Article: Oral Health - General Health Connections
"An Opportunity for transparency, accountability, and cost reduction. "
By Dr. Fred S. Ferguson
President and CEO, About Smiles, Inc.
Oral health is about knowledge and action (i.e., behavioral health). It connects to and protects general health and can lower healthcare costs. The common oral illnesses—tooth decay, bleeding gums, oral malodor, and bone loss—are the most prevalent chronic health concerns across the life span.
Beginning in early childhood, harmful bacteria are acquired through saliva transmission as a result of common child-care practices and interpersonal behaviors. Certain habits, lack of effective self or child-care, diet concerns and harmful lifestyle choices are among many risk concerns promoting growth of harmful mouth germs that cause common oral illnesses.
Genetics does play an important role in periodontal disease. However, environment (i.e., factors specific to an individual’s situation), as described above, plays the dominant role in oral health. Evidence is growing that poor oral health does impact general health and may increase risk for common chronic illness such as diabetes, cardiovascular conditions, stroke, and pneumonia. There is no accurate data on serious brain impairment or death caused by abscessed teeth; however, this outcome has been documented among those in disadvantaged communities.
How does oral health relate to general health?
- First: Poor oral health begins from a lack of timely education (pre and postnatal) and common child-care habits that include frequent sugar and starchy foods that promote tooth decay. In 2003, tooth decay was acknowledged by the Centers for Disease Control and Prevention and the American Academy of Pediatrics as the most common chronic illness of childhood. Poor childhood oral health often continues as predictable oral illness for teens (more risk behaviors). Oral problems are cumulative with age; again predictable based upon risk concerns (e.g., stress, lack of sleep, oral medications, tobacco, alcohol).
The earlier oral illness begins and the later risk concerns are controlled, the greater the harm to oral and general health. It is well recognized that behavior change is the challenge for overall health and wellness. As risk concerns for mouth problems are often the same as for general health, increasing oral health knowledge and increased positive dental-care practices have the potential to protect overall health and wellness while decreasing the risk of chronic health conditions.
- Second: Studies show that poor oral health harms child growth, development, school outcomes, nutrition and, especially, individuals with special needs, the infirm, and the elderly. Oral complaints including dental pain, infection, and sensitivity also significantly impact self-confidence in school and the workplace. Although necessary to correct oral problems, dental care is not curative. Although improving “access to care” is very important, it does not address risk concerns. Optimization of oral health requires empowering the consumer’s knowledge and practice and providing universal access for early diagnosis and evidenced-based preventive care.
- Third: Studies increasingly demonstrate that oral infection contributes to the risk and morbidity of common chronic health illnesses. Abscessed teeth and chronic gingival inflammation results in periodontal bone loss. Periodontitis results in release of harmful bacteria and the components of inflammation through the blood stream and harm healthy tissues. Additionally, studies suggest that oral infections may if fact worsen chronic illnesses such as diabetes, cardiovascular and respiratory conditions, endometriosis, and stroke.
How can good oral health benefit the healthcare industry?
The separation of “dental and medical” in our healthcare/benefits industry presents significant obstacles to overall health promotion and cost reduction. Tracking oral health provides a feasible and transparent data set applicable to primary prevention for overall health and wellness. This would be a significant benefit to caregivers, individuals, groups and the healthcare industry.
Oral health reflects “daily practice,” which is essentially behaviorally driven, sharing threats with general health: daily activities, behaviors, family history, conditions and situations specific to the individual or caregiver. Additionally, oral health data sets can provide accountability standards for providers, payers, and consumers.
Studies show that caregivers and individuals can become very competent in oral health activity once they receive information and that children who have early (by-age-one) dental visits experience fewer oral problems throughout their lives. Corporate industry shows that preventive dental visits are low cost and are beneficial for workers’ health, confidence, and productivity.
Dental visits do happen frequently relative to other healthcare encounters. This provides opportunity for general health promotion and screening for chronic medical health concerns. Insurance and benefit payers should provide benefits for annual preventive dental visits, requiring such activity for members to maintain their health benefits.
How can and why should we obtain oral health data?
Oral heath data can be easily obtained through web-based age and gender-specific risk assessment questionnaires completed by the caregiver or individual. Web access can be provided through home, library, health provider’s office, workplace, school, or PDA. The individual or caregiver would benefit through receiving real-time individualized behavioral intervention that impacts both oral and general health, tracks their progress over time and provides tools that direct timely dental visits and enable wise consumerism.
For the insurance and health benefits industry, data sets can enable case managers to provide timely referrals for patient care specific to at-risk groups or individuals. Behavioral health intervention for oral health brings awareness to concerns such as obesity, tobacco, and alcohol use.
Child-care challenges, financial problems, product-marketing, educational and work pressures, and stress are but some of the concerns that increase risk for harmful child care habits (snacks as rewards), lack of daily child oral care and, lifestyle choices (frequent sugared drinks), which can impact both oral and general health. Empowering caregivers to recognize the daily impact of these situations on their child's oral health will also benefit their child's overall health and wellness. Consider that a web-based school K through 12 oral health program can support behavioral health education for youth while empowering them to recognize how these threats can impact their future as parents and adults.
Studies show that people desire autonomy and competence in their health choices, and strongly desire to interact with their health care providers. As individuals and caregivers are the drivers of their “behavioral” health, competent oral health practice provides a reliable foundation for overall health promotion for all ages. People can easily visualize that their “Smile” is significant to their quality of life, confidence, and wellness. Providing an easy to access, reliable, interactive and personalized oral health behavioral intervention tool is a significant first step to empower health and wellness for everyone and can bring transparency and accountability to our health care system.