Poor oral health affects more than just the mouth. It can seriously compromise a person's general health, quality of life and life expectancy. Oral diseases can and do lead to systemic problems--damaging other parts of the body and resulting in the need for expensive emergency department visits, hospital stays and medications. The consequences of poor oral health, however, go far beyond damaging medical effects. Oral disease can also wreak economic havoc--keeping children out of school and adults home from work--not to mention lower productivity of workers in pain. Untreated oral diseases can also drive up health care costs in general. The good news is that with proper oral health care, both at home and in professional settings, many of the negative consequences associated with poor oral health can be prevented. The State of Texas has a unique and unprecedented opportunity to significantly increase access to oral health care for all Texans. Complying with the Frew agreement is a key priority. However, there are additional ways that Texas policymakers can improve the oral health of the state. In an effort to begin a constructive dialogue about improving the oral health of all Texans, the Texas Dental Association (TDA) with grant funding from the American Dental Association (ADA) commissioned an independent third-party report on the issue of access to oral health care in Texas modeled after the 2000 groundbreaking surgeon general's report, Oral Health in America. The TDA assembled a team of five nationally recognized dentists from both academia and private practice to oversee the project. The dentists (hereafter called the editorial review board or ERB) were asked to identify the state's most pressing issues, needs and challenges associated with improving the oral health of all Texans, with a special focus on the state's most vulnerable. The ERB looked carefully at the economic, medical and social consequences of untreated oral disease in Texas. It reviewed the current systems of oral health care delivery and payment throughout the state. The team also studied the oral health status of Texans in general and analyzed the oral health disparities that exist in the state. Finally, the ERB made specific and practical policy recommendations to expand access to oral health care in Texas, including: 1) Identifying a "dental home" for every Texan. 2) Strengthening the Texas Department of State Health Services (DSHS) Oral Health Program (OHP). 3) Creating new programs to encourage general dentists and specialists to practice in underserved areas and to treat underserved populations. 4) Developing a comprehensive oral health public awareness and education campaign. 5) Expanding access to oral health services for older Texans. As the face of Texas continues to change, the state must put in place a new, more aggressive strategy to improve access to oral health care. This challenge must be approached as a shared responsibility--among dentists, allied health professionals, primary care providers, policymakers, community-based organizations, parents and schools. The job is too big--and too important--for any one group to try to tackle alone. The time to act is now.