HJAR Sep/Oct 2021

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2021 51 Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas A STUDY published in the Journal of Peri- odontology cited that the U.S. spent $154.1 billion in 2018 due to periodontal disease alone. 1 It’s estimated that in 2030, approximately 20% of adults in the U.S., which is roughly 80 million people, will be 65 years of age or older. These adults will possess the majority of their teeth, will have developing dental needs, and experience difficulty in accessing dental care benefits and coverage. 2 Despite these facts, policymakers have neither de- fined nor addressed this increasing need for dental care coverage for older adults. AlthoughMedicaid andMedicare provide resources for adults to receive care, Medic- aid adult dental benefits fluctuate due to the availability of state funds, andMedicare Part C must be purchased to access dental ben- efits. With these two government resources being limited in coverage for dental care, this older adult generation is left with no dental benefits. Advocates for the inclusion of dental ben- efits inMedicare cite the multiple sources of documentation that poor oral health nega- tively affects overall health. Arguments in- clude that poor oral health increases the cost of managing systemic disease and dental care, and treatment would offset healthcare costs. 2 There has long been a divide between dental and medical insurance coverage. Much of this disconnect is because these two disciplines have remained separate in training and exclusive of each other. When given a choice of the two, medical insurance wins. The dilemma, then, is providing afford- able dental coverage. 3 It’s well documented that people with dental coverage are more likely to visit the dentist than those without. Those without coverage seek dental care in emergency situations, or if they have the means, they pay out of pocket. It stands to reason that those who fall in the first category, not hav- ing dental benefits, are more likely to have poorer oral health outcomes. These people are left with a choice: be proactive and seek preventive dental care now, or pay for larger dental issues later. There are other types of costs indirectly related to poor oral health, including eco- nomics and well-being. Consider produc- tivity loss when a person misses work due to an emergent dental event, plus the loss of wages. 4 Poor oral health impacts qual- ity of life in many ways, including restful sleep, restriction in normal daily activities, and the pain it causes. This pain can lead to eating problems, which affect nutrition. Teeth grinding can also be very damaging to the dentition, and this particular habit also increases the chances of headaches and anxiety, which lead to negative mental health outcomes. The costs of poor oral health are also evident when people enter the workforce. Employment earnings are key in having the capability to purchase health services for most workers and their families. 5 When people with poor oral health seek employ- ment, evidence of their poor oral healthmay show up in applicants’smiles. As unfair as it may sound, people are judged on their ap- pearances, including their smiles, and this can be a major setback. 6 The social determinants of health remain valid, as there has been strong evidence that people who have more education have bet- ter jobs, are healthier and live longer than those who are economically challenged, have less education, work minimum wage jobs and die earlier. 7 These highly educated people have a better quality of life than the less educated. Since better jobs coincide with better health benefits, this health inequity should be corrected. According to an ADA report, “38% of people report life in general is less satis- fying due to their poor oral health. One in five adults experience anxiety and 23% are embarrassed by the condition of their teeth. One in four adults avoid smiling and 22% of young adults avoid social activities due to the appearance of their teeth.” 8 These effects of dental disease are preventable; what’s needed is education and health equity. There have beenmany studies connecting oral health association with overall health. When poor oral health is untreated, it can greatly affect a person’s overall health, es- pecially in the case of periodontal disease with diabetes and/or cardiovascular disease. A study was conducted to estimate lifetime costs and health gains using a microsimu- lation model of oral health conditions. 9 The objective was to see if nonsurgical periodon- tal treatment would help reduce the costs of healthcare treatment for the subgroups of patients having periodontal disease along