MEDICINE The Oral Health Debate

Running head: THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 1

The Oral Health Debate: Why Your Mouth Matters

Student’s Name

Institutional Affiliation

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 2

Contents

The Oral Health Debate: Why Your Mouth Matters ...................................................................... 4

Abstract ........................................................................................................................................... 4

Introduction: Why Oral Health Matters .......................................................................................... 4

The Burden of Poor Oral Health ..................................................................................................... 6

Burden to Children ...................................................................................................................... 7

Burden to Adults ......................................................................................................................... 8

Barriers to Care ............................................................................................................................... 9

Cost Difficulties .......................................................................................................................... 9

Medicaid .................................................................................................................................. 9

Medicare ................................................................................................................................ 10

Affordable Care Act .............................................................................................................. 10

Emergency Rooms (ER) ........................................................................................................ 11

Access to Dental Hospitals ........................................................................................................ 11

Overall Dental Shortage especially in Rural Areas ............................................................... 11

Health Literacy Issues ............................................................................................................... 12

Lack of Diversity in Dentistry ............................................................................................... 12

Ethnic Disparities in Oral Care .............................................................................................. 13

Oral Health and its Relationship with Systemic Diseases ............................................................ 14

Diabetes ..................................................................................................................................... 14

Cardiovascular Heart Disease ................................................................................................... 14

Chronic Obstructive Pulmonary Disease .................................................................................. 15

Adverse Pregnancy Outcomes .................................................................................................. 15

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 3

Risk Factors for Poor Oral health and what to do ......................................................................... 16

Smoking .................................................................................................................................... 16

Diet ............................................................................................................................................ 17

Medication ................................................................................................................................. 17

Policy Changes: What is being done and what can be done ......................................................... 17

Federal Programs....................................................................................................................... 18

Healthy People 2020 .............................................................................................................. 18

Expansion of Medicaid .......................................................................................................... 18

State Programs........................................................................................................................... 18

Mid-levels in the Oral Health Field........................................................................................... 19

Dental Hygienists .................................................................................................................. 19

Dental Therapists ................................................................................................................... 19

Community Program Initiatives and Startups ........................................................................... 20

Water Fluoridation ................................................................................................................. 20

Sealant Programs ................................................................................................................... 20

Partnering with Dental Schools ................................................................................................. 21

What Health Providers can do? ................................................................................................. 21

Changing Perceptions ............................................................................................................ 21

Health Foundations and Organizations for Oral Health ........................................................ 22

Improving Oral Health Exam ................................................................................................ 22

Patient Education ................................................................................................................... 23

Conclusion .................................................................................................................................... 23

References ..................................................................................................................................... 24

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 4

The Oral Health Debate: Why Your Mouth Matters

Abstract

The state of oral health in the United States has been poor for a long time despite the

growing realization that oral health is inextricably linked with overall health. The burden of oral

health issues is particularly felt by children who have to forego many schooling hours to attend

dental visits, adults who have to forfeit work to seek dental care and aged people above 60 who

are at a high risk of oral health issues. The difference in access to oral care varies between ethnic

groups, with socio-economic status also being an important determinant of oral care. This paper

will address the burden of oral care to individuals and healthcare system in relation to risk of

systemic diseases and cost and propose policy and program solutions to the problem.

Introduction: Why Oral Health Matters

The connection between oral health and overall general health has long been established.

The World Health Organization’s definition of health as a starting point offers an all

encompassing perspective on health thus: “A complete state of physical, mental, and social well-

being and not just the absence of infamy” (U.S. Department of Health and Human Services,

Centre for Disease Control and Prevention, and National Centre for Health Statistics, 2016, pp.

4). Ipso facto, oral wellness constitutes general body health as well. But it is also important to

understand oral health, its definition and import, before attempting an exploration of its

relationship with the overall body. Oral refers to the mouth, and extends to the teeth, gums, and

supporting tissues to include “ligaments, bones, hard and soft palate, soft mucosal tissue lining of

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 5

the mouth and throat, tongue, lips, salivary glands, chewing muscles, and lower and upper jaws”

(Branch-Mays, Pittenger, Williamson, Milone, Heinn, & Thierer, 2017, pp. 1416). Oral also

covers craniofacial structure which includes oral and nerve tissues that connect different parts of

the brain and face to the mouth. Any health issue to any of the itemized parts could impair the

ability to chew, taste, smile, talk, and express emotions. Oral health therefore refers to the

wellness of all this parts and not just healthy teeth.

