Caswell A. Evans, Jr., D.D.S., M.P.H.

University of Illinois at Chicago, College of Dentistry

In 2000, Surgeon General David Satcher released Oral Health in America: A Report of the Surgeon General (HHS, 2000). This report highlighted the lack of understanding about what constitutes oral health as well as the association between oral health and overall health. Oral health is much more than just healthy teeth; it also includes the health of many other anatomical structures such as the gums, bones, ligaments, muscles, glands, and nerves. In addition, oral health affects some of our most basic human functions, thereby shaping an individual’s self-image and sense of well-being:

These are tissues whose functions we often take for granted, yet they represent the very essence of our humanity. They allow us to speak and smile; sigh and kiss; smell, taste, touch, chew, and swallow; cry out in pain; and convey a world of feelings and emotions through facial expressions. (HHS, 2000)

In the coming decade, certain demographic changes will emphasize the importance of the connection between oral health and overall health and well-being. For example, the combination of increased longevity with the aging of the baby boom generation will contribute to rapid growth in the cohort of adults over age 65, a group that typically has higher rates of chronic disease and disability.

Many medical conditions may affect oral health, and vice versa. For example, the metabolic processes of diabetes mellitus can explain the increased destruction of tissue seen in diabetic periodontitis. In turn, like other infections, periodontal disease has been shown to exacerbate glycemic control in diabetic patients, and lower overall medical costs have been seen among diabetic patients who receive proper periodontal care. Other mild associations have been seen, such as between periodontal disease and myocardial infarction, but studies to date have not proven a causal relationship. Several studies have shown an association between periodontal disease and adverse outcomes in pregnancy such as premature deliveries, fetal growth restriction, and other complications. However, the reasons for the associations are not clear.

The oral cavity may serve as a source for early detection of other medical concerns. For example, lesions in the mouth may be the first indication of HIV infection and may be used to determine the staging and progression of AIDS. In addition, saliva may be used to detect and measure medications, hormones, environmental toxins, and antibodies and thereby might serve to replace invasive blood testing for the monitoring of chronic disease.

Lastly, the connection between oral health and overall health can be seen in the case of oral and pharyngeal cancers. Over 35,000 cases of oral and pharyngeal cancers are diagnosed annually, and there are almost 8,000 deaths each year due to these types of cancer (American Cancer Society, 2008). African American males in particular have a relatively high incidence of oral cancers and as a group are typically diagnosed at later stages of the disease and have a significantly lower 5-year survival rate.

These examples all serve as reminders for how oral health and general health and well-being are associated. A fair question is “How well is the oral health workforce positioned to manage these current and future challenges?” As the focus turns to the issues of the oral health workforce, there will undoubtedly be varying viewpoints, and given the same information, there may be substantially different conclusions. However, solutions should focus on health outcomes, health benefits, and the best interest of the patient. In particular,

• Is the workforce sufficient in number, distribution, and skills to attend to these health concerns?
• Is the makeup of the workforce sufficient to provide the necessary range of services?
• Is there enough cultural and ethnic diversity to ensure access to a welcoming environment?

The connection between oral health and overall health and well-being cannot be ignored. This is reflected in the narrowing gap between public health dentistry and organized dentistry. However, there is still room for greater collaboration, understanding, and sharing of expertise, especially at the local and state levels. As these and the other challenges that lay before us are confronted, it is vital to first come to a greater appreciation for a shared vision of opportunities.