Advancing Oral Health in America (2011) / Chapter Skim
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2 Oral Health and Overall Health and Well-Being
2 Oral Health and Overall Health and Well-Being
Pages 31-80
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From page 31... ...
Finally, the chapter concludes with a discussion of basic health literacy issues (including oral health literacy) , especially how they affect the ability of individuals, communities, and practitioners to improve oral health status.
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The surgeon general's report Oral Health in America made it clear that oral health care is broader than dental care and that a healthy mouth is more than just healthy teeth (see Box 2-1)
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. Although there is a wide range of diseases and conditions that manifest themselves in or near the oral cavity itself, discussions of oral health tend to focus on the diagnosis and treatment of two types of diseases and their sequelae: dental caries and periodontal diseases.
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became more prevalent. Among poor MexicanAmerican children ages 6–11, untreated dental caries decreased from 51 to 42 percent (Dye et al., 2010)
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For example, the latter survey found that more than a quarter of adults ages 20–64 and nearly one-fifth of respondents over age 65 were experiencing untreated dental caries at the time of their examination (Dye et al., 2007)
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36 ADVANCING ORAL HEALTH IN AMERICA TABLE 2-1 Prevalence of Caries Experience and Untreated Caries by Age and Poverty Status (1999–2004) Caries Prevalence Caries Untreated Population Characteristics Experience Caries Age and Dentition Percentage Percentage 2–11 primary teeth Total 2– to 11-year olds 42.2 22.9 2–5 years 27.9 20.5 6–11 years 51.2 24.5 Poverty < 100% 54.3 32.5 100–200% 48.8 28.4 > 200% 32.3 15.0 6–11 permanent teeth Total 6– to 11-year olds 21.1 7.7 Poverty < 100% 28.3 11.8 100–200% 24.1 11.9 > 200% 16.3 3.6 12–19 permanent teeth Total 12– to 19-year olds 59.1 19.6 Poverty < 100% 65.6 27.1 100–200% 64.4 27.0 > 200% 54.0 12.9 20–64 permanent teeth Total 20– to 64-year olds 91.6 25.5 20–34 85.6 27.9 35–49 94.3 25.6 50–64 95.6 22.1 Poverty < 100% 88.7 43.9 100–200% 88.9 39.3 > 200% 93.1 18.0 65+ permanent teeth Total 65+ 93.0 18.2 Poverty < 100% 83.5 33.2 100–200% 90.9 23.8 > 200% 95.5 14.2 SOURCE: Dye et al., 2007.
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Oral Health Status: Beyond the Teeth Oral health is more than healthy teeth, and oral diseases and disorders are more than caries and periodontal disease. Oral diseases and disorders can be either acute (e.g., broken tooth)
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oral health status overall, underserved and vulnerable populations continue to suffer disparities in both their disease burden and access to needed services. Dental caries remains a significant problem in certain populations such as poor children and racial and ethnic minorities of all ages (Dye, 2010; Dye et al., 2007)
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, have risk factors for dental caries similar to those for other age groups, but adolescents' risk for oral and perioral injury is especially exacerbated by behaviors such as the use of alcohol and illicit drugs, driving without a seat belt, cycling without a helmet, engaging in contact sports without a mouth guard, and using firearms (IOM, 2009)
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. But, available data indicate that people with special needs suffer disproportionately from periodontal disease and edentulism, have more untreated caries, have poorer oral hygiene, and receive less care than the general population does (Anders and Davis, 2010; Armour et al., 2008; Havercamp et al., 2004; Owens et al., 2006)
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. Poor Populations Poor children are more likely to have untreated dental caries and less likely to receive sealants than nonpoor children, despite having almost universal access to dental insurance through Medicaid (Dye et al., 2007; HHS, 2000b)
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. Oral health services for pregnant women and mothers may include education and counseling about how their own oral health relates to their children's oral health, as well as how to prevent dental caries in their young children.
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average, and more than two-thirds of AI/AN children ages 2 to 5 have untreated dental caries (Dye et al., 2007; IHS, 2002)
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This is fitting, given the highly preventable nature of oral diseases, including dental caries and periodontal disease. The objective of oral health promotion and disease prevention is to promote the optimal state of the mouth and the normal functioning of the organs of the mouth without evidence of disease.
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Effective Interventions Many oral diseases can be prevented through a combination of steps taken at home, in the dental office or other care locations, or on a community-wide basis. For example, caries incidence can be reduced through water fluoridation at the community level, topical fluoride treatments can be applied by health care professionals in a wide variety of settings, and fluoridated toothpaste can be used in the home.
