Public health advocates have long considered dental care a neglected area of medicine, with dentistry in a silo of its own. Obamacare was intended to provide universal health coverage and boost access to medical care. However, it did not expand dental coverage beyond what was included in Medicaid expansion. Dental insurance must be purchased separate from health insurance for most people. Medicaid and SCHIP provide some dental benefits for children but not all state Medicaid programs provide dental care for low-income adults. Medicare does not cover dental services, except for a few Medicare Advantage plans. There was recently some discussion of adding dental benefits to Traditional Medicare, but dentists resisted. They did not want a national program that capped their fees. Estimates vary, but about 9% of children lack dental coverage while 23% of adults under age 65 lack coverage. Just over one-third of seniors have some type of dental coverage.
The American Dental Association puts the number of Americans with an annual dental visit at about 43%, but admits their figures probably underestimate the true number. According to the Centers for Disease and Prevention, about two-thirds of adults between the ages of 18 – 64 had a dental visit in the previous year. Yet, that’s not good enough in the opinions of some advocates, who want to integrate dental care more closely with medical care.
“We are at a pivotal point — I call it the convergence era — where dentistry is not going to be separated from overall health for much longer,” says Stephen E. Thorne IV, founder and CEO of Pacific Dental Services, based in Irvine, California. “Dentistry will be brought into the primary care health-care team.”
Indeed, data has emerged that poor dental health is correlated with heart disease. Indeed, there are numerous conditions that scientists are analyzing to see if your mouth influences other areas of your body.
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.
Periodontal disease, infection and inflammation of the gums and bone that support the teeth, is the main culprit. Nearly half of adults 30 and older have periodontal disease; by age 65, the rate climbs to about 70 percent. In the early stages, called gingivitis, gums are swollen and may bleed. Periodontitis, a more serious condition in which gums can pull away from the teeth, is the sixth most common human disease.
Periodontitis is associated with a slew of systemic ills: heart attacks, strokes, heart failure, diabetes, endocarditis, chronic kidney disease, recurrent pneumonia, chronic obstructive pulmonary disease, gastritis, rheumatoid arthritis, cancer and cognitive impairment.
When I read about periodontal disease supposedly contributes to heart disease years ago, I was reminding of the old mantra in statistics, “correlation is not causation.” Poor health is correlated with low income as is poor dental health. There are undoubtedly some cause and effect with respect to some diseases of the body and oral health, while other conditions are the result of a lifestyle of neglect due to poverty.
Bad habits, including tobacco use, alcohol consumption and high-sugar diets, are implicated too. They raise the risk for cavities and most oral diseases, and are also linked to ills such as cancer, chronic respiratory disease and diabetes.“
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.
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. “Could you say that people who are taking care of their mouths are in better health overall? You would probably find that to be true,” she says. “Is it because they’re taking care of their mouth? I can’t say that.”
If state and federal officials want to encourage more dental care, they should work to boost access to care instead of trying to boost dental coverage. Increasing access to dental care should be done by allowing dental hygienists to practice independently of their dentist overlords and to facilitate training and license dental therapists to work independently like a small handful of states currently do.
The entire article in Scientific American is worth reading: Why Isn’t Dental Health Considered Primary Medical Care?
Just an excuse to force people to purchase unnecessary dental coverage, which has always been a poor value for people without a pre-existing dental problem.