Oral health – why it matters to public health

By Mary Thompson, PHN, 

Houston County Public Health

 

“The past half century has seen the meaning of oral health evolve from a narrow focus on teeth and gingiva to the recognition that the mouth is the center of vital tissues and functions that are critical to total health and well-being across the life span.” This quote is from former United States Surgeon General Dr. David Satcher in a report he made on oral health in America in 2000.

Oral health is about so much more than teeth and gums. The mouth not only reveals signs of poor nutrition and diseases, such as infections, immune disorders, injuries and certain cancers, but research has shown associations between chronic oral infections and heart and lung diseases, stroke, low-birth-weight, premature births, as well as diabetes. Among the top risk factors for oral disease are high-sugar beverages and foods (which also contribute to obesity), along with tobacco and alcohol. On the other hand, a healthy mouth will provide protection against chronic infection and disease.

There are several ways in which people suffer from pain and discomfort because of poor oral health: tooth decay, oral and craniofacial disease, gum disease, cleft lip and palate, oral and facial pain syndromes, traumatic injury and mouth and throat cancers.  Untreated oral disease can lead to death. Yet many of these conditions and diseases are preventable.

While Minnesotans in general enjoy a high level of oral health, there is room for improvement, especially among underserved populations who bear the brunt of oral disease. Those who make up these populations include low-income children and adults, people of color and the elderly. The chief barriers for these groups are inadequate access to affordable dental care and a need for a better understanding of the social and environmental factors that are responsible for these disparities.

 

Children

Even though tooth decay is nearly 100 percent preventable, it is the most common chronic childhood disease and is five times more common than asthma. The incidence of cavities increases as income declines. The poorest children are twice as likely to experience tooth decay and are almost three times as likely to have their tooth decay go untreated than more affluent students. In Minnesota, more than half, 55 percent, of Minnesota third graders experienced caries disease, which is slightly higher than the nation (53 percent).

 

Low income and elderly

At some point in their lives, most adults have suffered from tooth decay and gum disease, which are the most common oral diseases affecting both health and productivity. The poorest Minnesota adults, defined as making $15,000 or less yearly, were three times less likely to visit a dentist in 2010 than adults making $50,000 or more.  Among the elderly, a person without a high school degree was 10 times more likely to have all his/her teeth extracted than someone with a college degree. Older adults on fixed incomes are less likely to seek oral health care, compromising their quality of life and health.

When people don’t go to the dentist regularly for preventive care, likely because they don’t have insurance, this leads them to seek dental care in emergency departments and hospitals, resulting in exorbitant health care costs that could be prevented. From 2008 to 2010 in Minnesota, the cost for hospital-treated, non injury associated oral conditions that could have been treated by a dentist rose by nine percent with a cost totaling  $148 million.

When charges like this are not paid by uninsured or under-insured patients, the burden falls to the hospital or health care organization, which in turn may pass the cost on to insured patients through higher heath care charges.

Despite the statistics just noted, Minnesota has much to be proud of regarding oral health. We need to expand on what is proven to work. Dental sealants are practically 100 percent effective in preventing tooth decay in children.  They are a thin plastic-like coating bonded to the chewing surfaces of the back teeth to protect them from decay. There currently is a school-based sealant program in Minnesota that targets high-risk students at schools where more than 50 percent of students are eligible for the free or reduced price lunch program. Check with your own dentist if your children do not yet have sealants.

Another proven method for preventing decay is community water fluoridation. All of the communities in Houston County do have fluoridation. If you and your children drink that water you do have protection against cavities. If your water supply comes from a private well or you drink bottled water ask your dentist about fluoride varnishing to get this same protection. Through the benefits of water fluoridation and fluoride toothpastes, adults 60 years and older represent the first generation where the majority will keep their natural teeth over their lifetime.   Public Health does provide fluoride varnishing for children who are on medical assistance or have no insurance as an important protective mechanism against cavities.  You can call 507-725-5810 if you want to learn more.

Another startling fact is that only 22 to 34 percent of women in the U.S. consult a dentist during pregnancy. Most infants and young children acquire bacteria that cause caries from their mothers. It is so important that pregnant women and new mothers are provided with timely oral education and health care. Many studies have found that inflammation of the gums is associated with poor pregnancy outcomes including preterm birth, low birth weight, or both. It is clear that oral health programs need to focus on educating and improving prenatal education and oral health care for pregnant women.

It is an important goal of both health care and public health to improve the health literacy of all citizens. Health literacy is the degree to which individuals have the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions.

The American Dental Association takes this farther as it relates to oral health: Oral health literacy is the degree to which individuals have the ability to obtain, process and understand basic health information and services needed to make appropriate oral health decisions.  It is so important for us all to have health literacy, including oral health. This is for the sake of our own health and quality of life, as well as those we are responsible for, the young and the elderly. Public Health takes this very seriously and we look forward to working with our communities in a variety of ways so that we all can enjoy the quality of life that good health helps provide.

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