the United States, in 2010 HHS announced a department-wide Oral Health Initiative to create new initiatives in oral health and improve coordination (and align resources) among agencies with existing initiatives (HHS, 2010a,b). In launching this effort, HHS underscored the same key message: oral health is integral to overall health.

ORAL HEALTH AND OVERALL HEALTH

The surgeon general’s report referred to the mouth as a mirror of health and disease occurring in the rest of the body in part because a thorough oral examination can detect signs of numerous general health problems, such as nutritional deficiencies and systemic diseases, including microbial infections, immune disorders, injuries, and some cancers (HHS, 2000). In addition, there is mounting evidence that oral health complications not only reflect general health conditions but also exacerbate and even initiate them. Periodontal disease has been associated with adverse pregnancy outcomes (Albert et al., 2011; Offenbacher et al., 2006; Scannapieco et al., 2003b; Tarannum and Faizuddin, 2007; Vergnes and Sixou, 2007), respiratory disease (Scannapieco and Ho, 2001), and cardiovascular disease (Blaizot et al., 2009; Janket et al., 2003; Scannapieco et al., 2003a; Slavkin and Baum, 2000). Periodontal disease has been also shown to affect glycemic control in patients with diabetes (Löe, 1993; Taylor, 2001; Teeuw et al., 2010).

Gies noted the seriousness of the oral-systemic connection nearly a century ago, stating “[c]ertain common and simple disorders of the teeth may involve prompt or insidious development of serious and possibly fatal ailments in other parts of the body” (Gies, 1926). Popular attention to oral health issues and the connection between oral health and overall health increased dramatically in 2007 with the death of Deamonte Driver, a 12-year-old Maryland boy who died when bacteria from an untreated tooth infection spread to his brain (Norris, 2007, 2010; Otto, 2007). Driver’s death transformed the oral health discussion as more people—including members of Congress—have begun to recognize the potential seriousness of untreated oral disease. In fact, this tragedy is credited with spurring Congress to require that states provide dental services in their Children’s Health Insurance Program (CHIP) benefit packages during the program’s federal reauthorization (Iglehart, 2009). Unfortunately, Driver is not the only child to die directly as a result of oral infection (Casamassimo et al., 2009).

The impact of poor oral health is not limited to health alone. Costs of care can be high, and there are also costs related to lack of care, including lost work hours, lost school time, and increased cost of caring for advanced disease. In an often cited study based on the 1989 National Health Interview Survey (NHIS), the authors found that 164 million hours of work



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