Once the arcane province of those studying systemic effects of periodontal disease, new investigations, presented in JOMS and elsewhere, have now linked overall health outcomes, the initiation and progression of systemic disease, and longevity to oral health status. In their seminal series of papers in JOMS, Ray White et al have identified molecular markers of inflammation in both partially erupted and fully erupted third molars, previously associated with diseases of systemic inflammation. Patients with retained third molars have now been shown to be at greater risk than smokers for having a premature low birth weight newborn. Since The Nun Study of 678 aging nuns by Wekstein and Saxe was presented as the cover story in Time magazine, longevity and high levels of cognition during aging have been associated with excellent oral health.1, 2 Poor oral health is now known to be associated with:
Myocardial infarction
Valvular heart disease
Peripheral vascular disease
Stroke
Carotid vascular disease
Delivery of premature low birth weight babies
Pneumonitis
Lung abscess
Brain abscess
Gastro esophageal reflux disease
Systemic septicemia
Type 2 diabetes
Complications of diabetes
Complications of chemotherapy
Complications of radiation therapy
Complications of bisphosphonate therapy
Poor socioeconomic outcome
The public has greater awareness of the connection between oral health and systemic health. Health-conscious individuals, who in the past would tolerate severe oral health compromise, now recognize the essential aspects of good oral health. Said simply by former Surgeon General C. Everett Koop, “You are not healthy without good oral health.”
The oral cavity has finally been revealed in its true nature, an essential human organ system whose teeth, supporting structures, specialized organs, joints, glands, sinew, and morphology are essential to life. This affords dentistry a unique opportunity to improve human health, but while the connection has been realized for decades, little change in health care policy seems to have occurred.
How does the current health care policy circumstance fit into this essential truth? The answer (that every oral and maxillofacial surgeon needs to inform their patients) is, “Not at all.” Consider:
1.150 million Americans without dental insurance, 3 times the rate as for patients without medical insurance
2.Elimination of dental benefits from Medicaid programs
3.Absence of any oral health care benefit to the elderly receiving Medicare, made more poignant by the enactment of greatest government largesse toward any group in US history, the trillion dollar Medicare Part D program.
4.Waiver of oral health requirements for federally qualified health centers
5.Suppression of commercial health insurance coverage for treatment of temporomandibular disorders and skeletofacial deformities
6.Suppression of insurance coverage for anesthesia/pain and anxiety control concurrent with oral surgical care
7.Increasing rates of early childhood caries
8.Over 1 million lost school days due to toothache
9.Oral health as the number 1 unmet health care need in children
10.New fluoridation measures met with defeat in recent years
While the “hidden epidemic” of poor oral health described by another Surgeon General, David Satcher, progresses, the public and health care policy makers remain unmoved. Oral health care remains an out-of-pocket expense for those who can afford it. Examine some of the reasons this failure has occurred and why it is likely to remain.
The failure of this needed health care policy change says much about our political process and those making decisions on our behalf. Unlike Medicare Part D, there is no corporate (eg, drug companies) group to advocate for change. Society has tired of mandates and “do gooder” policies that work for the common good, but are paid for by a few. Our society has become tolerant of a tiered health system in which only some receive necessary care. Thus, oral health care remains a relatively inexpensive out of pocket discretionary health care expense to some. While a few patients need a great deal of care, most patients require only preventive visits and an occasional significant but tolerable expense.
Oral health does not have the public clarion ring of diseases like breast cancer or birth defects. Like the difficulties in getting donor attention to lung cancer and oral cancer, the victim is often blamed when poor oral health progresses. Bacterially infected (carious) teeth are listed in physicians’ exams as being “rotten” or exhibiting “poor oral hygiene.” Patients are described as “not taking care of their teeth.” Since health behaviors contribute greatly to oral health status, the public reply is to place the onus of oral health on the individual.
The commitment of the health professions to serve the common good are ever more linked to the motivations of society. Unlike physicians, 4 out of 5 dentists are self-employed. They cannot donate services for which there are insufficient fees and substantial fixed costs. Also, when dentists advocate for oral health, they are unfortunately deemed by the public and politicians to be self-serving.
If there is going to be a change in oral health care policy, it is going to have to come from the public. Even a casual observer will note that oral health is not among the issues that seem to rivet the contemporary electorate. So don’t expect any changes anytime soon.
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