杨贵妃传媒視頻

Millions of people each year are skipping out on their annual trip to the dentist. And it鈥檚 not because they鈥檙e afraid of the drill.

Many people a dentist or can鈥檛聽pay for a visit:聽 33.3 million Americans live in a region with a shortage of dental professionals; kids, seniors and minorities are particularly vulnerable.

And because dental care usually isn鈥檛 provided as part of a standard health insurance package, even under Medicare, many Americans simply can鈥檛 afford it. In 2008, 4.6 million kids skipped their dental checkups because their families couldn鈥檛 pay, and in 2006, only 38 percent of retirees had dental coverage.

But a has some ideas on how to improve dental access, including recruiting more dental students from minority, low-income and rural populations to serve the neediest areas. The IOM also recommends investigating ways to expand Medicaid dental coverage for adults (Medicaid currently only requires dental coverage for kids) and increasing reimbursement rates for providers.聽According to a by the CDC鈥檚 Sandra Decker, in today鈥檚 Journal of the American Medical Association,聽paying more increases the number of kids who get regular teeth cleanings.

But some players in the world of teeth may be unhappy with the IOM report.

That鈥檚 because the IOM also recommends that states change their laws to allow dental hygienists, assistants and other professionals to take on a greater role in treating patients. Right now, the laws dictating what types of procedures dental hygienists and assistants are allowed to provide varies greatly by state. 聽Restrictive laws, the IOM writes, may result in states missing 鈥渃ritical opportunities to serve greater numbers of individuals in need of care鈥� where there are not enough dentists to meet the needs of the local population.

But advocates for dentists, including the American Dental Association, have for years against allowing anyone except dentists to extract teeth and fill cavities. In for example, a program to train ordinary citizens as 鈥渄ental therapists鈥� to reach the small villages scattered throughout the sparsely populated state was met with harsh criticism. The ADA even sued to block the program, saying therapists could end up doing harm to patients. The case was later dropped.

The new health law passed by Congress also includes a to expand the services dental hygienists and aides can provide in rural areas, including pulling teeth and filling cavities. The program, however, has not yet been funded. The ADA isn鈥檛 complaining. 鈥淲e didn鈥檛 want this concept to get a foot in the door,鈥� an ADA spokesman told Kaiser Health News last month.