With the roll-out of the Affordable Care Act, one discipline has been largely absent from the regulations: dentistry.
"Right now, dentistry is not included in the ACA," said Dr. Steve Holm, president-elect of the Indiana Dental Association.
Holm, a dentist with Airport Road Dental Associates in Portage, said opinions are divided among dentists about their lack of a place in health care reform. Some believe it has not gone smoothly so far, and others support the effort to make health care more available, he said.
"I think the approach is cautious," he said. "We want to be at the table, but we want to see how it will involve us."
Dental organizations find ways to meet the oral health care needs of those in need.
"We're trying to do something to solve the access to care problem," Holm said.
People can get care at local universities, such as Indiana University Northwest. Or they can participate in multiday blitzes, such as Mission of Mercy.
"We just see patients that don't have the funds to go elsewhere," he said.
Indianapolis is expected to host such an event this fall or in spring 2015, he said.
In LaPorte, local dentists participated in Operation Stand Down, a program providing dental care for military veterans. After the initial visit, patients were paired with local dentists for follow-ups, Holm said.
And most dentists participate in a Donated Dental Services program that provides care for people meeting certain income requirements.
Dentists often are involved in charitable treatment, said Dr. Loren Feldner, a dentist who sits on the board of directors for the Chicago Dental Society.
"There's a huge philanthropic arm," he said.
Feldner said dentistry got involved in some unintended consequences of the Affordable Care Act.
One consequence is determining whether dentists fall under the 3 percent medical device tax requirement.
Dentists wonder whether mouth guards or the wire and brackets for orthodontia are considered medical devices, Feldner said.
Even with expanded care and charitable care, only 50 percent of people visit a dentist, a number that hasn't changed since 1980, Feldner said. Some are scared, and some don't make time for it.
"It's not a priority — their dental care," he said.
The American Dental Association estimated 8.7 million children could gain extensive dental coverage through the Affordable Care Act by 2018. About 17.7 million adults could gain some sort of coverage, the association estimated.
For children, the expansion will be almost evenly split among Medicaid (3.2 million), health insurance exchanges or marketplaces (3 million) and employer sponsored insurance (2.5 million), the associated estimated.