Societal position on Oral systemic health disparities

Let’s take a moment to consider objectively. Most of our perception states are passive. In daily situations, you wouldn’t suddenly wonder what the condition of your feet is. Of course, with very few exceptions, including when you accidentally hit your toe on the corner of a table or when I just mentioned it. Either way, You will be distracted and divert attention to your feet. The same goes with dental cavities or tooth decay, but with more than just the distraction for the unbearable periodic pain. According to a report from the CDC, “Untreated tooth decay can affect essential aspects of daily living, including eating, speaking, and performing at home, school, or work. Children with poor oral health miss more school and receive lower grades than those with better oral health.” To put it another way, oral health can result in gaps in early childhood education. Knowing the significance, you might be asking, “What is the situation of children’s oral health today?”

In December of 2020, the LA Department of Public Health published a survey addressing oral health conditions in its Children. The survey has served as a follow-up study since 2005, involving 10,489 children from kindergarten to third grade from 72 public elementary schools to represent the County. “The percentage of LA County kindergartners and third graders with evidence of current or previous tooth decay has decreased from 66% to 55% — a relative improvement of 17% .” While the Department emphasizes the 17% decrease as an effective change considering the rate, the 55% is considerably high in contrast to similar countries like England, with around 25% of children aged 5 experiencing dental caries, according to England’s Public Health Department(England). The LA Department of Public Health later points out the more specific issue: “Nearly two out of three Latinx children and more than one out of two Black/African American and Asian children have decay experience, substantially higher rates than for White children (32%).” To summarise, the high degrees of dental issues in Los Angeles correlate to disparities between social-economic groups. Resume to our understanding of tooth decay itself results in divergence. Oral health disparities need to be addressed urgently to avoid cyclic deterioration. To solve an issue, one must first identify its core compositions, which I argue to be the ambiguous social positioning of dental health equality in the United States. In other words, I believe American society’s emphasis on preventive oral health is relatively insufficient when compared to other developed countries.

Some might argue the income-related disparities in untreated dental caries will ultimately resolve over time as basic dental coverage improves. While the focus of public dental coverage for lower-income communities is a reasonable approach to our issue, in fact, States across America demonstrate expansion in dental coverage. As of 2021, the Medi-Cal Dental Program, a part of the Californian medicare, offers a family of three incomes under $46,755 free primary dental care, such as annual Exams, Cleaning, and Fluoride Treatment(Finocchio). However, more needs to be done. Gary Slade, professor at the University of Northern Carolina School of dentistry, led a recent study on the trend of income disparities in tooth decay by categorizing dental caries among U.S. children and the percent poverty threshold between 1988–2014. “Overall, findings corroborate previous studies showing no real progress in eliminating disparities in other oral health indicators, including income-related disparities in untreated dental caries and negligible changes in the use of dental services across income groups,’’ Slade concludes(191). In other words, Slade found that despite improvement in dental insurance programs, including extended coverage of medicare over the years, there remains no notable process in resolving dental health disparities. While Slade’s findings seem to convey our stagnation on the enduring issue, it certainly does not mean to stress the impracticality of a solution. Instead, I believe Slade’s discoveries inform us of the ramification of the oral health disparities in America that require further societal devotion.

For instance, the relative lack of accessibility and low dental clinic attendance rates partly explain the unsolved dental disparities. In a research focus on health care utilization rates of children from age 0–9 and 10–19 between the U.S. and the Netherlands, Dougal S. Hargreaves and his team found “The lowest income quintile of children in the Netherland reported significantly more dental contacts than the poorest quintile in the United States with a ratio of 4.02 to 1”. At the same time, he further denotes this ratio is only 1.19 to 1 in the wealthiest quintiles in each country(2116). Put Dougal’s data in simple terms, Children in low-income households saw their dentist four times less often in America than in the Netherlands, while high-income households saw their dentist at about the same rate. Here we see a gap in accessibility of dental services between social-economic groups that could be the leading cause of dental disparities in America. Further, Dougal’s findings can also reflect the surface-level emphasis on the oral health of American Societies.

Link back to accessible dental coverages growth in Los Angeles as claimed by the local Health Department, I suggest that the distinction between qualification and availability of affordable dental care remains unclear. San Joaquin TEETH, an organization funded by the local Health Department to improve the pediatric oral health under Medi-Cal, recently found “ there are only 2.2 dentists per 5,000 residents in San Joaquin County, and with approximately 65% of low-income individuals covered by Medi-Cal, only 2% of dentists takes Medi-Cal beneficiaries.” Under the same Medi-Cal Coverage across California but with considerably more rural areas, San Joaquin reveals the extreme deficiency in oral care access for low-income individuals in California, despite the superficial coverage. With further interpretation, the exceedingly low participation of dentists in today’s Medi-Cal indicates society’s serve degree of neglect in oral health disparities and policy marker inaction.

For example, the ongoing COVID-19 crisis clearly shows the deficiency of societal focus on dental health. Centers of Medicare Services, part of the United States Government, observed: “dental service rates among children dropped from nearly 100 services per 1,000 beneficiaries to a low of 7 services per 1,000 beneficiaries in April, back up to 31 screens per 1,000 beneficiaries in May 2021.” COVID-19 impacted dental health and more severely in oral health disparities following the logarithmic decline of Medicaid effectiveness on dental services. The decrease in dental service accessibility was not much of a surprise in April, as all kinds of businesses, including dental clinics, were temporary down for the COVID-19 preventive approach. However, the accessibility level of dental clinics to lower-income groups didn’t significantly improve relative to other health services, despite clinics starting to reopen. According to Cherry Fish in a webinar hosted by the Harvard School of Dental Medicine on how COVID-19 increases Existing Disparities, the Biden administration reverses the previous requirement in ‘Federal Medical Assistance Percentage’ preserved Medicaid eligibility and benefits in November 2020, allowing states to cut dental included benefits without penalties. Although the prevention of the epidemic and ensuring the overall economic level are among our top priorities at present, our systemic oral health should be essential when strict epidemic prevention measures are available. I’m not saying that oral health should be put on the level as COVID-19; however, it’s important to note the federal level limitation on oral health positions for the lack of attempt in sustaining dental care accessibility.

