Don't Just Grin And Bear It
The systemic effects of dental and oral health can't be ignored.
Hi Unbiased Scientists,
Apologies for not delivering a newsletter last week! I was offline tending to some personal matters, but I am back and will be sharing two newsletters this week to make up for lost time (and content)! This week’s article is about the systemic effects of dental issues. Special thanks to Dr. Ashley Lerman, DDS, for her contributions to this piece and for lending her expertise on oral health.
Let’s take a moment to discuss dental coverage (or lack thereof) in the US.
Historically, dental care and medicine evolved separately, which resulted in different insurance models. Unlike medical insurance, dental insurance emphasizes preventative care like checkups and cleanings to try and avoid expensive problems down the road. However, coverage for major procedures is often limited, leaving patients with substantial out-of-pocket costs.
Unfortunately, the cost of dental care can lead people to delay or forgo treatment, which usually leads to more complex and expensive problems in the long run. Some experts believe better integration between dental and medical care could improve health outcomes and potentially reduce costs, and new insurance models might make paying for necessary dental work more manageable. Something has to change because a recent analysis found that an estimated 68.5 million adults in the US do not have dental insurance. This is problematic for many reasons, not the least of which includes that dental health problems can impact the rest of our body in many ways. Let’s discuss.
What are some systemic effects of dental issues?
Dental problems can surprisingly lead to a variety of serious health issues throughout the body. Here's how:
Heart Disease: Bacteria from infected gums can travel through the bloodstream and reach the heart. This can lead to inflammation in the heart valves (endocarditis) or contribute to the development of atherosclerosis (clogged arteries). Research shows that periodontal disease is associated with an increased risk of cardiovascular disease.
Respiratory Issues: Bacteria from the mouth can be inhaled into the lungs, increasing the risk of pneumonia, bronchitis, and other respiratory infections. This is especially dangerous for people with compromised immune systems or lung conditions.
Diabetes Complications: Gum disease can make it harder to control blood sugar levels, as inflammation makes the body less responsive to insulin. Uncontrolled diabetes, in turn, worsens gum disease, creating a vicious cycle.
Osteoporosis: Chronic inflammation caused by gum disease might contribute to bone density loss, increasing the risk of osteoporosis.
Alzheimer's Disease: While the link is still being studied, there are indications that bacteria from gum infections could play a role in the development or progression of Alzheimer's disease.
Pregnancy Complications: Pregnant women with periodontal disease may be at a higher risk for premature birth and low birth weight babies.
There are also associations between poor oral health and preeclampsia, gestational diabetes, miscarriage, and stillbirth.
Pregnancy’s effect on the mouth:
Gingival tissues express estrogen-specific receptors (estrogen-sensitive tissue)
Nausea/vomiting affect tooth enamel
Pregnancy likely affects cellular and humoral immune responses of the tooth-supporting periodontal tissues (periodontium)
Pregnancy-associated pyogenic granuloma or epulis gravidarum may occur due to local accumulation of dental calculus
Pregnancy-associated gingivitis is the most common reversible condition during pregnancy, with a prevalence ranging from 30% to 100%
Source: Choi et al. Family Practice, 2021
The Oral Health in Pregnancy Disconnect
80% of OB providers don’t use oral health screening questions in their prenatal visits; 94% do not routinely refer patients to a dentist
Many dentists may be concerned about the safety of dental procedures during pregnancy
Nearly 85% of OB providers do not routinely inspect patients’ oral cavities
Source: CDC: Pregnancy and Oral Health
Important Note: These links don't mean dental problems will definitely cause these systemic issues. However, taking care of your oral health reduces your risk of developing these more serious conditions.
Why is dental care siloed from other medical care? Let’s dig into the history of dental coverage.
Historical Origins: Early dentistry (specifically in Europe during the Middle Ages) was often seen as a trade rather than a medical specialization. Barbers and blacksmiths might perform rudimentary dental work. This separation, along with opposition from organized medicine, influenced how dental care developed independently.
Insurance Models: Employer-sponsored health insurance became common in the US after WWII, but typically excluded dental coverage. This cemented the perception of dental care as optional rather than essential for overall health.
Practical Considerations: Dental procedures often require specialized equipment and settings, making it less practical to integrate them seamlessly into standard medical offices.
The History of Dental Coverage
Early Efforts:
In 1932, a study published by the Federal Committee on the Costs of Medical Care laid out a plan for publicly funded healthcare, including dental care. Opposition led to this plan not being realized, and instead, insurance led to insurance being separated between medical and dental care, as well as being employer-sponsored.
A public option did not come about until 1965 with the advent of Medicare and Medicaid.
Insurance for dental care originated in the US in the late 1940s, with labor unions in the US successfully negotiating dental benefits for workers after the passage of the Taft-Hartley Labor Law.
Slow Growth: Dental insurance remained far less common than medical insurance for decades. Plans often had low maximum benefits ($1000 annually was typical), perpetuating the idea of dental care as a luxury.
Recent Changes: The Affordable Care Act (ACA) includes provisions for pediatric dental coverage, recognizing its importance for children's health. However, adult dental coverage through the ACA or private insurers often remains limited and costly.
Consequences of the Divide In Medical and Dental Coverage
Unequal Access: Many people, especially those with lower incomes, lack dental insurance, leading to delayed or neglected care.
As of 2023, about 68 million Americans lack dental insurance (about 23% of Americans aged 19-64 lack dental insurance)
Widening of Other Inequities: A 2011 study found that children with poor oral health were nearly 3x as likely to miss school from dental pain.
Missed Connections: Oral health problems can signal or exacerbate systemic health conditions like heart disease and diabetes. The separation of dental and medical care makes it harder to manage these conditions holistically.
Efforts for Change
Integration Initiatives: Some clinics are experimenting with models integrating dental and medical care, especially for underserved populations.
Some medical schools include electives for teaching medical students about oral health.
Organizations are pushing for policies and insurance models that recognize the importance of dental care to overall health. A recent article published by Smithsonian magazine discusses the connection between oral health and overall health. In recent years, there has been a movement to integrate these two fields. There is growing evidence that poor oral health can lead to other health problems, for example, gum disease has been linked to heart disease, stroke, and diabetes. Despite this evidence, there are still barriers to integrating oral and medical care, such as lack of insurance coverage, lack of communication between dentists and doctors, and differences in electronic health records. However, there are efforts underway to overcome these barriers.
P.S. Did you know I host another podcast called Bytes of Health? Episodes air DAILY and answer commonly asked pediatric questions in 5 minutes or less! Dr. Ashley Lerman joined me for an episode on dental health tips for parents:
Special thanks to Dr. Ashley Lerman for her contributions to this article. You can follow Dr. Lerman on Instagram at mommypediatricdentist, as well as FirstGrin at @firstgrin.