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Oral Health: Personal or public problem?

February 20, 2018
By Kristina Reed

Why should someone else’s oral health be your problem, or the government’s for that matter? Who cares about someone else’s toothache or gingivitis?

Well, you should.

Why the public’s oral health matters:

Oral health policies and outcomes affect more than just individuals. They have measurable consequences for our nation and the economy. One way that oral health influences the economy is through its effect on employment. Job candidates with visible or untreated oral health problems are significantly less likely to be hired, which contributes to chronic unemployment in some segments of workers and starts a cascade of economic effects. Oral health problems can translate into lost earnings, along with a loss of tax revenue and economic activity and an increase in costs associated with public assistance.

Oral health problems also affect the economy by leading to increased health care costs. When care is difficult to access – due to factors including inadequate insurance coverage and cost – patients are more likely to develop preventable problems. Many patients will defer treatment until the problem becomes severe, then seek emergency treatment. This is more expensive and rarely solves the problem, as emergency treatment is not meant for chronic health issues, making it likely that care will need to be sought once again. Meanwhile, the emergency system becomes overburdened, lowering the quality of care for all. The overall effect is an increase in health care costs, with no improvement in health outcomes. This is a frustrating and vicious cycle, especially because oral health problems are preventable through sound public health measures.


The problem with how we think about oral health:

Intersections among policy, outcomes, disparities, and costs are obvious to experts, but the public still has a narrow view of the consequences of poor oral health. Most people make simple and immediate associations: poor oral health leads to pain and “low self-esteem”. Prompting may cause people to consider some ripple effects, such as missed work days or opportunities. Yet, the common view is that these negative impacts are problems for individuals and family members, not matters of public concern. If the problem is thought of as the occasional toothache and a little personal embarrassment, then it becomes difficult to justify the need for policy and programs.

Ordinary Americans also believe that oral health problems can be prevented, but place the responsibility for doing so on individuals. In the public’s eye, prevention involves three simple behaviors: brushing, flossing, and visiting the dentist regularly. These are assumed to be matters of personal choice, willpower, and responsibility. This mindset leaves little role for policy and little chance that problems can be solved through a public response. The factors shaping the integration or separation of medical care and oral health are completely absent from the public’s thinking, and public health efforts are not considered. Oral health care remains low on the public policy agenda even in the midst of intense debate about other health care issues. We need to consider structural and systemic factors that influence oral health and the kinds of policies and programs that could change them.


Why public health interventions work:

How can oral health be improved? Experts see oral health issues as completely preventable with public health efforts that reach large numbers of people consistently. A great example of a successful public health approach is water fluoridation, which is inexpensive, low-key, and has resulted in dramatic improvements in dental health. Other preventive measures, like screening and dental sealants could improve outcomes further if made widely available. The availability and affordability of healthy food also plays an important role in oral health, and federal nutrition programs and policies have been connected to oral health outcomes. Similarly, access to affordable, quality oral health care is essential to effective public policy on oral health. There is also need for a variety of changes in current health insurance schemes, such as expansion of eligibility for Medicare and Medicaid, increase of oral health coverage in these plans, and inclusion of at least some oral health treatment in private medical insurance. Other policies could better integrate oral health concerns into medical care, such as screenings for oral infections during pregnancy. It is important to recognize that oral health intersects with several other issues and public health solutions should be from a variety of angles.