BOX 2-1

Dental, Oral, and Craniofacial

The word oral refers to the mouth. The mouth includes not only the teeth and the gums (gingiva) and their supporting tissues, but also the hard and soft palate, the mucosal lining of the mouth and throat, the tongue, the lips, the salivary glands, the chewing muscles, and the upper and lower jaws. Equally important are the branches of the nervous, immune, and vascular systems that animate, protect, and nourish the oral tissues, as well as provide connections to the brain and the rest of the body. The genetic patterning of development in utero further reveals the intimate relationship of the oral tissues to the developing brain and to the tissues of the face and head that surround the mouth, structures whose location is captured in the word craniofacial.

SOURCE: HHS, 2000b.

has divided them. Dental coverage is provided and paid for separately from general health insurance (see Chapter 5), dentists are trained separately from physicians (see Chapter 3), and legislators often fail to consider oral health in health care policy decisions. In effect, the oral health care field has remained separated from general health care. Recently, however, researchers and others have placed a greater emphasis on establishing and clarifying the oral-systemic linkages.

The surgeon general’s report Oral Health in America emphasized that oral health care is broader than dental care, and that a healthy mouth is more than just healthy teeth (see Box 2-1). The report described the mouth as a mirror of health or 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, 2000b). For example, oral lesions are often the first manifestation of HIV infection, and may be used to predict progression from HIV to AIDS (Coogan et al., 2005). Sexually transmitted HP-16 virus has been established as the cause of a number of oropharyngeal cancers (Marur et al., 2010; Shaw and Robinson, 2010). Dry mouth (xerostomia) is an early symptom of Sjogren’s syndrome, one of the most common autoimmune disorders (Al-Hashimi, 2001); xerostomia is also a side effect for a large number of prescribed medications (Nabi et al., 2006; Uher et al., 2009; Weinberger et al., 2010).

Further, there is mounting evidence that oral health complications not only reflect general health conditions, but also exacerbate them. Infections



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