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The Oral Health Imperative

October 20, 2016

Photo of Deamonte Driver. In 2007, Deamonte Driver of Prince George's County, Md. died when an abscessed tooth sent bacteria to his brain.​ His surviving brother was found to have six similarly rotted teeth. The case set off alarms about the state of oral health care in America.
In 2007, Deamonte Driver of Prince George's County, Md. died when an abscessed tooth sent bacteria to his brain.​ His surviving brother was found to have six similarly rotted teeth. The case set off alarms about the state of oral health care in America.

Each year, Americans lose 164 million hours of work, 51 million hours of school and $1.6 billion in ER costs because of oral health emergencies brought on by a lack of preventive dental care – and tragedy can befall those who wait too long, experts said in a recent web conference.

Despite calls dating at least to the 1970s to integrate dental services into primary care clinics, the profession remains largely separate from a health care system that increasingly is centralizing in response to government incentive programs.

"It's certainly not a new issue," said CAPT Renee Joskow, HRSA Senior Dental Advisor and herself a practicing dentist.  "But right now it's been gaining a lot of attention, and there is a sense of urgency," on the heels of multiple studies pointing to service gaps that can cost lives – not to mention millions in avoidable health care costs.

Photographs of HRSA's Dr. Renee Joskow and Anita Glicken of the University of Colorado​.
A sense of urgency: HRSA's Dr. Renee Joskow and Anita Glicken of the University of Colorado​ noted that almost two decades of federal reports have reached the same conclusions on the importance of oral health to overall physical and mental well-being. HRSA is among agencies leading the effort to integrate dentistry into primary care.

​Many patients still "don't know that oral health is related to overall physical health," Joskow noted in a Sept. 7 webcast, and is intimately entwined with a range of health issues and related diseases, such as diabetes, HIV/AIDS, smoking and substance abuse.

Rather, many Americans still think of their teeth as somehow apart and unrelated to their medical and mental health.

Each year, Joskow added, there are 27​ million dental check-ups, for example, but four times as many medical appointments that often don't include oral screenings -- "and that's millions and millions of lost opportunities" to prevent potentially grave consequences.

Anita Glicken, associate d​ean in the Physician's Assistant program at the University of Colorado School of Medicine, recounted the case of a pregnant woman who lost her child due to an unrecognized case of advanced tooth decay – as oral bacteria migrated into her bloodstream. Known as Sepsis, the condition can induce early labor, or even attack the developing fetus in the womb.

"Everyone was focused on the baby, and the survival of the baby," Glicken said, while overlooking "the oral health problem."

Similarly, Joskow said, oral diseases often go unrecognized in social services visits, schools and emergency rooms, allowing bacteria to spread and potentially wreak havoc both on internal organs and patients' mental health.


"Millions of lost opportunities": Under the prevailing national care model, even cases of serious oral disease can go undetected for lack of oral health specialists on primary health care teams, Joskow said.

​​Out of embarrassment or fear, patients may even lie to conceal a serious dental problem in themselves or their children – underscoring the importance of behavioral health specialists and counselors on staff in primary care clinics.

"Dentalphobic patients often won't talk about their condition" with an oral health specialist, Joskow said, but they might tell a caseworker as part of a family medical history or background interview.

In June, HRSA awarded nearly $156 million to 420 health centers nationwide to hire some 1,600 oral health providers. They are expected to treat about 785,000 new patients.

Staffing in 2014 included over 3,700 dentists, more than 1,600 dental hygienists, and over 7,400 dental assistants, technicians and aides who served about 4.7 million dental patients.

HRSA has long been at the forefront of oral health integration, Joskow noted, including funding in 2009 for two Institute of Medicine studies: Advancing Oral Health In America (PDF - 1.4 MB) and Improving Access to Oral Health Care for Vulnerable and Underserved Populations (PDF - 3.3 MB). She serves on the multi-agency Oral Health Coordinating Committee, which recently published the critical HHS Oral Health Strategic Framework, 2014-2017 (PDF - 3.3 MB).

​Watch the archived webcast.

Date Last Reviewed:  July 2017