Getting the Score on Oral Health—And Committing to Doing Better

Getting the Score on Oral Health—And Committing to Doing Better

By Sarah Bedard Holland, Executive Director, Virginia Oral Health Coalition

Our health care system treats our mouths separately from the rest of our bodies. If you need medical care, you go to a doctor. But if the problem is in your mouth, you not only have to see another provider but you also have to use different insurance, if you’re lucky enough to have it.

In fact, oral health is health. If you are in poor oral health, you aren’t healthy. Poor oral health is linked to diabetes, heart disease, unemployment, social isolation, malnutrition—even preterm birth. Left untreated, oral disease can cause terrible pain and, in rare cases, lead to life-threatening infections.

Last month, Virginia became the first state in the nation to grade itself on oral health. The Virginia Oral Health Coalition, an alliance of hundreds of partners striving to ensure Virginians have access to comprehensive, affordable health care that includes oral health, produced the report.

The bad news? Virginia only earned a C+ overall, based on nine key measures of oral health.

The report found that our state has some excellent systems and programs in place. For example, 96 percent of Virginia’s public water systems are fluoridated. In addition, 52 percent of third-graders in Virginia have sealants, thin plastic coatings that prevent tooth decay, on their permanent molars, a testimony to the effectiveness of our school-based dental sealant programs.

But the report also found serious shortcomings.

Forty-seven percent of our third-graders have had tooth decay, which is the most common chronic childhood disease—five times more prevalent than asthma. Fewer than a quarter of children ages 1 to 2 covered by Medicaid had received a preventive dental visit, even though such visits are recommended for all children in the first year of life.

Only 44 percent of pregnant women in Virginia visited a dentist, despite the fact that dental care is a necessary part of prenatal care. Pregnancy causes hormonal changes that increase the risk of developing gum disease which, in turn, can affect the developing baby’s health. And, as I noted, poor oral health during pregnancy has been linked to preterm birth.

And 50 percent of Virginia adults have lost at least one tooth because of tooth decay or gum disease. That’s a lot of people.

Across all measures, we found racial and economic disparities. Very simply, if you are low-income, black, or Hispanic, you are much more likely to have poor oral health. Clearly, we must think more broadly about the system changes required to help these populations access oral health care while addressing other, related issues such as homelessness and food insecurity.

The good news here is that Virginia can do better. In some respects, we already are. For example, a new dental benefit for pregnant women enrolled in Medicaid is laying the foundation for improved prenatal care. The Virginia Oral Health Coalition is reaching out to pediatricians across the state and educating them on how they can promote better oral health by helping get kids in to see the dentist early and start their preventive care.

The new report is helping us identify our best opportunities for improvement. We know, for example, that dental insurance coverage is a serious problem for adults in Virginia—38 percent lack such coverage—so that’s something we need to focus on from a policy perspective.

We also have in Virginia the partnerships and commitment required to improve oral health. That is how this report came about in the first place: through a collaborative, consensus-building process over seven months that brought together major stakeholders like the state Department of Health, the state Medicaid program, the Department of Health and Disability Services, the state hospital association, federally qualified health centers and free clinics, community organizations that care about oral health, and provider groups representing both dentists and physicians.

Together, we made a commitment to achieving the best oral health in the nation. In order to do that, we needed to know where we stand. With this report, we have a pretty good idea. We know that there is work to be done, and we are moving forward.

In January, with support from the Northern Virginia Health Foundation and the Potomac Health Foundation, we will convene our first regional meeting, focusing on oral health disparities, efforts, and programs in the northern part of the state. Our goal is to zero in on the regional-level data and information at our disposal and help stakeholders in Northern Virginia come up with targeted solutions for improving oral health.

Oral health is about our overall health, and it’s important for all Virginians to have good oral health. We are just at the beginning of this journey to achieve excellent oral health statewide, but I am confident of our ability to make progress toward that goal quickly.

The Northern Virginia regional meeting will take place Jan. 26, 10 a.m. to 2 p.m., in Fairfax. If you would like to attend, please contact me at