For 50 years, the oral health of Americans had been improving. By 2004, the trend reversed.

The state of oral health in the US is on the decline, with 100 million people lacking dental insurance and cavities going unfilled. This, while so many millions are spending on tooth whitening and breath freshening.

Oral health is an integral part of a person’s overall health. According to the Academy of General Dentistry, there is a relationship between gum (periodontal) disease and heart disease. A recent study on periodontal disease and atherosclerosis confirmed this finding. flossing showed evidence to support flossing to fight disease. Over 90% of systemic diseases (those that involve many organs or the whole body) show up in the mouth cavity first: dry mouth, mouth ulcers, swollen gums.

This is serious business: systemic diseases include cancer, diabetes, heart disease, kidney disease, and leukemia.

While we’ve seen a degradation in the state of American oral health, we’ve also witnessed dramatic growth in consumer-facing oral health retail categories: a proliferation of new toothpaste flavors, from vanilla to cinnamon and citrus; and, the emerging category of “mobile” oral health, products for taking care of teeth on-the-go such as Oral-B Brush-Ups, and my personal favorite, Listerine PocketPaks breath strips, based on that great dissolving strip technology.
And don’t forget the growth category of home whitening systems, which now exceeds a $1 billion market.

Yet while many of us have been whitening and brightening, millions of Americans aren’t spending much on oral health. The chart on the right comes from a New York Times analysis based on just-released data from the CDC. It indicates that after improvements in oral health, a growing number of kids and adults are going with untreated cavities.

Poverty is directly correlated with poor dental health. See this study from the Journal of Epidemiology and Community Health from February 2007 for more on that relationship.

The Times pointed out an example of what happens when people don’t attend to oral care: “A child in Mississippi and another in Maryland died this year from infections caused by decayed teeth.”

This is a public health issue that we all pay for in the form of much higher costs in emergency room visits, systemic disease and lost human lives.

Health Populi’s Hot Points: Access, my friends, access, is the point. Because dental care is a health care service that is paid for by millions of people 100% out-of-pocket, those people with lower incomes often go without primary dental screening and simple procedures such as cavity-filling. While we’re increasing spending on tooth whitening and citrus-infused breath mints, these are not equal to sound primary oral care. People with lower incomes could access dental care if there were practitioners available to serve them at a relatively reasonable price point. With a dentist shortage predicted, it’s time to open up the professional dental market to new practitioners, much as we’ve begun to see occur with nurse practitioners operating in retail health clinics. The Robert Wood Johnson Foundation wrote about this in 2002; it’s five years since they made their recommendations. More than time enough to know we must welcome and train a new mid-level dental practitioner akin to a nurse practitioner or physician’s assistant.