Health professionals discuss the future of oral health care

Sunday, November 15, 2009 | 12:01 a.m. CST
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COLUMBIA – A tooth is attached to a person, who is attached to a family, which is attached to a community.

So said Dr. Jack Dillenberg, dean of the Arizona School of Dentistry and Oral Health, during his presentation at an oral summit held Friday, Nov. 13.

Oral Health Plan

Missouri’s Department of Health and Senior Services unveiled the new statewide oral health plan on Friday.

Missouri ranks lower than the national average of people who visited the dentist within the last year. This puts Missouri at 47th in the national (1 being high, 51 being low), according to a Henry J. Kaiser Foundation study in 2008.

In Missouri, 63 percent of people visit the dentist; nationally, that number is 71.3 percent.

Goals of the new plan include:

  • increased public education and awareness of the importance of oral health,
  • providing materials and education about oral health prevention and treatment,
  • ensuring all Missourians have affordable and accessible dental care,
  • bringing dental health and general health providers together,
  • increasing the number of oral health professionals in dentally underserved areas of Missouri,
  • encouraging policy makers to prioritize funding for oral health care, and
  • increasing preventative strategies like fluoride and dental sealants.

The plan is available in print form, disk form, or online.

He suggested to a room full of dentists and hygienists that they can use teeth to get to know the patient and be involved in the community. Dillenberg’s focus is helping people and teaching students to help people, not just fixing dental problems.

Dillenberg gave two examples to illustrate his point:

  • He spoke about treating a woman with a bruise on her face. You can fix her teeth, Dillenberg said, but if you send her back to an abusive home, you are not helping her.
  • He said employers are more likely to hire someone without legs than someone without teeth. A tangible way dentists and hygienists can help people get jobs and stay healthy is to fix their teeth.

When treating people of low income, Dillenberg urged the doctors to pay special attention to their own mannerisms. “You don’t think people can tell if you don’t like them?” he asked. “Shame is the worst thing you can do with any of us.”

Connections between oral and general health

In extreme cases, untreated dental problems can lead to death, according to the presentation given by Dr. Mary Lee Conicella, Aetna’s national director of clinical operations. She gave four examples since 2006:

  • Deamonte Driver, 12, died of a dental-related brain abscess.
  • Alexander Callendar, 6, died when bacteria spread from a tooth infection.
  • Diane Stamps, adult Medicaid patient, died when a tooth infection spread to her spinal fluid and her brain.
  • Finally, a Michigan woman with gum disease died of a blood infection after the state eliminated adult dental Medicaid benefits in July 2009.

“When you cut money, it has an effect,” said Dr. JoAnn Gurenlian, president of the consulting firm Gurenlian & Associates, while speaking at the summit.

Aetna, an insurance provider, has a dental and medical integration program that tries to get people who haven't been to the dentist recently to go, Conicella said.

The program identifies people who:

  • are pregnant,
  • have diabetes,
  • have heart disease, or
  • have cerebrovascular disease.

These members learn how gum disease impacts their medical condition, and they receive better dental benefits, such as extra cleaning and some gum work fully covered, according to Conicella’s presentation.

Dr. Timothy Custer from the Dental Network of America and registered nurse Rose Rocha from BlueCross and BlueShield of Illinois discussed the connections between oral health problems and high-risk medical conditions.

Periodontal disease, an infection in the gums, can be linked to early births, diabetes complications and cardiovascular disease.

Other health problems that could be associated with periodontal disease include kidney disease and obesity, according to the presentation given by Custer and Rocha.

There is growing research that supports these connections. “This doesn’t mean that there is a cause and effect,” Rocha said. “But there is a link.”

Custer echoed the importance of education about oral health and general health: “The general public probably doesn’t have any idea of the connection.”

New era of care

The purpose of Friday’s summit was to figure out how to integrate dental and other medical care.

The Illinois BlueCross BlueShield insurance company encourages cooperation between medical and dental providers.

“We identify people with chronic disease,” Rocha said, and incorporate questions about oral health. Information about finding a dentist and dental costs has been added to the BlueCross and BlueShield of Illinois Web site, and they also send mailings about dental sealants to families with children.

For now, the new initiatives only apply people covered by BlueCross and BlueShield in Illinois, Texas, New Mexico and Oklahoma, but it’s a start and is a model for other programs.

“There is a long way to go before they adopt that in a more established way,” Custer said.

Play in the sandbox

In the meantime, the conversation is happening at places like Friday’s summit. Rocha pointed to the difficulty of getting everyone on the same page so they have a consistent message.

“Everyone” includes dental care providers, other medical care providers, school nurses and educators, emergency room doctors, social workers and more – between which there is often very little communication.

This can be especially hard for oral health professionals. “Dentistry doesn’t play in the sandbox very well with other providers,” Gurenlian said.

“Change isn’t easy. Innovation isn’t easy,” Dillenberg said. “Don’t be afraid. Courage is an important part of this health stuff.”

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