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2 Keynote Address THE IMPORTANCE OF ORAL HEALTH LITERACY Congressman Elijah E. Cummings Congressman Cummings noted the importance of regular preventive dental care in assuring good general health, but pointed out that many individuals, including some health professionals, do not understand the significance of the relationship between oral health and general well- being. This lack of understanding can have profound and unfortunate ramifications. Congressman Cummings quoted his mother, a former sharecropper with a very limited education, who used to say, “There is nothing like a person who don’t know what they don’t know.” In the context of oral health literacy, there is much work to be done to let people know about what they need to know. Families need to be educated about the impor- tance of oral health, and have access to dental services. Cummings observed that the average American wants to have good health and access to good healthcare, including dental care. However, while some progress is being made, budget deficits have led to cuts in many programs. The tragic death of Deamonte Driver, a 12-year-old boy from Maryland, highlights the importance of access to dental care. Deamonte could not access a dentist to treat an abscessed tooth and the infection spread to the boy’s brain. This tragic death motivated Con- gressman Cummings to become involved in oral health care issues and he began to advocate for better dental health care coverage. At the fed- 5
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6 ORAL HEALTH LITERACY eral level, a guaranteed dental benefit was secured in 2009 for children enrolled in the Children’s Health Insurance Program. And in 2010, Presi- dent Obama signed into law the Patient Protection and Affordable Care Act. Congressman Cummings said he is a proud supporter of this land- mark legislation and then highlighted some of the legislation’s provisions to promote children’s dental health. Pediatric dental care is fully covered as an essential health benefit in every insurance package that qualifies for inclusion in health insurance exchanges.1 Standalone dental plans must meet all certification standards that apply to qualified health plans without annual or lifetime limits. The Affordable Care Act also authorizes funding to launch a dental information campaign, to educate new parents and those who live in traditionally underserved areas. Congressman Cummings observed that just as death is a part of life, “a part of life is death.” Deamonte Driver’s mother, who had been strug- gling as a result of her son’s death, received training and has become a dental assistant. She works in a dental office and is reminded of her son’s death as she promotes dental health. Cummings mentioned this as a moving example of something positive coming out of the family’s tragic experience. A large segment of the American public, even the well-educated, lacks basic knowledge about oral health. Parents may be very well-intentioned but not provide good dental care for their children. Congressman Cummings cited a friend, a psychiatrist, who said, “a person could have good parents, but that does not necessarily mean that what that parent does is good for them.” He noted that if parents lack information, and therefore the ability to teach their child about dental health, it is certainly not good for the child. It is critical to teach parents the importance of dental care. To illustrate this point, Congressman Cummings recounted an encounter he had at a hospital. When introduced to a young child about 2 years old, Congressman Cummings noticed that the child’s smile was marred by a little tooth that was completely decayed. When he advised the mother to take the child to a dentist, the mother said that she did not have to because “these teeth are going to fall out anyway.” Congressman Cummings suggested that people’s behavior is moti- vated by two things, to enjoy pleasure or to avoid pain. He stated that parents who truly love their children would do anything to make sure that their child avoids pain. But if they do not know how to avoid dental pain, there is a problem. In his view, the goal is to have a nation of knowl- edgeable parents that are equipped to protect their children. 1 Under the Affordable Care Act, state health insurance exchanges are being created as marketplaces where individuals and employees of small businesses can shop for a range of health insurance choices.
