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The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary (2009)

Chapter: 2 The Connection Between Oral Health and Overall Health and Well-Being

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Suggested Citation:"2 The Connection Between Oral Health and Overall Health and Well-Being." Institute of Medicine. 2009. The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12669.
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Page 5
Suggested Citation:"2 The Connection Between Oral Health and Overall Health and Well-Being." Institute of Medicine. 2009. The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12669.
×
Page 6
Suggested Citation:"2 The Connection Between Oral Health and Overall Health and Well-Being." Institute of Medicine. 2009. The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12669.
×
Page 7
Suggested Citation:"2 The Connection Between Oral Health and Overall Health and Well-Being." Institute of Medicine. 2009. The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12669.
×
Page 8

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2 The Connection Between Oral Health and Overall Health and Well-Being Caswell A. Evans, Jr., D.D.S., M.P.H. University of Illinois at Chicago, College of Dentistry In 2000, Surgeon General David Satcher released Oral Health in Amer- ica: A Report of the Surgeon General (HHS, 2000). This report highlighted the lack of understanding about what constitutes oral health as well as the association between oral health and overall health. Oral health is much more than just healthy teeth; it also includes the health of many other anatomical structures such as the gums, bones, ligaments, muscles, glands, and nerves. In addition, oral health affects some of our most basic human functions, thereby shaping an individual’s self-image and sense of well-being: These are tissues whose functions we often take for granted, yet they represent the very essence of our humanity. They allow us to speak and smile; sigh and kiss; smell, taste, touch, chew, and swallow; cry out in pain; and convey a world of feelings and emotions through facial expressions. (HHS, 2000) In the coming decade, certain demographic changes will emphasize the importance of the connection between oral health and overall health and well-being. For example, the combination of increased longevity with the aging of the baby boom generation will contribute to rapid growth in the cohort of adults over age 65, a group that typically has higher rates of chronic disease and disability. 

 THE U.S. ORAL HEALTH WORKFORCE Many medical conditions may affect oral health, and vice versa. For example, the metabolic processes of diabetes mellitus can explain the i ­ncreased destruction of tissue seen in diabetic periodontitis. In turn, like other infections, periodontal disease has been shown to exacerbate glycemic control in diabetic patients, and lower overall medical costs have been seen among diabetic patients who receive proper periodontal care. Other mild associations have been seen, such as between periodontal disease and myo- cardial infarction, but studies to date have not proven a causal relationship. Several studies have shown an association between periodontal disease and adverse outcomes in pregnancy such as premature deliveries, fetal growth restriction, and other complications. However, the reasons for the associa- tions are not clear. The oral cavity may serve as a source for early detection of other medi- cal concerns. For example, lesions in the mouth may be the first indication of HIV infection and may be used to determine the staging and progression of AIDS. In addition, saliva may be used to detect and measure medications, hormones, environmental toxins, and antibodies and thereby might serve to replace invasive blood testing for the monitoring of chronic disease. Lastly, the connection between oral health and overall health can be seen in the case of oral and pharyngeal cancers. Over 35,000 cases of oral and pharyngeal cancers are diagnosed annually, and there are almost 8,000 deaths each year due to these types of cancer (American Cancer Society, 2008). African American males in particular have a relatively high incidence of oral cancers and as a group are typically diagnosed at later stages of the disease and have a significantly lower 5-year survival rate. These examples all serve as reminders for how oral health and gen- eral health and well-being are associated. A fair question is “How well is the oral health workforce positioned to manage these current and future challenges?” As the focus turns to the issues of the oral health workforce, there will undoubtedly be varying viewpoints, and given the same informa- tion, there may be substantially different conclusions. However, solutions should focus on health outcomes, health benefits, and the best interest of the ­patient. In particular, • Is the workforce sufficient in number, distribution, and skills to attend to these health concerns? • Is the makeup of the workforce sufficient to provide the necessary range of services? • Is there enough cultural and ethnic diversity to ensure access to a welcoming environment? The connection between oral health and overall health and well-being cannot be ignored. This is reflected in the narrowing gap between public

ORAL HEALTH AND OVERALL HEALTH  health dentistry and organized dentistry. However, there is still room for greater collaboration, understanding, and sharing of expertise, especially at the local and state levels. As these and the other challenges that lay before us are confronted, it is vital to first come to a greater appreciation for a shared vision of opportunities.

Next: 3 Current Oral Health Needs and the Status of Access to Care »
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Access to oral health services is a problem for all segments of the U.S. population, and especially problematic for vulnerable populations, such as rural and underserved populations. The many challenges to improving access to oral health services include the lack of coordination and integration among the oral health, public health, and medical health care systems; misaligned payment and education systems that focus on the treatment of dental disease rather than prevention; the lack of a robust evidence base for many dental procedures and workforce models; and regulatory barriers that prevent the exploration of alternative models of care.

This volume, the summary of a three-day workshop, evaluates the sufficiency of the U.S. oral health workforce to consider three key questions:

  • What is the current status of access to oral health services for the U.S. population?
  • What workforce strategies hold promise to improve access to oral health services?
  • How can policy makers, state and federal governments, and oral health care providers and practitioners improve the regulations and structure of the oral health care system to improve access to oral health services?
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