periodontitis if they had ≥ 1 of the risk factors (RFs) smoking, diabetes, interleukin-1 genotype; or as LoR if no RFs. LoR event rates were 13.8% and 16.4% for 2 or 1 annual preventive visits (absolute risk reduction, 2.6%; 95%CI, 0.5% to 5.8%; p = .092). HiR event rates were 16.9% and 22.1% for 2 and 1 preventive visits (absolute risk reduction, 5.2%; 95%CI, 1.8% to 8.4%; p = .002). Increasing RFs increased events (p < .001). Oral health care costs were not increased by any single RF, regardless of prevention frequency (p > .41), but multiple RFs increased costs vs. no (p < .001) or 1 RF (p = .001). For LoR individuals, the association between preventive dental visits and tooth loss was not significantly different whether the frequency was once or twice annually. A personalized medicine approach combining gene biomarkers with conventional risk factors to stratify populations may be useful in resource allocation for preventive dentistry (ClinicalTrials.gov, NCT01584479).

Caregivers’ Health Literacy and Their Young Children’s Oral-health–related Expenditures

Caregivers’ health literacy has emerged as an important determinant of young children’s health care and outcomes. We examined the hypothesis that caregivers’ health literacy influences children’s oral-health-care–related expenditures. This was a prospective cohort study of 1,132 child/caregiver dyads (children’s mean age = 19 months), participating in the Carolina Oral Health Literacy Project. Health literacy was measured by the REALD-30 (word recognition based) and NVS (comprehension based) instruments. Follow-up data included child Medicaid claims for CY2008-10. We quantified expenditures using annualized 2010 fee-adjusted Medicaid-paid dollars for oral-health–related visits involving preventive, restorative, and emergency care. We used descriptive, bivariate, and multivariate statistical methods based on generalized gamma models. Mean oral-health–related annual expenditures totaled $203: preventive—$81, restorative—$99, and emergency care—$22. Among children who received services, mean expenditures were: emergency hospital-based—$1282, preventive—$106, and restorative care—$343. Caregivers’ low literacy in the oral health context was associated with a statistically non-significant increase in total expenditures (average annual difference = $40; 95% confidence interval, -32, 111). Nevertheless, with both instruments, emergency dental care expenditures were consistently elevated among children of low-literacy caregivers. These findings provide initial support for health literacy as an important determinant of the meaningful use and cost of oral health care.

Summary of: An analysis of patient expenditure in the GDS in Scotland 1998-2007

Introduction The purpose of this paper is to examine the size and variability of patients' expenditure in the general dental service (GDS) in Scotland during the recent past. Methods Retrospective analysis of individual patient's expenditure drawn from a 5% random sample of patients treated in the GDS in Scotland between January 1998 and September 2007. Three measures of expenditure per patient were used to assess the size and variability of patients' expenditure in the GDS: patient expenditure per claim, patient expenditure during a 12-month period and patient expenditure during the sample period. Results The size of patients' expenditure on the GDS is small relative to non-NHS insurance arrangements and other components of personal expenditure. There is relatively little variability in patients' GDS expenditure. Conclusions The relatively small size and variability of patient expenditure in the GDS in Scotland suggests that the system of patient charges provides some insurance against the cost of oral healthcare. However, a complete assessment of the insurance properties of the system of patient charges would require several other factors to be accounted for.

An analysis of patient expenditure in the GDS in Scotland 1998–2007

Introduction The purpose of this paper is to examine the size and variability of patients' expenditure in the general dental service (GDS) in Scotland during the recent past.Methods Retrospective analysis of individual patient's expenditure drawn from a 5% random sample of patients treated in the GDS in Scotland between January 1998 and September 2007. Three measures of expenditure per patient were used to assess the size and variability of patients' expenditure in the GDS: patient expenditure per claim, patient expenditure during a 12-month period and patient expenditure during the sample period.Results The size of patients' expenditure on the GDS is small relative to non-NHS insurance arrangements and other components of personal expenditure. There is relatively little variability in patients' GDS expenditure.Conclusions The relatively small size and variability of patient expenditure in the GDS in Scotland suggests that the system of patient charges provides some insurance against the cost of oral healthcare. However, a complete assessment of the insurance properties of the system of patient charges would require several other factors to be accounted for.

Risk assessment and management of periodontal disease

As our understanding of periodontal diseases has increased, it has become clear that certain risk factors are associated with the diseases' incidence, severity and progression. This article focuses on the role of risk assessment and disease management in improving patient outcomes, both in the general population and in specific population groups with an increased risk of developing periodontal disease or with associated comorbidities. The author reviewed literature related to the efficacy of risk assessment and periodontal disease management in improving clinical outcomes. In addition, he examined studies demonstrating a link between periodontal disease and specific patient populations and other comorbidities. Risk assessment can help predict a patient's risk of developing periodontal disease and improve clinical decision making. In turn, patient adherence to a self-care oral health regimen is a key component to successful periodontal disease management. The clinical practice of risk assessment may reduce the need for complex periodontal therapy, improve patient outcomes and ultimately reduce oral health care costs. Patients are encouraged to become actively involved in periodontal disease management by following a daily three-step regimen of brushing, flossing and rinsing with an antimicrobial mouthrinse.

Financing and Reimbursement of Elders’ Oral Health Care: Lessons from the Present, Opportunities for the Future

This article describes current financing and reimbursement for elders' oral health care and presents innovative options and opportunities for the future. Current health and dental care financing data from the Centers for Medicare and Medicaid Services and Agency for Health Care Research and Quality are reviewed. Existing and potential reimbursement options for the future are presented. Options for future financing and reimbursement include extending dental insurance into retirement, inclusion of oral health care into existing comprehensive health care plans, developing retiree plans for selected, well-defined (by the sponsor) groups of retirees, pre-paying dental care during employment, development of an Elders Health Insurance Program for the poor and near poor, and developing optional "Part D (for Dental)" plans within the Medicare program. Given the absence of universal oral health insurance, a mix of financing options and reimbursement schema will be required to cover the costs of oral health care and eliminate disparities in oral health access and outcomes for the growing elderly population.