Oral health is crucially essential to the overall health for children and adults. An

unhealthy mouth or any other organ makes it difficult to chew and thus deprives the body off

essential nutrients. As social aspect is an important determinant of health as defined by WHO,

inability to speak because of pain or bad breath undermines interaction and lowers self esteem.

Being the gateway to the body, the mouth could also offer important insights into the general

health of the body. A mouth lesion for instance is often used as the first test for HIV Aids

(Russel, 2010). Weak and bleeding gums may be used to show early signs of disorders in the

blood while change in teeth coloration may indicate signs of bulimia (U.S. Department of Health

and Human Services, 2014). Similarly, bacteria can use the mouth as a window to get into the

body and cause infections especially where the immune system is weak or altered by medication

and other substances. In extreme cases that highlight the closer connection between oral health

and overall health, periodontal disease has been found to have causative and predisposal

relationship with several systemic conditions. A number of cardiovascular diseases and certain

types of cancer have been found to have close relationship with periodontal disease. A

realization that oral health and overall health are inextricably intertwined is therefore crucially

vital in formulating holistic health policies.

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Despite the high prevalence of oral health issues and the established connection with

overall health, the state of oral health in America is dire. A surgeon general report of 2000

described America’s oral health as a “silent endemic” which not only imposes an enormous

burden on the society but also lowered the quality of life (Mayberry, 2017). As the government’s

cavalier attitude persists, the public too has shown similar indifference. Poor dentition is

considered by many in America as a sign of poor hygiene and poor social status. Moreover,

many people find tooth decay embarrassing and would rather visit the dentist regularly than

undergo proper treatment to correct the problem. The two conditions namely the attitude of the

state and the people have denied oral health the policy, funding, and awareness it deserves and

thereby burdened the society and individuals with associated chronic problems as shall be

explored imminently. This paper will address the oral care debate as it relates to the burden it

brings about, barriers to care, and relationship with systemic diseases and other risk factors.

Moreover, the paper will propose reforms at federal, state, curriculum, and health providers’

level to give oral care the prominence it deserves.

The Burden of Poor Oral Health

The reality of oral health is that at one point in life, everyone will develop tooth cavity,

arguably the most common chronic oral health issue. America’s Centre for Disease Control

established that of adults aged 20 to 64, 91% had dental caries between 2011 and 2012 (Calvo,

Chavez, and Jones, 2016). Essentially, these people, children and adult, experienced one or more

of the burdens of poor oral health that include inability to chew and eat, speak and socialize, as

well as the potential to contract systemic diseases. These burdens varied from children to adults

as shall be discussed in the following pages.

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Burden to Children

In absence of proper and regular oral hygiene, children are highly predisposed to oral

health issues, the most prevalent one being tooth decay. The tragedy of tooth decay in children is

that it multiplies the risk of caries three-fold in adulthood, the consequence being a burdened

childhood and adulthood (Mayberry, 2017). Among kindergarten children alone, tooth decay has

a 44% prevalence that dwarfs all other diseases including asthma; the closest second (Russel,

2010). These children suffer delayed developmental and learning milestones that unless

remedied quickly may disadvantage a child in the long run.

The most common effect of tooth decay among children is malocclusion, which is simply

a misalignment of teeth in the lower from upper jaw. The result is that a child is unable to feed

properly and thus misses out on the many nutrients that a child requires (Russel, 2010). In the

absence of the nutritional nourishments, a child fails to mature physically as it ought to be the

case. Moreover, the child may miss nutrients essential to the development of a healthy brain and

cognitive development may be delayed.

