America's oral health outlook: an emphasis on oral-systemic connection

By Vicki Cheeseman, Associate EditorThe role of oral health in America and its place within the health-care system as a whole requires ongoing emphasis to motivate the public to elevate dental care to its rightful position. Recently, the Institute of Medicine published a report titled “Advancing Oral Health in America: The Role of HHS” through an established committee whose purpose was “to explore how HHS (U.S. Department of Health and Human Services) can enhance its role as a leader in improving the oral health and oral health care of the nation.” A second report that focuses on improving access to oral health care in America will be issued at a later date.I recently had the opportunity to interview Dr. Harold C. Slavkin, DDS, one of the committee members, about his view of the report and the state of oral health in our country. Dr. Slavkin is the founding director of the Center for Craniofacial Molecular Biology and a professor in the School of Dentistry at the University of Southern California. His expertise is in health promotion and disease prevention, access to health care for underserved populations, funding for health care, epidemiology, and craniofacial morphogenesis. Helpful linksOral health and the role of HHSADEA supports national oral health reportInterview with Maria Perno Goldie, RDH, MSDentistry and the oral-systemic connectionWhat is the most critical message HHS wants to send to the American public and the dental profession about the current state of oral health and what needs to be done to improve it?Dr. Harold Slavkin:“The mouth is connected to the rest of the body.” Throughout the human lifespan, the craniofacial-oral-dental complex is critically integrated into all of being alive. From maternal ingestion of drugs that can produce birth defects, to microbial infections that result in the No. 1 chronic disease of children (tooth decay), to chronic and destructive microbial infections that produce periodontal disease in adults, to the consequences of diabetes, to the management of chronic facial pain, to cardiovascular, pulmonary, and osteoporosis diseases and disorders, to drug therapy that causes xerostomia and tooth decay in elderly ... the mouth is connected to the rest of the body.Please explain the makeup of the committee and tell us how many members are from the dental profession.Dr. Slavkin: As you examine our IOM Panel, I think you will find six people with extensive backgrounds as oral health professionals (oral and maxillofacial surgery, general dentistry, dental public health, dental hygiene). In addition, we were most fortunate to have experts in nursing, pediatrics and medicine, public health, health economics, health law, and health policy. We also gained enormous information from many health professional groups. Personally, I am a dentist, ADA member, scientist, and science administrator. I worked on the first-ever Surgeon General’s Report, “Oral Health in America,” when I was director of the NIDCR. I practiced general dentistry for seven years many years ago. I am also a member of the American Dental Education Association, International and American Dental Research Associations, the Pierre Fauchard Academy, the International and American College of Dentists, and the IOM. What does the committee see as the most challenging obstacles to address in order for its goals to be fulfilled?Dr. Slavkin: Speaking only for myself, at this time in U.S. history I sense that our national recession and the attendant unemployment, the supply and cost of fossil energy, and the immediate budget uncertainties can be considered “distractions” or challenging obstacles.Briefly compare the state of America’s oral health with that 25 to 50 years ago. What do you see are the most positive strides that have been made in the area of oral health?Dr. Slavkin: Through my prism, U.S. dentistry can be considered excellent for two-thirds of the U.S. population. Water fluoridation, topical fluoridation, dental sealants, routine oral prophylaxis, healthy choices (dietary and exercise), decline in smoking — all contribute to people living longer with teeth than ever before in human history. And we know that socioeconomic determinants are profoundly important for the prevalence of diseases and disorders. Therefore, many oral diseases and disorders are closely associated with education and poverty in the USA.What do you believe that parents should do differently to promote better oral health for their children?Dr. Slavkin: In my opinion, oral health begins as maternal prenatal health care and extends through infancy, early childhood, and across the entire lifespan. Tooth decay is caused by microbial infection coupled with dietary choices. The infant or child acquires bacteria, primarily Streptococcus mutans, from his or her caregiver. Anticipatory guidance as well as oral health literacy is established within preventive strategies and interventions during the first few years of life.Which sectors of the American population have the most pressing oral health needs?Dr. Slavkin: “Pressing oral health needs” to me is complicated. Infants born with cleft lip and palate or as craniofacial syndromes (1:750 live births)? Almost 58% of children suffering from the No. 1 chronic disease of children? Children with oral-facial trauma, broken teeth, jaws? Children with severe malocclusion? More than 40% of adults with severe periodontal disease? Chronic facial pain? Oral and pharyngeal cancers? TMJ disorders? People with immunodeficiency diseases and disorders? One-third of cancer patients who develop rapid tooth decay following chemotherapy? Others?In my opinion and based on the evidence that is available to me, I suggest that children 0 to 5 years old living in poverty and the poor elderly are the most vulnerable populations. I suggest you assess a number of papers recently published in Academic Pediatrics (2009 and 2010) that analyze children’s oral health in America. How often is the state of America’s oral health assessed?Dr. Slavkin: This was not in the report per se. National surveillance is through NHANES and Healthy People 2020 data sets. In addition, various states or local communities garner foundation support and assess “the silent epidemic” as was done in California. I also believe that HRSA monitors oral health in each state on a regular basis.Do you have any additional words you’d like to share?Dr. Slavkin: The IOM report makes a cogent recommendation to integrate oral health throughout the health professions, to significantly advance health literacy, and to align “the mouth with the rest of the body.”Perhaps this segment from the “Advancing Oral Health in America ...” report sums up the entire issue of the current state of oral health best: HHS has the opportunity and responsibility to bring together different sectors to effect change in oral health care. There are many reasons that HHS should seize this opportunity. However, most important is that in spite of improvement, the American people continue to suffer, often silently, from avoidable and treatable oral diseases.More about Dr. Slavkin —He served as dean of the School of Dentistry from 2000 to 2008. He is the former director of the National Institute of Dental and Craniofacial Research (1995-2000), the lead agency on the Surgeon General’s “Report on Oral Health.” He was the 2009 recipient of the American Dental Association’s Gold Medal Award for Excellence in Dental Research. He also received the William J. Gies Award from the American College of Dentists. He has published more than 400 scientific papers in peer-reviewed journals. Dr. Slavkin is a member of the Institute of Medicine, a fellow in the American Association for the Advancement of Science, and a member of the American Dental Association. He earned his dental degree from the University of Southern California, and he holds honorary science degrees from a number of universities, including Connecticut, Georgetown, Montreal, Maryland, New Jersey Medical and Dental, and Peking.