By John W. Reinhardt, D.D.S.
Dean, University of Nebraska Medical Center College of Dentistry
On May 25, U.S. Surgeon General Dr. David Satcher released the first-ever
Surgeon Generals Report on Oral Health in America. This sweeping
review identified areas to improve our nations oral health. What
does this mean for Nebraskans? The first conclusion, you probably
already knew: See your dentist regularly! But there is more
to it than that. Here are a few other points from the report:
First, oral health is an indicator of our general health. The
mouth is the gateway to our bodies wellness and fitness. Dental
diseases, if untreated, result not just in discomfort, but poor diet, speaking
disorders, and lowered self-confidence. Oral cancers (diagnosed in
about 30,000 Americans annually), if detected and treated early, have high
survival rates. Left undetected, oral cancers can progress swiftly;
more than 25% of those diagnosed with oral cancer die from it. The
most effective way to detect oral cancer early is a routine screening examination,
and todays dentists and dental hygienists are highly trained to detect
oral cancer in its early stages.
The report also explained how periodontal (gum) disease is related to
significant health problems. For example, studies show that women
with gum disease are more likely to deliver premature, low birth-weight
babies. Studies have also linked gum disease with heart disease,
suggesting that the same kinds of bacteria that cause gum disease may be
responsible for artery-clogging plaques that can cause heart attacks.
Other studies indicate that stroke and diabetes also occur more often in
people with gum disease. Although more research is needed, its clear
that oral health is integral to total health.
The report praises the advances in oral health sciences during the past
50 years, including remarkably successful techniques to prevent tooth decay.
These advances have resulted in more people keeping their natural teeth
throughout their lives, resulting in improved overall health.
However, these advances in oral health care are not enjoyed by everyone.
Lower-income families; minorities such as Native Americans, Hispanics,
and African Americans (especially children and elderly in these groups)
are missing out on the benefits that many in the rest of the country are
receiving. Even Dr. Satcher, an African-American and the U.S. Surgeon
General, did not have his first dental visit until he was a college student.
Some barriers to good oral health care and medical care are economic.
While 43 million Americans have no health insurance, 150 million have no
dental coverage. Only 32 states cover any kind of dental care for
Medicaid-eligible adults (Nebraska is one that does), and less than half
of 1 percent of Medicaid expenditures are for childrens dental services.
Medicaid reimbursement rates for dental services are woefully low (although
recently increased in Nebraska); and, when coupled with time and administrative
burdens to the dentist, offer few incentives to provide Medicaid treatment.
There are other barriers to access. Some regionsincluding rural and
urban areassuffer shortages of dentists and dental hygienists. According
to a state report, in 1999, about half of Nebraskans were affected, by
some extent, by lack of access to dental care. Forty-six counties were
designated as State Dental Shortage Areas. Sixteen of Nebraskas 93 counties
are without a dentist. Some Medicaid-eligible Nebraska children must
travel five hours to find a pediatric dentist for their complex treatment
needs. Water fluoridation is one of the simplest, safest, and most
cost-effective ways of preventing cavities and benefits people of all ages
and backgrounds. Unfortunately, about 100 million U.S. citizens–one-third
of our population– do not have fluoridated drinking water. In Nebraska,
70 percent of the community water supplies are artificially fluoridated,
but 25 percent of our population is not on community water supplies.
Dental schools throughout the nation are working in many ways to address
the problems outlined in this landmark report from the surgeon general.
At the University of Nebraska Medical Center College of Dentistry, we accept
Medicaid reimbursement for patient treatment; recruit and train diverse
students (including those from rural backgrounds who are more likely to
return to practice in rural areas); train students in rural and public
health settings; train specialized pediatric dentists; and teach students
how to treat physically, emotionally, and medically complex adults.
We also are working with public health agencies and professional organizations
to address the problems of providing good oral health care to the entire
state of Nebraska.
The conclusion we can draw from the Surgeon Generals report is that
all of us should recognize the importance of good oral health. Brushing,
flossing, and making regular visits to a dentist are a good start.
Dentists, together with government agencies, need to take steps to ensure
that the gift of good oral health is available to all.