Similarly, tooth decay causes delayed speech and reduces self-esteem. When a child

becomes aware of their tooth decay and begin to feel embarrassed, they may be hesitant to open

their mouth among strangers. The result is that the child is unable to exercise speech and

therefore ends up lagging behind peers. Moreover, the child may be hesitant to laugh, smile, and

interact with others. This lowers self-esteem and undermines the child ability to socialize.

Children with oral health issues also suffer lost time because of missing classes to attend

dental appointments, failure to concentrate in class because of tooth pain, and fear of

participating in class activities because of embarrassment. Mayberry (2017) estimates 51 million

hours are lost by children because of absence caused by tooth decay. The lost class time results

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into delayed learning which is often uncompensated. Unsurprisingly, most of these lost hours are

by children from poor families. This means that poor households miss out on the chance to

improve their status through education because of oral health issues.

Burden to Adults

Adults bear the bigger burden of oral health issues because of lost time, expenses, and

increased risk to dental and associated diseases. In terms of lost labor and working hours, a 2000

HHS report indicated that absence from work because of visit to dentists and ability to work lost

America 164 hours of work annually (Calvo, Chavez, and Jones, 2016). The loss affects the

productivity and economy of a country in addition to the pressure imposed on the healthcare

system.

Adults are more predisposed to oral health issues because of the declining immune

system and the fact that their teeth are permanent. Adults are generally more hesitant to visit

dental clinic whenever they have oral health issues with all statistics from the National Centre for

Health Statistics, CDC and independent research showing that less than two-third of the adult

population in the US attend clinic whenever they have dental issues (Mayberry, 2017).

Paradoxically, the risk increases of dental issues increases with age with 23% of adult population

in America aged 65 to 74 having serious dental issues (Mayberry, 2017). Commensurately, the

risk of periodontal disease, diabetes, oral ulcers and cancer increase with old age. The treatment

of these diseases is expensive thus adding a cost burden to adults and especially those in the

lower income bracket. Maddeningly, the barriers to care are many and complicated and

politicians continue to erect new ones as they change medical funding.

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 9

Barriers to Care

Despite the established connection between oral health and overall health and the burden

it causes for individuals and the society, access to oral case has remained out of reach to many

people. The most important barriers relate to difficulty with cost, access to dental services, and

ethnic disparities in oral care. As relates to cost, Medicaid and Children’s Health Insurance

Program, Medicare, Affordable Care Act and ER visits have failed to reduce the cost difficulties

on patients. Regarding access to services, shortage of dentist, literacy levels, and lack of cultural

diversity reduce access to oral care. Concerning ethnic disparities, minority races have more

difficulty accessing care because of systemic, systematic, and cultural issues.

Cost Difficulties

Cost remains the leading factor that bars access to dental services with research showing

that only one in five adults can afford dental care (Calvo, Chavez, and Jones, 2016). The low

income earners are more adversely affected by the cost factor because treatment has to compete

with other more pressing and basic needs. The number of uninsured adults in America has

remained a consistent 36.2% in the last four years (Calvo, Chavez, and Jones, 2016). It is

indicting that little has been done to insure more Americans generally and specifically to cover

oral health. Medicaid and Children’s Health Insurance Program, Medicare, Affordable Care Act

and ER visits, as shall be discussed in the following pages, have not changed the situation

especially as it relates to cost.

Medicaid

Medicaid is an insurance program funded by the state and federal government to provide

assistance to low-income populations who would ordinarily not afford healthcare. The program,

as currently conceptualized and implemented, covers oral issues for children but not adults.

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 10

Moreover, dental care provision under the program is left to the discretion of individual states.

Sixteen states limit coverage for oral health except when it entails extraction of a tooth likely to

cause other infection (Calvo, Chavez, and Jones, 2016). Other states impose a limit on the

amount an individual under the cover can use per year.

Besides the limitations imposed by the Medicaid program, 80% of dentists do not accept

Medicaid patients (Calvo, Chavez, and Jones, 2016). Dentists are discouraged by the low

reimbursement rates which can fall as low as 50%. Conversely, private insurance offer higher

reimbursement rates. Moreover, Medicaid continues to be unpopular with dentists as most

patients under the program do not show up for appointments, the administrative and

credentialing regulations are bulky, and patients do not adhere to treatment plans (Calvo,

Chavez, and Jones, 2016). As currently implemented, Medicaid does not solve the cost problem

of access to oral care.

