We thank Dr. Shorey for his insightful comments. The causes of oral health disparities and the barriers in access to care are multiple. While disproportionately affecting the poor, uninsured working families, the disabled, and racial and ethnic minority groups, it is clear that the problems are not solely economic in nature. While financial solutions are a necessary prerequisite to addressing disparities and access issues, it also is clear that financial solutions are by themselves insufficient.
As the problems are multifactorial in nature, so must be the solutions. In this regard, Dr. Shorey is correct in noting that knowledge, attitudes and behaviors (such as oral self-care activities, dietary habits, etc.) are important components to be addressed in our efforts to understand and eliminate oral health disparities. In this regard, the NIDCR-supported oral health disparities research center in Detroit is focusing on just such issues.
Improving oral health literacy will be one essential component, along with financial and health systems solutions, to eliminating oral health disparities. In addition, it will also be essential to significantly improve the cultural competence of oral health care providers in order to solve the disparities problem. In this regard, it will also be necessary to better educate dentists to provide care for special needs patients. We fully agree with Drs. Perlman and Waldman that persons with developmental and physical disabilities have significant unmet oral health care needs.
While the focus of our JADA article was limited by space to describing the work of the five NIDCR-funded Centers for Research to Reduce Oral Health Disparities, the NIDCR’s commitment to improving the oral health of these special populations is outlined in its "Plan to Eliminate Craniofacial, Oral and Dental Health Disparities."1 Individuals with disabilities, both physical and mental, are specifically identified as a disadvantaged and underserved population subgroup, and as a focus for oral health disparities research.
To that end, NIDCR launched, in December 2003, a research funding opportunity entitled "Oral Health of Special Needs and Older Populations" (PA-04-031),2 which targets directly the authors’ concerns. The Institute is actively soliciting proposals for clinical research on an array of topics focused on improving the oral health status and quality of life of people with physical, intellectual and developmental disabilities.
We urge Drs. Perlman and Waldman, and the many others dedicated to serving special needs patients, to bring their expertise to the pursuit of research support through this unique funding opportunity.
The ultimate elimination of oral health disparities depends on strong support for a broad-based and adequately funded research agenda. Further, the combined efforts of the research and practice communities will be essential to achieving the necessary policy changes needed to translate research into action.
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