A Conversation with the Tooth Fairy
TF: Thanks for taking this impromptu call, but I needed to get a few things off my chest. You can imagine my schedule, what with all the dimes under the pillows and whatnot, and a lot of other responsibilities and issues that demand my attention.
AJPM: Such as?
TF: Access to oral health, disease and injury prevention, and the link between oral health and general health are my top priorities right now. It’s really keeping my policy wonks busy. And don’t get me started about oral health literacy or those fruitcakes still arguing about fluoridation. You saw what happened in Portland, Oregon in May? That’s the fourth time they’ve rejected community water fluoridation since 1956, and each time they get the science wrong. It’s making me crazy.
AJPM: Yes, Portland’s regular rejection of an evidence-based public health measure is a bit puzzling, but they are known for their eccentricities.
TF: Eccentricities, my pouch of dimes! Of the 30 largest cities in the U.S., Portland is the only one that doesn’t fluoridate its drinking water to help prevent tooth decay!
By the way, did you see the latest study on fluoridation in the Journal of Dental Research? Good stuff. Don’t forget that the CDC calls fluoridation one of the 10 great public health achievements of the 20th century, and it’s endorsed by the biggies like the AMA and the WHO. What more do those fact-free thinkers in Portland need?
And speaking of the CDC, what’s with states not developing Oral Health Plans? 18 states have no plan! This also is making me crazy. Washington, DC is among those without a plan, which doesn’t surprise me, but what’s up with the rest? Pathetic. Get with the program! The CDC can help, so there’s really no excuse. And remember, more young children suffer from tooth decay than from any other chronic condition, including asthma.
AJPM: Good point. You mentioned access to oral health. What does this mean in practical terms?
TF: It’s simple to say, harder to do; kids, teenagers, adults, and seniors can find and see a dentist when they need to, and everyone can afford it. That means enough dentists relative to the population, and a way for poor folks to pay for dental services.
Poverty is no fun, and to add to the misery financially strapped families, for a bunch of reasons, have higher rates of tooth decay. I don’t want to bore you with statistics, but close to one in four kids living in poverty have untreated decay, as do 42% adults aged 20–64, and the occurrence of untreated decay is nearly three times greater among adults aged 65 and over living in poverty. So far, too many publicly funded programs don’t cover oral health care for adults with low incomes.
It’s probably news to you that more than one-third of older adults aged 65–74 living below the federal poverty level are without teeth. Any idea what that means? Poor chewing efficiency can limit food choices and diminish the pleasures of eating. Being without teeth might also change your physical appearance and even affect speech. Folks report oral pain, food avoidance, and self-consciousness or embarrassment because of their mouth, teeth, or dentures. Social contact and intimacy can be restricted and your self-esteem can take a nosedive. In a nutshell, your quality of life suffers.
TF: That’s not all. The medical, functional, emotional, and social consequences of oral health makes it an important contributor to overall health for individuals and the population. To take just one example, tooth loss among older people has been shown to be associated with both weight loss and obesity—often as a result of avoiding some foods and eating easier-to-chew junk food. Appropriate oral treatment would not only enhance quality of life but also encourage healthier eating patterns that could result in improved long-term health.
While on my soap box, I’ll argue that oral health must be better integrated into medical care. People reporting poor health are significantly more likely to have multiple chronic conditions (including oral health problems), but because these folks are more likely to visit a physician than a dentist, it’s important that clinicians recognize common oral conditions and risk factors, and refer the patient for subsequent treatment. Oral health care must be regarded as a specialty like cardiology, neurology, or internal medicine, rather than distal to general health.
Which reminds me, when are those health literacy people going to address jargon like “dental caries” and “edentulous” when they mean tooth decay and no teeth? It’s enough to bring back my bruxism. I must remember to send a stern memo to the IOM.
AJPM: Thanks very much Tooth Fairy for sharing your thoughts, and keep up the good work.
— Michael Lytton, AJPM Blog Editor
Dye BA, Li X, Beltrán-Aguilar ED. Selected Oral Health Indicators in the United States, 2005–2008. NCHS data brief 96. 2012.
Dye BA, Li X, Thornton-Evans G. Oral Health Disparities as Determined by Selected Healthy People 2020 Oral Health Objectives for the United States, 2009–2010. NCHS data brief 104. 2012.
Lin M, Sappenfield W, Hernandez L, Clark C, Liu J, Collins J, Carle AC. Child- and State-Level Characteristics Associated with Preventive Dental Care Access Among U.S. Children 5–17 Years of Age. Matern Child Health J 2012;16 (Suppl 2):320–9.
Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of Oral Disease Among Older Adults and Implications for Public Health Priorities. Am J Public Health 2012:102(3):411–418.
Malvitz DM, Barker LK, Phipps KR. Development and Status of the National Oral Health Surveillance System. Preventing Chronic Disease 2009;6(2).
Selwitz RH, Ismail AI, Pitts NB. Dental Caries. Lancet 2007;369(9555):51–9.
Bader JD, Rozier RF, Lohr KN, Frame PS. Physicians’ Roles in Preventing Dental Caries in Preschool Children: A Summary of the Evidence for the U.S. Preventive Services Task Force. Am J Prev Med 2004;26(4):315–25.
Truman BI, Gooch BC, Evans CA, Jr. The Guide to Community Preventive Services: Oral Health. Am J Prev Med 2002;23(1 Suppl 1):1–2.
Treadwell H, Ro M. Community-Based Oral Health Prevention: Issues and Opportunities. Am J Prev Med 2002;23(1 Suppl):8–12.
Stavisky J, Bailit H. The Robert Wood Johnson Foundation’s Response to Improving the Nation’s Oral Health. Am J Prev Med 2002;23(1 Suppl):13–15.