Medicare

The program is funded by the federal government and covers people above 65 years as

well as those with special needs. The program increased the number of insured Americans to

60% because of the enrollment of retirees (Calvo, Chavez, and Jones, 2016). However, it does

not have dental cover, which is quite ironical as adults above 65 years are predisposed to oral

health issues. The program leaves out the more than 23% adults over 65 years and is thus not

helpful in reducing cost difficulties (Mayberry, 2017).

Affordable Care Act

The program only has dental coverage for children but not adults. Since inception, the

Affordable Care Act has reduced the number of uninsured children to 11% in 2014 (Calvo,

Chavez, and Jones, 2016). Since the benefits of good dental care at childhood persist to

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 11

adulthood, the program is important, though minutely so, in addressing cost problems. However,

like Medicaid and Medicare, it leaves out the most vulnerable population, adult above 65 years.

Emergency Rooms (ER)

The emergency room is becoming a resort for many Americans as a patient presenting the

ER must be attended by the doctor regardless on insurance status (Calvo, Chavez, and Jones,

2016). Unfortunately, most ERs do not employ dentists and thus many do not end up receiving

the care they deserve. Patients end up being seen by physicians who mostly recommend

painkillers, hardly what is needed for most oral health issues. From the analysis of the four

funding system, it is clear that none addresses the problem of cost.

Access to Dental Hospitals

Access to dental hospitals has been gradually decreasing since the baby boom because of

fewer dental graduates, movement from and general refusal to work in rural areas, and lack of

diversity in the profession. The American Association of Dental Schools report that since 2014,

the number of dentists has been reducing and the situation is only getting worse as dental schools

are closing, including the prestigious Georgetown University in Washington that has since

abandoned its dental faculty.

Overall Dental Shortage especially in Rural Areas

Overall, the US is suffering from a declining number of nurses with the rural areas being

the worst hit. In the 1982 academic year, the US produced slightly above 5700 dentists (Collier,

2009). Over the next quarter decade, the US population has increased by a third while the

number of dentists has reduced to 4700 grandaunts every year (Collier, 2009). The 700 dentists’

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entering the profession annually has been consistent over years but the imminent retirement of

the baby boomer generation dentists is likely to create a deficit that the market cannot fill.

The rural areas have been worst hit by the prevalent dentist crisis. The South West,

Plains, and New England are the areas worst hit by the crisis. While the national ratio stands at

about 1 dentist for 1,700 people, some rural areas such as South Dakota have one dentist serving

more than 2,300 (Collier, 2009). The shortage in rural areas is attributable to financial incentives

with many dentists preferring to work in urban areas where they would get more money.

Moreover, the Medicaid program as adopted in many rural states does not cover the whole costs

and dentists have to content with low reimbursement rates.

Health Literacy Issues

High health literacy is directly related to better oral health. An overwhelming body of

research shows that general literacy and health literacy in particular translate to better oral

healthcare (Russel, 2010). Strikingly, health literacy is linked to gender, education, and financial

status. A research by (Collier, 2009) showed that women have better oral health than men

because of health literacy and personal reasons. Women are generally more conscious about their

appearance and are thus more likely to seek primary and secondary oral care. The same research

also shows that Whites reported better oral care than Blacks. The ethnic differences in access to

oral care are linked to education and financial status. The more educated a person is the easier it

is for them to access and understand health information. Similarly, more financially stable people

can afford private insurance or paying out of their pockets for oral care.

