were missed annually as a result of dental visits or problems, with more hours being lost by lower-level workers (Gift et al., 1992). In addition, they found that 51 million hours of school were missed by school-age children for dental visits or problems, with the most hours being lost by female, Hispanic, lower-income, and uninsured children. Anecdotal evidence suggests that having visibly missing teeth may be associated with difficulties in finding a job, and a recent study suggests that fluoride exposure during childhood has a strong, statistically significant effect on women’s earnings (Eckholm, 2006; Glied and Neidell, 2008; Hyde et al., 2006; Shipler, 2004). For over a century, poor oral health has been a factor in the readiness of military troops to be deployed (DOD, 2002; King and Hynson, 2007; Marburger et al., 2003; Teweles and King, 1987).

INFLUENCES ON ORAL HEALTH AND THE ORAL HEALTH CARE SYSTEM

A number of factors contribute to poor oral health, including the relative lack of attention to oral health among nondental health care professionals,2 uneven and limited access to oral health care and dental coverage, social determinants of oral health, and the limited oral health literacy of the population. As poor oral health is a multifactorial problem, solutions will need to come from several different areas. In addition, appropriate quality measures in oral health care are necessary to reform the oral health care system to appropriately balance concerns for cost, quality, and access.

Absence from General Health Care

Oral health care has been largely absent from general health care. Nurses, physicians, and other health care professionals have generally not been trained in providing oral health services or screenings (Danielsen et al., 2006; Jablonski, 2010; Mouradian et al., 2005). In addition, dental professionals are generally educated and trained separately from other health care professionals, which reinforces the separation of care as well as lack of training in appropriate referrals between professionals (Mouradian et al., 2003; Pierce et al., 2002). Recently, several efforts have been made to introduce basic oral health care into primary health care.

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2 Dental professionals include dentists, dental hygienists, dental assistants, dental laboratory technicians, and new and emerging dental professionals (e.g., dental therapists). Nondental health care professionals refers to all other types of health care professionals, including, but not limited to, nurses, pharmacists, physician assistants, and physicians.



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