The United States has problems with oral health. While most Americans’ oral health has improved markedly over 60 years, many millions are left behind and hurting. Today, 130 million Americans, primarily adults, have no dental coverage. Many Americans with coverage find today’s health insurance cost-sharing requirements a prohibitive barrier to care. Medicare provides no dental coverage for 70% of its enrollees; 40% of them did not visit a dentist in 2014 and 60% have severe or moderate gum disease. Medicaid does cover dental services for low-income children but 17 million of them got no dental care in 2009. In most states, Medicaid covers no or little dental care for poor adults, while 47 million Americans live in areas where finding a dentist can be impossible.
Because of these access issues, 25% of adults over age 65 have lost all their teeth. In 2009, US hospital emergency departments saw 850,000 visits for preventable dental pain. The avoidable disease called dental caries (or cavities) is 5 times more prevalent than asthma and affects 60% of children age 5 to 17. For those left behind, it’s a crisis. Oral health is an important part of US racial and ethnic health disparities.
Bad oral health results in pain, substandard nutrition, sleep loss, lost school time, work absence, worse jobs, and lowered self-esteem. Chronic oral infection is a proven risk factor for diabetes, osteoporosis, heart and lung disease, preterm birth and low birth weight. On the contrary, good oral health care improves overall health, reducing chronic inflammation, infection and bacteria that poor oral conditions harbor inside the body. The link between tobacco use and oral disease has been recognized since the US surgeon general’s 1964 report on smoking and health.
Over the past two decades, scientific evidence from government, academia, and nonprofits has documented these problems. The landmark 2000 surgeon general’s report, Oral Health in America, called the nation’s poor oral health status a “silent epidemic” characterized by disparities in health status, access, and unmet needs.
Excerpts from December 2016 | John E. McDonough | Op-Ed
How can health coaches improve dental care?
ASK: Ask about your patient’s dental care. Do you have a dentist? When was the last time you visited the dentist? Do you have any pain or bleeding in your mouth? Do you have a way to pay for dental care? Are their barriers that prevent you from accessing dental care (i.e. fear, payment, provider hours)?
EXPLORE: Their personal motivations around regular oral care. There are several opportunities for behavior change around teeth brushing, flossing and exposure to high sugar foods that can lead to tooth decay.
EDUCATE: (with permission of course!) Many patients are unaware of the link between oral disease and overall health. Educate the patient on the importance of a healthy mouth and how their overall health or chronic health condition is impacted by neglected dental care.
REFER: As you begin to integrate asking, educating and educating about oral health into your routine practice, it is important to have a referral network of dental providers and community resources that can help patient access dental services. Consult your local or state public health department for educational materials, referral options, and dental health programs that may be available in your community.
As a team, consider adding dental health screening into your routine assessment for all patients, but particularly those with chronic conditions. Click here for one example of a rapid screening assessment tool. Build dental service providers into your referral network or medical neighborhood. Invite them to lunch and learn about best practice daily dental hygiene. Oral health providers are a critical link to keeping patients as healthy as possible.