Lack of Diversity in Dentistry

The dentistry profession is one of the most unequal workforces in terms of diversity and

minority representation. In 2015 for instance, only 15% of students enrolled to study dentistry

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were from the minority communities of African Americans, Latinos, and Native Americans

(Mertz, Wides, Kottek, Calvo, Gates, 2017). The underrepresentation is quintessentially systemic

and systematic as these communities combined are outnumbered by Whites many times. The

consequence of lack of diversity is a crop of dentists who lack the cultural competency to work

in areas dominated by minorities. Research shows that when patients sight a dentist of their

ethnic orientation, they feel more comfortable and are likely to communicate better and establish

a good doctor-patient relationship (Collier, 2009). Moreover, a dentist serving his people is better

positioned to understand the root of the problem as well as recommend traditional solutions.

Moreover, the dentist may be a role model to the minority and underrepresented community and

inspire more people to join the dentistry profession.

Ethnic Disparities in Oral Care

Research by Mertz, et. al (2017) established great ethnic disparity in oral care in

America. For children, Hispanics followed by Blacks had the poorest oral care especially as

compared to Whites. Hispanics and Blacks had the lowest preventive and curative access to oral

care. These differences could be explained in terms of the socio-economic status. Children from

Black and Hispanics families were unable to access oral care because of poverty and low

maternal education. Their parents did not have the health literacy to understand pertinent health

issues nor the economic power to afford oral care. Similarly, these ethnic groups were more

likely to have single parents who more often than not only afforded the basic things of life.

Importantly, the Blacks and Hispanic also ranked the lowest in terms of insurance. In states

where Medicaid does not cover oral health, oral care among these two ethic groups was found to

be the poorest.

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 14

Oral Health and its Relationship with Systemic Diseases

The mouth is the window of the body and thus could provide entry for virus and bacteria

especially where the gum has been eroded and the immune system compromised. The following

pages will explore selected systemic diseases and their relationship with oral health issues.

Diabetes

Many patients with periodontal disease have diabetes mellitus and many patients with

diabetes eventually get periodontal and close gum diseases. The trend has prompted deeper

research to understand whether the relationship between the two diseases is causative or merely

correlative. One such study is the review of literature to identify how oral health issues are

affected by diabetes (Branch-Mays, Pittenger, Williamson, Milone, Heinn, and Thierer, 2017).

Moreover, the same study carried out a close examination of diverse literature where periodontal

disease has been studied as a modifier of glycemic, the sugar that induces diabetes. The study

concluded that the periodontal disease resulted mostly from diabetes. Poor management of

diabetes in most cases resulted to the patient contracting periodontal. Similarly, periodontal

patients were at a very high risk of contracting diabetes because of the poor control of glycemic.

The comprehensive study therefore concluded that the relationship between diabetes and

periodontal disease was two-way whereby each could trigger the other.

Cardiovascular Heart Disease

A growing body of evidence suggests a close relationship between oral health issues and

cardiovascular diseases (Branch-Mays, et. al, 2017). Gum diseases, especially when allowed to

fester without medical care, provide entry points for bacteria and viruses that are transported to

the heart through the blood stream. These disease causing bacteria attach on the wall of the heart

and blood vessels and cause swelling and pain. The infection of the inner muscles of the heart is

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 15

manifest through diseases such as endocarditic and atherosclerosis. If the blood stream is

significantly obstructed, an individual may suffer a heart attack.

Gingivitis and periodontal diseases are the most predisposing oral health issues for

cardiovascular diseases. Therefore, care should be taken to diagnose and medicate the diseases

early. Basic oral hygiene should also be taken seriously as even a gum plague may offer entry

point into the blood stream for the bacteria that may cause inflammation and blockage of blood

vessels.

Chronic Obstructive Pulmonary Disease

Studies into the relationship between oral health issues and systemic diseases have

concluded that there is a strong link between periodontal disease and chronic obstructive

pulmonary disease (Branch-Mays, et. al, 2017). The more severe the oral health issue is the

higher the risk of the systemic disease. However, experts in the field have also clarified that poor

dental hygiene alone is not the cause of these systemic diseases. Other predisposing factors such

as smoking are equally important in analyzing the link. However, there is evidence to show that

poor oral hygiene contributes to faster progression.