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Health care professionals also can remove plaque and other deposits from tooth surfaces, provide dietary counseling, and provide or recommend other measures that may prevent or control dental caries. Aside from clinical effectiveness, many studies support the costeffectiveness of preventive dental care, often due to the avoided expensive treatments associated with severe dental disease (CDC, 1999c; Lee et al., 2006; Quiñonez et al., 2005; Ruddy, 2007; Weintraub et al., 2001)
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. The results of that research indicated children living in areas with high concentrations of fluoride in the water had more "mottled teeth," but also lower incidence of dental caries (CDC, 1999a)
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In 1960, Crest became the first brand of toothpaste to receive endorsement from the American Dental Association (ADA) for its effectiveness in preventing dental caries (Miskell, 2005)
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A healthy diet is important for maintaining oral health, because it reduces the risk for dental caries and oral cancers (Mobley et al., 2009; Moynihan and Petersen, 2004) and potentially periodontal dis
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. Tobacco and alcohol use are risk factors for oral cancers and periodontal disease (Rethman et al., 2010)
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. This definition excludes both provider and system-level contributions to oral health literacy, but despite these limitations, the IOM Committee on Health Literacy, Healthy People
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Culture and Society Health literacy is inextricably linked with culture and society, which includes factors such as race, ethnicity, native language, socioeconomic status, gender, and age, as well as influences such as media, advertising, marketing, and the Internet. Culture provides the context for understanding illness, di Potential Intervention Points 2 Health System Health 1 Outcomes and Costs Culture Health and Literacy Society Education System 3 figure 2-1.eps FIGURE 2-1 Intervention points for health literacy.
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Even highly literate individuals struggle to make sense of the large amounts of information required to function effectively in the health care system. The problem of low health literacy is exacerbated and is becoming more apparent by the increasing prevalence of chronic diseases, including dental caries, that require longterm self-management by patients and the limited amount of time professionals have to spend with patients (OMH, 2001)
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The Importance of Health Literacy Health literacy is important because it can affect health care use, patient outcomes, and overall health care costs. Adults with limited health literacy have less knowledge of disease management and of health-promoting behaviors, report poorer health status, and are less likely to use preventive services (Arnold et al., 2001; DeWalt et al., 2004; IOM, 2004; Scott et al., 2002; Williams et al., 1998)
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. Poor health literacy is also expensive; it contributes significantly to both overall health care costs and individual expenditures (Eichler et al., 2009; Howard et al., 2005; Vernon et al., 2007; Weiss and Palmer, 2004)
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However, health care professionals are generally not trained in how to perform such an assessment and do not account for the low health literacy of patients when communicating health information. Practitioners often use medical jargon, provide too much information at once, and fail to confirm that the patient understood the information provided (Williams et al., 2002)
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Nearly two-thirds of the dentists said they did not have training in health literacy and clear communication. Improving the communication skills of oral health care professionals may require curricular changes in both health professional schools and continuing dental education programs.
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Similar patterns are seen in other types of health care professionals as well as for other oral diseases. For example, one study of internal medicine trainees showed that only 34 percent correctly answered all five general knowledge questions on periodontal disease; 90 percent of the trainees stated they did not receive any training regarding periodontal disease during medical school (Quijano et al., 2010)
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. Behavior Change While a full examination of the evidence base and approaches for behavior change is beyond the scope of this report, it is important to note that improving health literacy is just the beginning of the behavioral change process.
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figure 2-2.eps KEY FINDINGS AND CONCLUSIONS The committee noted the following key findings and conclusions: Oral Health and Overall Health • Oral health is inextricably linked to overall health.
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Health Literacy • Oral health care professionals often do not use the best techniques to communicate with their patients. Oral health care profession als need to be be trained in effective communication and cultural competence.
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2009. Health literacy in dentistry action plan 2010-2015.
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2010. Screening for oral health literacy in an urban dental clinic.
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1999a. Achievements in public health, 1900-1999: Fluoridation of drinking water to prevent dental caries.
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2009. The costs of limited health literacy: A systematic review.
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2004. The continuum of dental caries -- evidence for a dynamic disease process.
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2007. De velopment and testing of the test of functional health literacy in dentistry (TOFHLID)
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2005. The impact of low health literacy on the medical costs of Medicare managed care enrollees.
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2007. Oral health literacy among adult patients seeking dental care.
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for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews(4)
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2009. The contribution of dietary factors to dental caries and disparities in caries.
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2004. Dental pain prevalence and associa tion with dental caries and socioeconomic status in schoolchildren, southern brazil, 2002.
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2010. Obstetric outcomes after treatment of periodontal disease during pregnancy: Systematic review and meta-analysis.
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2007. Evaluation of a word recognition instrument to test health literacy in dentistry: The REALD-99.
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2007. Communication tech niques for patients with low health literacy: A survey of physicians, nurses, and pharma cists.
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2009. Interventions to improve care for patients with limited health literacy.
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2007. Low health literacy: Implica tions for national health policy.
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2005. Health literacy and functional health status among older adults.
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2010. Factors that limit access to dental care for adults with spinal cord injury.
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