Oral Health in America - January 2022 Bulletin

Section 1 Summary

Effect of Oral Health on the Community, Overall Well-Being, and the Economy

Oral health and disease affect all aspects of our society, from our financial well-being to our health care systems and even our ability to communicate with others. Section 1 of the NIH report Oral Health in America: Advances and Challenges examines the many ways that financial interests, demographic factors, and social and cultural changes influence the oral health of individuals and communities and contribute to oral health inequities in the United States. The authors of Section 1 analyze the current health policy landscape and make policy recommendations for improving oral health, such as restricting the sale of products detrimental to oral health and for creating public-private partnerships that can ensure the delivery of essential oral health care in times of crisis.

Status of Knowledge, Practice, and Perspectives

Health and the economy are inextricably linked. We cannot have healthy communities without a prosperous economy, and we cannot have a prosperous economy without healthy communities. Productivity losses associated with oral disease in the United States reached an estimated $45.9 billion in 2015. Lack of access to regular dental care leads to increased use of hospital emergency departments, which are often ill-equipped to solve underlying oral health problems, and are much more expensive than definitive dental treatment. With dental care costs increasing by 30% over the past 20 years, dental care is beyond the reach of many.

Advances and Challenges

The emphasis on Social Determinants of Health (SDoH) has increased substantially since the turn of the century. The idea that SDoH are true risk factors with direct causal links to oral health outcomes is gaining wide acceptance. There are large disparities in access to care based on income, race, and ethnicity, with 1 in 5 low-income adults reporting they have not visited a dentist within five years or more or had never visited a dentist. Deferring routine preventive and restorative dental care increases the need for more advanced and expensive dental services, which are even less accessible, further widening the disparities.

Promising New Directions

Programs which have integrated oral health care into primary care have improved access to oral health care; millions of people visit their primary care medical provider but do not have a dental home. Telemedicine and teledentistry have also reduced the burden of travel and expanded available services especially for rural populations. Many oral health outcomes have improved: tooth loss in older adults has declined, along with untreated tooth decay in children and oral health disparities among some racial and ethnic groups; while the use of electronic health records and the continued evolution of diagnostic codes for dental conditions can contribute to even greater integration of dental and medical care.

Additional Takeaways

In addition to issues of health equity and access to care, Section 1 of the report identifies the dual role commercial interests play in the nation’s oral health, both in developing products that improve health and in shaping consumer preferences or incentivizing products that are harmful. The emergence of COVID-19, along with other recent natural and man-made disasters, has underscored the importance of robust public-private partnerships that can ensure the continued delivery of essential oral health care in times of crisis. Policies that address the structural barriers that allow oral disease and oral disease inequities to exist are necessary to achieve a just and equitable system of health care.

Read Section 1 of the Report

Q&A With Section Editor

A conversation with Robert J. Weyant, MS, DMD, DrPH; professor, chair, and associate dean for dental public health and community outreach; University of Pittsburgh School of Dental Medicine. He served as senior editor for report Section 1: Effect of Oral Health on the Community, Overall Well-Being, & the Economy.

What are the most important takeaways about this section?

The most important takeaways are that creating optimal population oral health makes economic sense. Not dealing with the untreated dental diseases has significant impacts on the social and economic productivity of individuals and communities and are foundational to a well-functioning health care system, economy, and society. Further, we can indeed do positive things to reduce the unnecessary and unfair differences in oral health and access to dental care between individuals and groups.

What was a surprising finding?

For many they will find it surprising that oral health and dental care can have such important implications for national security. Oral disease complicates recruitment into the military – as so many recruits require dental care. This leads to delays in training and for some rejection from military service. Also – among active service members, oral disease can prevent deployment outside of the United States.

What should the American people know about this section of the report?

I think that the American people should know that poor oral health and compromised access to dental care are not about individual failings, and improvements in oral health and access to dental care are best found through legislative, system, and market solutions. We are where we are today because of deliberate policy choices made years ago. The most important one – treating dental care as an essential health benefit for kids but nobody else. We have clear evidence that seniors and adults have seen very little progress overall in the past 20 years, and that is because we have not expanded public coverage for dental care. This mismatch between professional recommendations and oral health policy reflects an attitude among policy makers that dental care for adults and seniors is not important.

What is the main call to action?

Walk the walk – Make dental care an essential benefit for adults and seniors. Realize that solutions and action must occur by focusing on the social, commercial, and political determinants of oral health and access to dental care.

Did You Know?

• Overall productivity losses in the United States associated with untreated oral disease were estimated to be $45.9 billion in 2015, with the United States ranking highest among 195 countries. See context.
• In 2018, about 66.7 million Americans had no dental coverage with a dentally uninsured rate of 2.5 times higher than the medically uninsured rate. See context.
• In 2014, there were 2.43 million emergency department visits for nontraumatic dental conditions, representing more than $1.6 billion in charges; the average charge per visit was $994 for adults and $971 for children. See context.
• During the past 20 years, dental care costs per person in the United States have increased 30%, placing access to dental care out of reach for many. See context.

Learn more about Oral Health in America: Advances and Challenges