Furthermore, despite States choosing to retain medicare, including dental care budget in the event of COVID-19, disparities in dental health continue to rise without further social sector involvement. According to local California Clinics and advocates, COVID-19 adds barriers to patients in need with dysfunction of direct services, including transportation(they can no longer transport prominent quantity people in vans) and nonupdated Maps of participating dental care providers(Fish 2020). Although the issues mentioned earlier are minor problems, it is precisely due to the collection and combination of these minor problems that have caused considerable oral health differentiation. Therefore, it is said that the complete solution of accessible dental care requires local and social attention. It shouldn’t be a blind treatment at the broad level.

Accordingly, establishing a genuinely open dental care system in Los Angles might be our priority if we were to address the oral health disparities. However, given a global perspective, further measures are needed to solve the problem completely. The U.K. is among the top on the list of world dental health, with only half of oral health disparate rate relative to the U.S., seemingly due to the near one-to-one dental care attendance rate among extremes in income groups (England). Yet, disparities still exist without the significant inaccessibility of dental care due to ethnic and family socioeconomic differences. In an oral health study among fire-year-old children in the UK, England’s public health department concludes the cause of its local oral health disparities “Inequalities in the levels of dental decay experienced by five-year-old children living in different parts of the country and in different life circumstances persist. Frequent exposure of teeth to free sugars, most commonly through eating and drinking sugary snacks and drinks, is the cause of decay.” England’s conclusion on the cause of oral health disparities among different socio-economical groups couldn’t be more straightforward-sugars causes cavies. Despite the simplicity in the grounds of oral disease, sugar is certainly not a foolish one. In fact, one of the most fundamental and long-lasting reasons for the gap in oral health problems among income differentiation is the difference in dietary habits, such as the intake of carbohydrates and vitamins, access to fluoride toothpaste, the quality of water, new oral cleaning requirements and so on. Those little details of life elevate the core issue of the gap between the rich and the poor, resulting in some levels of disparities across the Globe (Watt et al. 9).

Lastly, as time progress, the prevalence of tooth decay is decreased among both developing and developed countries, with a predominance of dental diseases among those with low socioeconomic status(Bastani 4). Los Angles’s dental disparities can be related to the global trend, as dental care improves at a better rate in the wealthier part of communities. One general approach could be an increase in the level of international attention to oral health. What needs to be changed is the degree of negligence on oral-systemic health inequality. For instance, the general public, including policymakers, should invest more in lower-income groups’ access to dental care beyond the qualification level of care. Further, in addition to access to care, policymakers can implement preventive measures for oral diseases at the school level. We see how serving healthier school meals to children can help reduce the dietary gap concerning dental health. However, regular oral health check-ups and health literacy propagation in school could also help reduce oral health disparities. However, change in policies and approaches in societies likely involves careful consideration in resource allocation that requires more societal level attention and public awareness in the impact of oral-systemic health.

Works Cited

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Developing Countries? A Scoping Review.” Cost-Effectiveness and Resource Allocation, vol. 19, no. 1, BioMed Central Ltd, 2021, pp. 1–54, https://doi.org/10.1186/s12962-021-00309-0.

CDC. “Oral Health Conditions.” Centers for Disease Control and Prevention, Centers for

Disease Control and Prevention, 3 Nov. 2020, https://www.cdc.gov/oralhealth/conditions/index.html.

Centers for Medicare & Medicaid Services. “Fact Sheet Fact Sheet: Centers for

Medicare & Medicaid Services.” CMS, 14 May 2021, www.cms.gov/newsroom/fact-sheets/fact-sheet-medicaid-chip-and-covid-19-public-health-emergency.

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Finocchio, Len, et al. “2021 Edition — Medi-Cal Facts and Figures.” California Health Care

Foundation, 18 Aug. 2021, https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/.

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Disparities?” Youtube, Harvard School of Dental Medicine Initiative, 17 Dec. 2020.

Hargreaves, Dougal S., et al. “US Children and Adolescents Had Fewer Annual Doctor

and Dentist Contacts Than Their Dutch Counterparts, 2010–12.” Health Affairs, vol. 34, no. 12, PROJECT HOPE, 2015, pp. 2113–20, https://doi.org/10.1377/hlthaff.2015.0709.

Los Angels County Department of Public Health. “Smile Survey 2020 — Los Angeles County

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Slade, Gary Douglas, and Anne Elizabeth Sanders. “Two Decades of Persisting

Income‐disparities in Dental Caries Among U.S. Children and Adolescents.” Journal of Public Health Dentistry, vol. 78, no. 3, WILEY, 2018, pp. 187–91, https://doi.org/10.1111/jphd.12261.

SJ TEETH. “San Joaquin TEETH 2017–2020 Report.” First 5 San Joaquin, First 5 San

Joaquin, 31 Dec. 2020, https://www.sjckids.org/Portals/2/assets/docs/contractors/Contractor%20Resources%202020-2021/SJ%20TEETH/SJ%20TEETH%20LDPP%202017-2020%20Report.pdf?ver=FcDv4CFyiHs67U-79I85bQ%3D%3D.

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Recommendations for Action.” British Dental Journal, vol. 187, no. 1, 1999, pp. 6–12, https://doi.org/10.1038/sj.bdj.4800191a.