Public health experts are finding connections between dental health and physical health (sometimes called systemic health). The correlation between physical and dental health is an area of growing interest in the public health community. The following originally appeared in Scientific American:
The list of connections between oral health and systemic health – conditions that affect the entire body – is remarkable. For starters, three common dental issues – cavities, tooth loss and periodontal disease – are all associated with heart disease, the leading cause of death in the United States. “To me, the number one hidden risk factor for the number one killer in our country is oral health,” says Ellie Campbell…
Many public health advocates wonder if dental health is so closely related to systemic health, then why is dental care not considered a component of primary care? More from Scientific American:
Historically, dentistry and medicine have operated as parallel fields: Dentists take care of the mouth, physicians the rest of the body. That is starting to change as many initiatives across the United States and other countries work to integrate oral and whole-body care to more effectively ackle diabetes, cardiovascular disease, joint replacements and many other conditions. The exact relationship between health of mouth and teeth and physical ailments elsewhere in the body is not well understood – and in some cases, is contentious – but experts agree there are links that should no longer be overlooked.
More than a decade ago the federal government hired a firm to run a pilot project that married physical and dental health care. The firm identified several factors that stood in the way of dental care and medical care integration: (1) Medical and dental care are funded separately, and fewer Americans have dental insurance than have medical insurance. (2) Dentists and primary care physicians are not trained to work together. (3) Systems to store dental records and electronic medical records are incompatible.
Nonetheless, research into the effect of dental care on health status is ongoing:
“We’ve published papers identifying links between periodontal disease and diabetes, hypertension, dementia, adverse birth outcomes, low birth-weight babies, preterm birth, spontaneous abortion, kidney disease,” says Jane Barrow, the initiative’s executive director.But correlation is not the same as cause and effect, and scientists have not nailed down the exact relationship between periodontitis, which affects more than 11 percent of the global population, and various systemic diseases.
Let’s ask the question another way. Would treating periodontal disease, or preferably preventing it, prevent heart disease? Some studies suggest a benefit (but they’re probably wrong). More from Scientific American:
[A] study that tracked the health habits of 11,869 adults 35 and older in Scotland found that within eight years, those who rarely brushed their teeth had more cardiovascular problems compared with those who brushed twice a day.That still does not prove that preventing periodontitis will hold heart problems at bay: Some other habit or feature of the toothbrushing group could have been the important factor. The relationship is difficult to tease out, Barrow says, because people who are taking good care of their mouths tend to take good care of themselves in general.
Dental health and physical health status are both correlated with income. That is, poor people tend to have worse health status and tend to have worse dental health than wealthier people. I suspect that many proponents’ primary goal, when discussing integrating dental coverage into health coverage, is increasing dental coverage. That is, forcing people (i.e. forcing employers, the government, Medicare and Medicaid) to provide dental coverage far more generous than what is currently available. Dental health parity anyone?
Is it odd that dental care is a separate field from primary care? There are a variety of providers besides dentists who care for patients but are not medical doctors. Podiatrists for feet, optometrists for eyes, audiologists for hearing and chiropractors for spinal alignment are all examples. If public health advocates really want to improve access to dental care, they should advocate for expansion of dental therapists and allow them to practice independently.
The article is an interesting read: Why Isn’t Dental Health Considered Primary Medical Care?