Adverse Pregnancy Outcomes

The relationship between periodontal disease and adverse pregnancy outcomes has been

studied for a long time but with inconclusive outcomes. However, a strong body of evidence has

linked the gum disease with still birth (Han, 2011). In one study involving a treatment group and

a control group using a similar design, a difference in adverse pregnancy outcome was found

between the two groups. The group that was under treatment recorded lower rates of still birth.

The link between gum diseases and adverse pregnancy outcomes is to be found in the gum as the

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 16

entry point of bacteria into the blood stream. The bacterium is transported to the intrauterine wall

where it causes inflammation and swelling, making it impossible for the fetus to survive.

Risk Factors for Poor Oral health and what to do

Some practices have been found to pose great risk to oral health by introducing bacteria

and providing conditions for them to thrive. Moreover, some practices cause gum plague and

weaken the immune system, setting the stage for even more serious oral health issues.

Smoking

A 2014 Surgeon General Report detailed the risk factors associated with smoking and

tobacco ingestion that showed that more than 20 million deaths were caused by active and

passive smoking (U.S. Department of Health and Human Services, 2014). The mouth, being the

entry point of these tobacco products, was also affected in many ways. Smoking causes oral

cancer as it provides the point of entry into the body. The repeated exposure to the smoke leads

to high exposure to smoke which causes the mutation of cells in the mouth. In America, 8 out of

10 people diagnosed with oral cancer were smokers (U.S. Department of Health and Human

Services, 2014).

Smoking also increases the risk of gum diseases and the weakening of the bones of the

mouth including jaw and teeth. Smokers are twice likely to suffer from periodontal disease than

non-smokers (U.S. Department of Health and Human Services, 2014). Like in oral cancer, the

constant exposure to harmful chemicals through exposure to smoke provides a thriving

environment for bacteria. Moreover, smoking weakens the immune system making it easier for

bacteria to thrive. Smoking and tobacco affect the social health adversely as they cause bad

breath and stained teeth, making it impossible for smokers to enjoy healthy interactions.

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 17

Diet

A good, balanced diet is vital to good oral and general body health. However, many

people, especially children, prefer sugar-filled foods such as soda, sweats, and snacks. These

foods cause accumulation of plague in the mouth and around oral organs Branch-Mays, et. al,

2017. When this plague comes into contact with sugar, the resulting acid attacks the teeth and

gum leading to tooth decay, the most chronic oral health issue especially for children.

Medication

Some of the prescription drugs or those bought over the counter cause mouth dryness, a

condition that puts the mouth and supporting tissue at the risk of infection. Saliva plays an

important role in keeping the oral cavity healthy. First, saliva dissolves plague and prevents it

from forming on teeth. Without the saliva, mostly as a result of the side effects from certain

medications, the risk of plague formation on teeth, and subsequently, teeth decay increases

(Branch-Mays, et. al, 2017). Moreover, the dry mouth is susceptible to fungal infection. People

who use inhaling medication for instance have been found to be at a higher risk of oral

candidiasis.

Policy Changes: What is being done and what can be done

The combination of oral health issues discussed in the previous pages can be addressed

through several policy changes. At the federal and state level, programs to create health literacy

and expand funding of oral health can be created and implemented. At the community and health

services provision level, simple changes can bring about profound transformation of the state of

oral health in America.

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 18

Federal Programs

Healthy People 2020

The Healthy People Program is an example of what is being done by the federal

government in relation to promoting oral health. Importantly, seventeen of the program’s

objectives address the oral health issue, a refreshing realization of the important link between

oral health and overall health. The oral health objective of the program is to “prevent and control

oral and craniofacial diseases, conditions, and injuries, and improve access to related services”

(U.S. Department of Health and Human Services, 2014, pp. 6). Moreover, oral health is

recognized as a leading health indicator under the program.

Expansion of Medicaid

As currently constituted, Medicaid does not cover oral health in all states. The federal

government should expand it to cover adult dental health everywhere. Moreover, the federal

government can improve its acceptance by dentists by increasing reimbursement rates. The

federal government should also improve remuneration for dentists and provide incentives in rural

areas to address the shortage crisis.

State Programs

Iowa is one of the states that accept Medicaid but it does not cover adults for oral health.

