Dental Health Is Public Health – University of Iowa College of Public Health











A little boy sitting in the dental chair smiling and holding a toothbrush

You may not think of your toothbrush as a powerful disease-fighting tool, but oral health has a significant impact on your health and quality of life. It affects the ability to speak, eat, and smile, and affects social interactions, work, and school performance. Poor oral health has also been linked to many diseases, including diabetes, cardiovascular disease, certain cancers and adverse pregnancy outcomes.

Unfortunately, millions of Americans suffer from pain and disability from tooth decay, gum disease, and other conditions. According to the Centers for Disease Control and Prevention (CDC), approximately 34 million school hours are lost each year to emergency dental care, and more than $45 billion in lost productivity is caused by untreated dental disease in the United States each year.

Although dentistry and public health have traditionally been viewed as separate fields, they often intersect in supporting oral health. Community water fluoridation, reducing tobacco and alcohol use, improving nutrition and cancer screening are some of the many ways public health and dental health work together. Several researchers in the School of Public Health conduct research on oral health topics such as access to care, cancer prevention and childhood dental health.

Dental Health and School Education

Tooth decay is the most common chronic disease among American children. Studies show that children from low-income families are twice as likely to develop tooth decay as those from higher-income families, and young children with public insurance also have higher rates of dental problems and unmet dental needs than young children with private insurance.

A study by the George Wehby Professor and John W. Colloton Chair in Health Management and Policy examined the oral health of low-income Iowa children in the first five years of their lives Relationship with subsequent academic performance. The study exploited unique population-based associations between Medicaid claims data, birth certificates, and standardized test scores in grades 2-11.

The results showed that children who received comprehensive dental exams and minor dental treatments (such as fillings) within the first five years of life had higher reading and math scores, compared with children who received major dental treatments (such as crowns or tooth extractions). higher.

These results suggest that “minor treatment can prevent dental problems from worsening into more serious problems later in life, and that a comprehensive dental checkup is also beneficial,” explains Webby. In contrast, the mainstay of treatment is signs of more serious dental problems that can disrupt a child's concentration, sleep and learning.

Findings support the importance of addressing barriers to dental care and promoting oral health in early childhood and suggest that low-income children have disproportionately high unmet oral health needs and are associated with income disparities in academic achievement.

barriers to care

Webby said barriers to accessing dental care include lack of time, information and transportation, but the two main barriers are affordability and insurance.

More than 84 million Americans with limited incomes rely on Medicaid for health insurance. With the passage of the Affordable Care Act (ACA) in 2010, many people became eligible for new medical and dental coverage in states that expanded Medicaid.

But Medicaid is complicated: States must provide dental benefits to children covered by Medicaid and the Children's Health Insurance Program. However, the federal government does not require Medicaid to cover adult dental services.

“It really depends on the state, and states vary widely in terms of dental services covered by adult Medicaid,” Webby noted. Some states provide extensive benefits, some provide limited benefits, and some provide only emergency benefits or no benefits for adults.

Another difficulty, Webby said, is “finding a dentist who accepts Medicaid and is willing to provide services.” “There are also geographic barriers – there are shortage areas in access and availability of dental care services.”

He added that shortage areas are not just a rural problem. “Even in urban areas, finding a dentist that accepts Medicaid patients may not be as easy as one might think.”

Webby said barriers to accessing dental care include lack of time, information and transportation, but the two main barriers are affordability and insurance.


reduce the gap

Racial and ethnic inequities in access to dental care have persisted for decades. Wehby and colleagues Wei Lyu and Dan Shane conducted a study to understand whether the recent ACA Medicaid expansion, including adult dental services coverage, affected racial and ethnic disparities in dental service use.

While the gap did not close in states with less generous dental benefits, “we found that Medicaid expansion and the broad adult dental benefit increased the use of dental services, particularly among Hispanic adults and non-Hispanic black adults. people and reduce racial and ethnic disparities in use,” the authors said in a paper published in Health Affairs

However, the researchers found that utilization remained low among all groups during the study period, regardless of expansion status or the generosity of dental benefits.

“Even as coverage improves and disparities in access close, more action is needed to further reduce barriers to access for all,” the authors concluded.

cancer prevention

Oral health involves more than just your teeth and gums. “This means the absence of chronic orofacial pain, oral and pharyngeal cancers, oral soft tissue lesions, congenital defects such as cleft lip and palate, and other diseases and conditions affecting the mouth, teeth and craniofacial tissues,” U.S. Surgeon General 2000 Report on oral health states.

Traditionally, cancers of the back of the throat (oropharynx) have been caused by tobacco and alcohol, but recent research suggests that the incidence of oropharyngeal cancers related to the human papillomavirus (HPV) is increasing. According to the CDC, up to 70 percent of oropharyngeal cancers may be caused by HPV.

It is recommended that children aged 11-12 years old receive the HPV vaccine, which is safe and effective in preventing HPV and the cancers it causes. However, HPV vaccination coverage remains below the 2030 Healthy People target of 80% coverage.

A study by Natoshia Askelson, associate professor of community and behavioral health, and her group showed that dental providers are willing partners in HPV vaccine rollout. The team used data from the study to develop a series of continuing education training for dental providers. The training covers the basics of HPV, the vaccine and its connection to oral health, and how to recommend the vaccine.

The goal of the intervention is to train dentists and dental hygienists so that they can strongly recommend the HPV vaccine to parents of their children. [adolescent] The patients they see,” Askelson said. “We know advice from a health care provider is more effective.”

The team collaborated with colleagues at the University of Iowa College of Dentistry to provide training to dental providers at federally qualified health centers in Iowa and the Oral Health Alliance of Western Iowa.

The team plans to pilot the training in a study to see whether dental providers will eventually make strong recommendations for the HPV vaccine and whether parents will follow through and get their children vaccinated.

The researchers are also working with otolaryngologists on a similar project.

“We wanted to develop an intervention that would help community otolaryngology providers understand how to best support HPV vaccination,” Askelson said.

Understanding orofacial clefts

Cleft lip and palate are one of the most common birth defects worldwide. The condition occurs when the developing facial structures of an unborn baby do not close completely, and is thought to be caused by an interaction of genetic and environmental factors.

“Orofacial clefts can cause serious medical, psychological, educational and financial problems,” said Azeez Alade, a doctoral student in epidemiology whose research focuses on identifying the genetic and genomic causes of orofacial clefts. “There is an urgent need to identify effective interventions, which requires a deeper understanding of the underlying genetics. The knowledge gained from our study will aid in risk prediction, genetic counseling, and ultimately promote prevention.”

Biostatistics doctoral student Tabitha Peter is also using her skills to better understand orofacial clefts. “In my thesis, I'm studying families and how genetic markers influence the physical characteristics of people in those families,” she said. “My work involves collaborating with other students in my department to code computational tools. This tool (R suite) is designed to analyze the association between multiple genetic markers and physical characteristics. A novel feature of the tool is that its analysis is correlated Methods for individual study data. One specific application of this tool is the description of a dataset of families affected by cleft lip/palate.

Supporting good oral health requires a multidisciplinary approach, and public health has broad expertise to address policy, disparities, genetics, disease and more. As former U.S. Surgeon General David Satcher said more than 20 years ago, “You can’t be healthy without oral health.”

This story originally appeared in InSight Magazine Spring 2023 Issue





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