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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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