A federal level reform on Medicaid to include coverage of aging adults for oral health would

benefit Iowa as well. At the state level however, Iowa has initiated several initiatives for

improvement of the oral health of Iowans. Through the Oral Health Centre for instance, the state

has a program to enhance oral health and reduce oral diseases. Through this program, the state

targets expectant women, children, and young adults for primary and secondary oral care

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 19

(Russel, 2010). The program has targeted schools and public healthcare settings, and community

centers.

Moreover, Iowa has launched a health plan called Iowa Oral Health Plan 2016-2020

(Calvo, Chavez, and Jones, 2016). The program has five focus areas, each dealing with a distinct

area of oral health. Focus area one deals with oral health literacy and information, an

appreciation that a literate populace would make better health decisions. Focus area two deals

with systems of care and seeks to expand the I-Smile model of care to all Iowans by 2020. Focus

area 3 deals with medical and dental integration and seeks to increase oral health providers to

improve care. Focus area 4 seeks to improve the oral care and general infrastructure so that these

services can reach everyone by 2020. Finally focus area 5 deals with insurance and

reimbursement and seeks to create awareness of payment resources at the disposal of all Iowans.

Mid-levels in the Oral Health Field

Dental Hygienists

The norm of general and best health practices is that prevention is better than cure. Since

most oral health issues are related to hygiene, they are preventable, further accentuating the role

of dental hygienists who deal with prevention and oral health education. Basically, dental

hygienic can cut down oral diseases by encouraging people to on diet and dental hygiene. Their

efforts could reduce referral to dentists, hence their very important role n dental health.

Dental Therapists

Dental therapist can fill the gaps where dentists are unavailable or busy. In rural areas of

the US for instance, dental therapists can help fill the gap as they have skills to do basic dentistry

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 20

work such as tooth filling and extraction. Moreover, as the primary source of contact with

patients in many instances, therapists can advise on maintenance of oral hygiene.

Community Program Initiatives and Startups

Communities and private individuals can come up with programs and initiatives to

promote oral wellbeing.

Water Fluoridation

Water fluoridation is one of the oldest and most effective ways of minimizing tooth

decay. Research shows that addition of fluoride into drinking water in the United States led to a

25% decline in tooth decay among children and adults (Santos, Nadanovsky, and Oliveira,

2013). The fluoride not only strengthens teeth but also fights bacteria in the oral cavity that may

cause health issues. For those reasons, the World Health Organization and US Public Health

Service have approved water fluoridation especially for public water. The method is inexpensive

as the cost is met by the community and water providers. It is also effective and therefore

suitable for many people to whom oral care is a luxury.

Sealant Programs

Sealant programs are initiatives that pain a thin coat on molars to avoid cavities. The

sealing of the chewing surface are approved remedies for cavities especially for children and

adolescents. Moreover, the sealants play an important role in cavities protection where it has not

occurred yet. In the first two years of sealing, cavities reduce by 80% while in the next four years

it reduces by 50% (Santos, Nadanovsky, and Oliveira, 2013). The result is that children are able

to remain at school for longer and develop all their milestones at the right time. In the US, the

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 21

program should be expanded to all schools especially those in rural areas and poor

neighborhoods where access to oral care is limited.

Partnering with Dental Schools

As indicated earlier, many dental schools in the United States are closing their doors

because dentistry has become expensive to offer. Moreover, the ethnic composition of students is

such that the minority communities are underrepresented. These schools can partner with

respective states to address these issues. First, states can offer incentives for dental schools to

continue their operations in their areas of jurisdiction. Such incentives could involve tax

exemption on learning and practical materials as well as increased scholarship to especially

minority ethnic groups’ students who qualify for the course but are financially disadvantaged.

Moreover, states could offer financial incentives to dentistry practitioners that agree to work in

certain areas especially rural ones.

What Health Providers can do?

Health providers are at the heart of oral health care provision and can do more to address

issues surrounding oral health.