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KEYNOTE ADDRESS 7 Congressman Cummings recounted a story about dental education that was, he said, told to him by Senator Ben Cardin. The senator had visited a school and a 5-year-old student who had recently participated in a school-based dental health program informed him that she knew how to brush her teeth. The senator asked the child to describe the process and she proceeded to discuss the steps needed to keep teeth clean and healthy, for example, brushing for a sufficient amount of time. The senator was about to leave and the little girl came up to him and said, Senator, I forgot to tell you one thing. I also have to brush my tongue. Cummings found this story amusing and instructive. Knowledge acquired at a young age is very significant, because it results in children growing up educated, and then being able to teach their children proper dental hygiene. With suf- ficient education, there will be generations knowledgeable about dental care, the importance of flossing, the benefits of dental sealants, and that dental pain is preventable. Congressman Cummings said he grew up thinking that you were supposed to have toothaches, that they were a part of life. He described the four items in his family’s medicine cabinet to address dental issues— toothpicks, turpentine, Orajel, and cotton balls. If a family member had a cavity, turpentine-soaked cotton was inserted into the cavity with a toothpick. If that did not dull the pain and money was available, Orajel could be purchased to deal with the pain. Congressman Cummings noted that there are people who believe that such remedies are what constitute dental care. They lack knowledge and resources. The results of this lack of fundamental knowledge about the impor- tance of oral health are evident, Cummings said. Tooth decay remains one of the most prevalent diseases among young people, even though it is entirely preventable. He added that poor oral health can have many negative effects on a person’s overall well being and recounted an episode from his daughter’s life. When she was about 7 years old, she brought home her class pictures. All the children in the picture were smiling, but his daughter was frowning. When he asked why she was frowning, she said that it was because her tooth had not fully grown in. The dentist cor- rected it, and a year later, she was smiling for her class picture. This story, as told by Cummings, illustrates the relationship between dental health and self-esteem. In his view, self-esteem is significant and many problems can be traced to a lack of self-esteem. If young people do not feel good about the way they look, he said, then more than likely they are going to feel bad about who they are. Cummings indicated that many children suffer needlessly because too many parents lack information about the importance of healthy teeth and gums. These children do not reach their potential in school, and they suffer all of the other negative effects of tooth decay. He is support-
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8 ORAL HEALTH LITERACY ing a statewide dental health campaign in Maryland that is similar to those in California, Delaware, and North Carolina and recently joined the Maryland Dental Action Coalition to launch a “Healthy Teeth, Healthy Kids” campaign. This coalition, made up of public and private advocates for children’s dental health, has recommended many of the important improvements implemented in Maryland during the last 5 years, from expanded Medicaid coverage and reimbursement to improvements in the state’s public health infrastructure. The Maryland Dental Action Coalition campaign, headed by Mr. John Welby of the Maryland Department of Health and Dental Hygiene, recog- nizes the importance of education in addressing the causes of oral disease. The coalition encourages healthy behaviors by providing information and working with public health advocates in Maryland and across the coun- try. Cummings described the coalition as an important catalyst for con- structive change, which has helped inform lawmakers on all levels about shortfalls in dental health. The coalition is also educating the public about the importance of healthy oral habits for moms, infants, and children. Congressman Cummings commended state-level efforts and indi- viduals who are committed to furthering dental health for a generation of children. In his opinion, young people will live their lives with the confidence that comes with a healthy smile. He noted that the nation’s children are the living messages we send to a future we will never see. The question he posed was, “Will we send them to a future healthy and smiling, with high self-esteem?” The public health system, providers, communities, and schools must continue to spread the message about the importance of good oral health. Fear remains a powerful impediment limiting access to care for far too many children, said Cummings. This barrier can be overcome with improved health literacy in communities and in schools. Cummings stated that the Affordable Care Act recognizes the important relationship between children’s health and the school system. The law authorizes grants to school-based health centers and expands programs to all 50 states. The Affordable Care Act addresses children’s needs where they spend much of their time, in school-based programs such as Head Start. The importance of education is not limited to children, Cummings said. The next generation of dental providers must also be addressed. Young adults of all backgrounds should be encouraged to consider a career in dentistry. The Patient Protection and Affordable Care Act autho- rizes grants to fund Title IV assistance for pediatric training programs. It also creates incentives for teachers to train residents of underserved communities and for medical students to work in areas of greatest need. Congressman Cummings expressed his gratitude for the support for these initiatives from the President and the Congress. He observed
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KEYNOTE ADDRESS 9 that real lasting change requires the continued commitment and col- laboration of the oral health community. He commended the Institute of Medicine for bringing together so many of the partners who have sup- ported dental health initiatives, representatives of the universities and health centers, advocates from business and professional communities, and members of government and nonprofit institutions. Congressman Cummings observed that investments made in children’s oral health will last a lifetime. Children, as they grow into adulthood will benefit from actions taken today. Cummings stated that improvements made to increase access to fluo- ridated water and dental care must be sustained. He added that the prog- ress already made must be protected, even in difficult budget times. Fur- thermore, continued investments in sealants and fluoridation are needed, as is support for efforts to grow and diversify the dental workforce. He emphasized the obligation to reach the nation’s families and stressed the importance of oral health, the power of prevention, and the importance of regular screenings. Congressman Cummings concluded by saying that improvements in oral health literacy depend on policy and on a moral commitment to the nation’s children and communities. From his perspective, there is a moral responsibility to ensure that no child suffers. Health literacy is key to change, but that change is not possible without the engagement of par- ents and families. Furthermore, children’s health is not possible without dental health.
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