A Public Health Perspective on Oral Health.
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“If two people seem to be equal in terms of skills and experience on a resume, and both appear for an interview, and one has a beautiful smile, while the other one doesn’t, who are you going to choose?”
When you think of aspects of health and wellbeing, you likely think of exercising and eating healthy, getting vaccinated, living in safe, hygienic conditions, and maybe even maintaining work-life balance for the sake of good mental health. One aspect of health that is often given little attention is oral health. After all, a little cavity here and there can’t hurt anyone, right?
Wrong. Oral health is a crucial aspect of general health and overall quality of life. The World Health Organization (WHO) states “[oral health] is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.”
Unfortunately, anyone can become a victim of dental disease, from those living comfortably to those living in underserved areas. Risk factors include limited access to preventative measures such as sealants or fluoride, as well as behaviors such as consuming diets high in processed, sugary food and drinks.
Oral diseases like tooth decay disproportionately affect those with limited access to healthcare. The nature of tooth decay in cavity formation is that it is irreversible once the tooth’s enamel has been destroyed. While decayed teeth may be filled or restored, if an individual is unable to obtain dental services, either due to a lack of dental practitioners in certain areas or maybe a lack of dental insurance, tooth decay may lead to permanent tooth loss. There is now an ample amount of research that demonstrates that tooth loss is associated with decreased quality of life.
What we need to prevent this from happening is a greater focus on public health dentistry. Boston has a wealth of healthcare resources and infrastructure, yet underserved populations continue to face barriers to dental care. From a public health standpoint, the City of Boston has attempted to make available more preventive facilities to combat this silent epidemic. Services include community health centers and dental schools that provide more accessible services to those in need. Boston University’s Henry M. Goldman School of Dental Medicine is a key stakeholder in the city that has made major improvements in the field of dental outreach and oral health promotion programs.
The Office of Global and Population Health at the Boston University Goldman School of Dental Medicine (GSDM) offers a myriad of outreach events and preventive services that are open to people from all walks of life, including students, children, and their families, the homeless population, those with special needs or financial difficulties, the uninsured or underinsured, refugees, etc. These amenities range from dental screenings and fluoride applications to oral health education.
For an inside look at BU’s nationally recognized oral health programs, we sat down with Kathy Marie Lituri, a Clinical Instructor and Oral Health Promotion Director at GSDM. In a few sentences, Kathy captured the essence of how oral health inequities manifest in Boston’s homeless population. She stated:
“It is how we’re able to eat and speak, how we feel confident laughing in public; it is a major factor in a person’s employability –if two people seem to be equal in terms of skills and experience on a resume, and both appear for an interview, and one has a beautiful smile, while the other one doesn’t, who are you going to choose?”
Sadly, this is the reality in Boston, and this reality is also paradoxical. Research reveals that homeless individuals who are unable to receive dental care are generally encouraged to find a job and subsequently, dental insurance. However, this same population’s lack of oral care can be a major impediment in their employability, due to discrimination in the job market related to missing teeth or deformities in the mouth. Key stakeholders must recognize that aspects such as employment or education are deeply intertwined with access to dental care.
Often, it’s more than just access. Just last week, a group of Boston University’s dental students met an elderly woman at Rosie’s Place who had recently gotten dentures. When asked if she has been able to take her dentures out at night before she sleeps, the woman said no.
If you had to take a guess, what could’ve been the reason for this? It was not that she was unable to understand the directions. It was not that she had forgotten to do so, or that she didn’t have a case to hold the dentures.
This woman was worried that if she removed her dentures at night, another individual at the shelter would steal them. This is not a barrier that you will find written in your typical list of obstacles to oral healthcare for underserved populations. This is a very real concern that is hindering a real person from making the most of the services to which she does have access.
Boston University’s Goldman School of Dental Medicine recognizes that these kinds of very real barriers exist and that they have severe impacts on the health of our population. BU’s many dental outreach programs have accordingly taken on more public health-centered approaches in their community initiatives. The denture example is one of many that demands personalized yet holistic methods of all health practitioners; only when the whole scope of this public health burden is known can we effectively address oral health disparities head-on.