Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011) / Chapter Skim
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2 Oral Health Status and Utilization
2 Oral Health Status and Utilization
Pages 41-82
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From page 41... ...
including poor oral health literacy, inadequate use of preventive services, and relative lack of oral health quality measures. These barriers are briefly considered here, as a fuller discussion of literacy, prevention, and quality measures can be found in the IOM report Advancing Oral Health in America (IOM, 2011)
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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)
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Figure 2-1 illustrates the range of consequences of early childhood caries in a morbidity and mortality pyramid. OVERVIEW OF ORAL HEALTH STATUS AND ACCESS TO ORAL HEALTH CARE IN THE UNITED STATES Although there is a wide range of diseases and conditions that manifest themselves in or near the oral cavity itself, this report will focus primarily on access to services for the prevention, diagnosis, and treatment of two diseases and their sequelae: dental caries and periodontal diseases.
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Copyright © 2009 American Dental Association. All rights reserved.
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Among adults, CDC observed improvements in the prevalence of dental caries, tooth retention, and periodontal health. For adolescents and youth, dental caries decreased, while dental sealants (used to prevent tooth decay)
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. In addition, disturbing disparities remain in oral health status for many underserved and vulnerable populations, which will be discussed in detail later in this chapter.
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Children and Adolescents Children While not all children are underserved, many children are vulnerable to developing oral diseases, particularly dental caries.
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. Dentally uninsured children receive fewer dental services than insured children (Kenney et al., 2005; Lewis et al., 2007;
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Some data indicate that publicly insured children are less likely to receive dental services and receive fewer dental services on average than privately insured children (Manski and Brown, 2007) ; however, studies that control for race and income (among other factors)
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, have a high prevalence of oral disease. Risk factors for dental caries are similar to those for other age groups, but adolescents' risk for oral and perioral injury is exacerbated by behaviors such as the use of alcohol and illicit drugs, driving without a seatbelt, cycling without a helmet, engaging in contact sports without a mouth guard, and using firearms (IOM, 2009)
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. Poor children ages 2–8 have more than twice the rate of dental caries experience as nonpoor children (Dye et al., 2010)
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. It is important to note that most children living below the FPL are eligible to receive dental care through Medicaid, and therefore have financing available for oral health care.
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. At that time, the IOM recommended to assess the oral health status, risk factors for oral diseases, and use and delivery of oral health services for older adults as well as to consider methods for performing oral cancer screenings in primary care settings.
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. But available data indicate that people with SHCN suffer disproportionately from periodontal disease and edentulism, have more untreated dental caries, poorer oral hygiene, and receive less care than the general population (Anders and Davis, 2010; Armour et al., 2008; Havercamp et al., 2004; Owens et al., 2006)
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First, they often take medications that reduce saliva flow, which promotes dental caries and periodontal disease (HHS, 2000b)
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. The provision of oral health services for pregnant women and mothers may include education 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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population throughout the life cycle. African American children and adolescents are have slightly more dental caries and more untreated dental caries than white children and adolescents (Dye et al., 2007)
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. AI/AN adults ages 35 to 44 also have more teeth with untreated dental caries, but fewer missing teeth, and about the same number of filled teeth as the overall population.
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. Mexican American adults have fewer dental caries experiences than white non-Hispanic adults; however, they have higher rates of untreated dental caries (Dye et al., 2007)
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. Finally, the water in rural communities is less likely to be fluoridated than city water, which means rural residents are more susceptible to dental caries.
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. Poor oral health literacy is strongly associated with self-reported lower oral health status, lower dental knowledge, and fewer dental visits.
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Increasing access to preventive services is an important component of improving access to oral health care for vulnerable and underserved populations. IOM's concurrent Committee on an Oral Health Initiative was directly charged to address the role of preventive services in oral health; therefore, a fuller discussion of this topic can be found in its report Advancing Oral Health in America (see Appendix D)
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. A Cochrane review of sealant studies found that resin-based sealants were effective at preventing dental caries, ranging from an 87 percent reduction in dental caries after 12 months to 60 percent at 48–54 months (Ahovuo-Saloranta et al., 2008)
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Many sealant programs target high-risk populations, which have proven to be effective for the prevention of dental caries as well as demonstrate cost savings (Kitchens, 2005; Pew Center on the States, 2010; Weintraub, 1989, 2001; Weintraub et al., 1993, 2001)
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Traditionally, dental treatment has focused on surgical interventions and standardized patient education. But recently some oral health educators and practitioners have adopted personalized chronic disease and risk assessment models for oral health diseases, particularly dental caries (Edelstein, 2010; Featherstone et al., 2003; Fontana and Zero, 2007; Lindskog et al., 2010; Yorty et al., 2011)
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. However, the ADA has recently convened a group of stakeholders, including the Centers for Medicare and Medicaid Services, in a Dental Quality Alliance, which is charged with developing pediatric oral health quality measures (Rich, 2010)
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• Many populations with poor oral health are underserved by the current oral health system. • Many complex and interrelated factors contribute to poor oral health and lack of access to oral health care, including social de terminants of health, poor health literacy, a lack of emphasis on preventive oral health interventions, and a lack of quality measures by which to evaluate and improve oral health care.
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Journal of the American Dental Association 131(5)
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2001. Recommendations for using fluoride to prevent and control dental caries in the United States.
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Journal of the American Dental Association 133(8)
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2010. Trends in paediatric dental caries by poverty status in the United States, 1988–1994 and 1999–2004.
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2009. Adhesively bonded versus non-bonded amalgam restorations for dental caries.
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1996. Stepwise prediction of dental caries in children up to 3.5 years of age.
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2007. Oral health literacy among adult patients seeking dental care.
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2005. Unmet dental care needs among children with special health care needs: Implications for the medical home.
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for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews (4)
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2010. A systematic review of dental recall intervals and incidence of dental caries.
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2004. Ozone therapy for the treatment of dental caries.
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2002. Recommendations on selected interven tions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofa cial injuries.
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2010. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents.
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2005. Fluoridated milk for preventing dental caries.
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