Changing Perceptions

Until recently, the public, policy makers, and provider’s perceptions about oral health has

been poor. Oral health has not enjoyed the prominence of place it deserves as it has been treated

as a secondary health issue. For the public, the attitude towards oral health remains poor. Many

people assume dental hygiene to mean oral health, which is not true. At the policy making level,

there has been a change of attitude in the last few years with the realization that oral health is

inextricably linked with overall health.

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 22

Health providers such as physicians, their assistants, medical students and others in the

health provision sector can do more to change these perceptions. At the public level, health

practitioners can start a campaign to educate people on the importance of oral health. At the

policy makers and provider’s level, stakeholders can organize conferences, meetings, and visits

to demonstrate the relationship between oral health and overall health.

Health Foundations and Organizations for Oral Health

Leaders and managers in healthcare also have an important role to play in oral health. An

important role, for instance could be the insistence on incorporation and full integration of oral

health into primary care. The move could see practically all medical students get the basic

education about oral care. Moreover, the integration of oral care into learning practice for

students could see physician assistant students benefit from practical experience in oral care.

Smiles for Life: A National Oral Health Curriculum

The initiative integrates oral healthcare into medical practice by designing a

comprehensive curriculum for medical students. Students will therefore graduate from medical

school with full grasp of all issues of oral care and how they relate with overall general health.

Improving Oral Health Exam

The oral health exam in America is not treated with the seriousness it deserves. Typically,

current providers only ask very few questions and do not ask those taking the exams to do

thorough mouth/teeth inspection. Changes need to be made to make the physical exam portion

more rigorous.

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 23

Patient Education

Patients need to be educated on oral health especially the preventive aspect to avoid oral

health issues. Moreover, the patient education could cover hygiene to ensure that patients

understand how overall oral cleanliness reduces oral diseases.

Conclusion

The state of oral health in the United States remains a secondary concern, but an

expensive one that many are unable to shoulder. Many people are turning to emergency

department for oral care in a move that costs the health care an ever rising 1.6 billion dollars in

2012. From a medical perspective, oral health is associated with other systemic diseases such as

diabetes, pulmonary and cardiovascular diseases as well as proneness to adverse pregnancy. Yet

despite the high cost and connection with other diseases, oral health especially for adults is not

covered any the main federal and state insurance cover. Going into the future, there is need for

more concerted efforts bringing in federal, state, and healthcare providers together to reduce cost

of oral care and improve access.

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 24

References

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An interprofessional education and collaborative practice model for dentistry and

pharmacy. Journal of Dental Education, 81(12), 1413-1420.

Calvo, J., Chavez, E., and Jones, J. (2016). Financial roadblocks to oral health for older adults.

Journal of American Society on Aging, 40(3), 85-91.

Collier, Roger. (2009). United States faces dentist shortage. Canadian Medical Association

Journal, 181(11), 253-254.

Han, Y.W. (2011). Oral health and adverse pregnancy outcomes-what’s next. Journal of Dental

Education, 90(3), 289-293.

Mayberry, M. (2017). Accountable care organizations and oral health accountability. Public

Health Policy, 107(S1) 1-5.

Mertz, E., Wides, C., Kottek, A., Calvo, J., Gates, P. (2017). Underrepresented minority dentists:

quantifying their numbers and characterizing the communities they serve. American

Journal of Public Health, 35(12), 2190-2199.

Russel, Bob. (2010). The Impact of unaddressed dental disease: emergency room utilization.

Iowa Department of Public Health-Oral Health Bureau.

Santos, A., P., Nadanovsky, P., and Oliveira, B. (2013). A systematic review and meta-analysis

of the effects of fluoride toothpastes on the prevention of dental Caries in the Primary

dentition of preschool children. Community Dent Oral Epidemical, 41, 1-12.

U.S. Department of Health and Human Services, Centre for Disease Control and Prevention, and

National Centre for Health Statistics. (2016). Health, united states, 2016.

THE ORAL HEALTH DEBATE: WHY YOUR MOUTH MATTERS 25

U.S. Department of Health and Human Services. (2014). The health consequences of smoking-50

years of progress. Retrieved from https://www.surgeongeneral.gov/library/reports/50-

years-of-progress/full-report.pdf

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