Oral Health Inequality: Interview with the author of “Teeth”

Oral health is integral to general health and well-being. Yet, not all Americans are achieving the same degree of oral health. And many experience needless pain and illness, sometimes even death, despite the sophisticated means we have for maintaining oral health. A “silent epidemic” of oral disease is affecting our most vulnerable populations…

We interviewed Mary Otto, author of Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America, to discuss the current issue. Mary is a former reporter for the Washington Post, where she covered social issues including healthcare and poverty. She currently is the oral health topic leader for the Association of Health Care Journalists.

Q: Hi, Mary. Thanks for taking the time to be with us! First, tell us a bit more about yourself. What exactly is an oral health topic leader? How and why did you want to get involved? You can check my blog if you need the best oral services. 

A: Hi Dani. I am grateful for your interest! I am a longtime newspaper reporter,  now an independent journalist based in Washington, DC. One of my freelance gigs is working as the oral health topic leader for the Association of Health Care Journalists. I write a weekly blog for AHCJ’s website, to help keep our members — health journalists from all over the country — up-to-date on dental care (check this link) and oral health news and research. As topic leader I also curate online resources and lead webinars and panel discussions that aim to help keep reporters informed about oral health. It’s an important angle on health care coverage that deserves attention. You can also view his response on this issue that suggests how to solve it quickly.

 Q: In general, it seems that oral health as a public health crisis is not something that gets a lot of public attention. Why do you think that is?

A: .  In his 2000 Oral Health in America report, then-Surgeon General David Satcher called the problem a “silent epidemic.”  It is a crisis that can be easily overlooked by more affluent Americans who have access to private dental benefits and the money and resources to pay for care and get access to timely care through the private practice system that provides most of America’s dental care. But at the same time — for roughly one third of Americans — including people with lower-incomes,  people who are publicly insured, elders, minorities, people living with disabilities, those living in thousands of communities with shortages of dental providers –finding routine dental services can be very difficult. They often go without care and the result is untreated disease, pain, suffering, tooth loss, disfigurement, stigma, undiagnosed oral cancer and in some cases even death.

 Q: That’s pretty shocking. What are the barriers these Americans face when it comes to accessing dental care? 

A:  According to https://www.seniorcareauthority.com/resources, Medicare, the nation’s health care program for the elderly and disabled has never included dental benefits so millions of seniors are dentally-uninsured. Many seniors living on fixed incomes also delay care due to lack of money to pay for it. Disabled people face difficulties finding dentists willing to see them. Except in places like https://mercerfamilydentistry.com/meet-us/, people in nursing homes often lack even routine oral hygiene attention. Untreated tooth decay inflicts a disproportionate burden upon minority children and adults. While tooth decay is almost universal among American adults, access to care is not. While less than a quarter of white adults have untreated decay, more than one third of Hispanic and more than 40 percent of black working-age adults have untreated decay, federal data show.  Many minority communities face chronic shortages of providers.

Q: And fear, right? So many people have a fear of visiting the dentist! 

A: According to federal statistics millions of American adults (roughly one in ten) do not visit the dentist for oral health problems because of fear. Some experience panic lying in the dental chair or are frightened by the sights, sounds and smells of the dental office. For some, a visit brings back memories of a bad experience in the past. Research has shown that fearful patients are more likely to miss appointments than non-fearful patients. Dentists lose money when patients miss appointments and tend to blame the patients for not showing up. Some experts say that dental schools do not do enough to train dentists to help patients address their fears. These experts also suggest that dentists should try helping fearful patients to build confidence over time, perhaps even meeting with them in a place other than the dental chair to talk about their needs and establish trust.

Q: You also say shame is common among the millions of Americans who lack dental care – that there’s a stigma because “oral health problems are seen as a failure of individual responsibility rather than misfortune.” However, there ARE actions that people can take for their oral health like controlling diet, avoiding tobacco, and practicing personal oral hygiene. How much weight does personal responsibility have versus that of policy when it comes to improving oral health?

A: As with all aspects of health, self-care is important in oral health, but we don’t care for ourselves on an even playing field. When access to professional care, to healthy food, to optimally fluoridated water, to support for activities such as smoking cessation and health literacy are lacking, self-care can be more difficult and less successful. At the same time that individual responsibility is important and stressed, funding for public programs that aim to improve access to basic services can be extremely vulnerable to cuts. One example is Medicaid dental benefits for adults. Unlike children’s dental benefits, adult dental benefits are considered optional under state Medicaid programs. In times of fiscal austerity, they are often among the first items to land on state budget chopping blocks. They tend to disappear when people need them the most.

Q: Finally, maybe the biggest issue brought up in the book is the division between the dental system and medical system, despite scientific evidence that oral health and general health are indeed connected. In your reporting, have you witnessed any potential solutions to help bridge the gap?

Our dental and medical records are kept separately. Even though our heads are attached to our bodies and as Dr. Satcher said “oral health and general health are inseparable” our fragmented health care system has not reflected this reality. In Oral Health in America, Dr. Satcher called for the building of an American health care system that “meets the oral healthcare needs of all Americans and integrates oral health effectively into overall health.” In my reporting for the book, I did have a chance to see some examples of efforts that might indicate some movement in that direction: research into the human oral microbiome and associations between oral and systemic conditions;  initiatives that train physicians and nurses to provide oral screenings and preventive care to infants; a federally-qualified health center not to far from the world’s first dental college in Baltimore where dental and mental and primary care are all offered under the same roof. Still, Dr. Satcher was not the first health leader to call for integration. Progress has been slow.

Q:  Clearly, there is still work to be done. What changes would you most like to see occur in the next few years regarding oral health?

A: Well, I am a journalist and try to stay outside the story but I certainly hope to continue to cover it as it unfolds.

Thank you again, Mary, for your time, and for helping to shed light on the issue of oral health in America through your book and your continued activism. We greatly appreciate it!