The National Picture

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Oral disease continues to be ubiquitous in many populations across the U.S.; in fact, globally.  The most recent estimate is 3.5 billion (with a “b”) people worldwide are affected by the burden of untreated dental caries, severe periodontitis, and edentulism.   That is an increase of 10 billion since 1990.  Feels disheartening at times.  In the dental profession we often say we “can’t drill and fill our way out of this,” and that is becoming more evident by the day.  Yet we continue to place significant emphasis on access to care and yearly dental visits.  Not that we should not include access in our focus, as we know dental disease is not self-resolving; but we have to look “upstream” in earnest if we are to turn this trend around.

The Surgeons’ General Report on Oral Health in 2000:  we thought the stars had finally aligned.  While it is nearly two decades old, it is still relevant; particularly if we do not forget the follow-up report, the 2003 Surgeons’ General National Call to Action to Promote Oral Health, in which five key actions were proposed to improve the oral health of the nation.   It is in these five recommendations that “looking back” provides evidence of significant progress as the nation “looks forward” to current and future initiatives.

  • Change Perceptions of Oral Health: Oral health is important for overall health! This message is resonating more than in any other time.   There is a continual increase in populations served by community water fluoridation, an increase in school-based/school-linked sealant and varnish programs; increased focus on oral health of older adults with potential cost savings in medical care; and inclusion of children’s oral health as an essential service in the ACA.  Healthy People, a federal initiative that determines the health objectives for the nation, selected oral health access as a leading health indicator, recognizing that oral health contributes to the health of the nation.
  • Overcome Barriers by Replicating Effective Programs and Proven Efforts: “Evidence-based” oral disease prevention has been the focus of many state oral health programs, national and local foundations, and federal funding policies. Better sealant materials, fluoride varnish, silver diamine fluoride, and motivational interviewing techniques have all shown results in preventing oral disease and are being replicated throughout the country.
  • Build the Science Base and Accelerate Science Transfer: The National Institute of Dental and Craniofacial Research (NIDCR) continues to look forward in their 2018 research themes and in their 2030 strategic plan with funding priorities that address the lag time between research and practice implementation, with focus on oral cancer, the oral biome, and personalized medicine. Efforts to understand personal behavior motivators are also revealing new approaches to preventing oral disease.
  • Increase Oral Health Workforce Diversity, Capacity, and Flexibility: National foundations (RWJ, DentaQuest, and Kellogg in particular) have catalyzed initiatives around workforce and the potential for replicability, with the result that many states have changed practice acts, scopes of practice and initiation of new provider types, as well as improving community-wide oral health literacy.  The National Interprofessional Initiative on Oral Health (NIIOH), the Oral Health Section of the American Academy of Pediatrics, the continued strength of the Oral Health Section of APHA, are drawing all health professionals into the realization that oral and systemic health are inextricably intertwined.
  • Increase Collaborations: This goes beyond collaboration to integration! Federal agencies are collaborating to assure consistent messaging and complimentary funding to state oral health programs.   While the goal of funding all 50 states has not been achieved, the number of states funded for infrastructure and/or workforce initiatives continues to increase.  State oral health programs are incentivized to collaborate with chronic disease programs; clinicians at community health centers and community safety nets are integrating oral health and primary care.  Universities and health science campuses are implementing the Interprofessional Education Collaborative (IPEC) competencies to prepare the workforce for tomorrow.

It is amazing to look back to 2000 and the Surgeons’ General’s report and see the progress that truly has been made.  While frustrations abound as to why more progress has not been made, and trepidation exists as to what the future might bring, it is a chance to look forward with renewed fervor and commitment to integrate oral health into the mindset of every person: to connect the mouth to the body, not only figuratively and in health practice, but also in health policy and financing in the public and private sectors.   The cost of dental care is still the most significant barrier to care for many people and does not align well with the goal of systems integration and collaborative practice.  Top down or bubble up?  Federal policy or grassroots advocacy?  The future of oral health and the reversal of global disease burden will require both approaches.   There is no silver bullet, no single cause of oral disease, no uniform strategy.  But where there is passion, there is hope.