Throughout the nearly year-long national debate on health care reform, there has been curiously little discussion of dental care. And that's worrisome; if people go years without seeing a dentist, oral disease can lead to a lifetime of bigger health problems.

According to Jack Bresch, director of public policy and advocacy official with the American Dental Education Association, there are some "very good" provisions in the pending legislation, like a requirement that pediatric dental care be included for children up to 21 years of age. Other measures would offer loan repayment programs for dental school faculty and make dental schools eligible for some federal grants that currently only medical schools can apply for.

But there's little for adult health care, even though some statistics say that at least 85 million people in this country go without dental care benefits.

Bresch says that dental care of any kind has long been ignored in discussions of public healt benefits. "For whatever reason, there were no meaningful measures [regarding oral care] in Medicare when it was created in the 1960s," he says.

However, he and others in the dental industry say there was a sea change among policymakers in Washington when the tragic case of Diamonte Driver made national headlines in 2007.

Driver was a 12-year-old Maryland boy who lacked access to dental care, and whose mother had neither insurance nor Medicaid. He came down with a toothache caused by an abscess. The problem could have been alleviated with a routine $80 tooth extraction, but the bacteria from the abscess spread to his brain. Two surgeries and $250,000 later, he died.

Bresch said that the incident spurred lawmakers to stress the importance of oral health. When President Obama signed the reauthorization of the Children's Health Plan last year (known as S-CHIP), there was for the first time, he says, a guaranteed dental program "that was specifically a result of the increased awareness because of Driver."

Trying to bring in more of the medically uninsured while simultaneously trying to reduce "the cost curve" has vexed Democrats and the president this year, as it has previous Democratic administrations. The Senate health measure passed on Christmas Eve would insure 31 million Americans.

But oral health? The debate on addressing adults without any coverage has been a non-starter all year. And the states have done little on the issue either. As Bresch says, "One of the first benefits to be cut by a governor looking to trim their budget is adult oral health care." Another measure that his group is working on is to increase Medicaid reimbursement payments for dental care.

But the bottom line is, help for adults without dental care is not being addressed in current legislation. And considering how difficult the battle for medical care has been, don't expect dental to be tackled any time soon.

This article appears in Mar 3-9, 2010.