HJAR Sep/Oct 2022

50 SEP / OCT 2022 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH DIALOGUE COLUMN ORAL HEALTH CANYOU IMAGINE going to bed every night worrying about how to provide enough food for your family? Or going to bed hungry and waking up even hungrier? When access to food is limited or even unreliable, food in- security exists. This social and economic is- sue is a complex one and one that affects oral health. Food insecurity is defined as a lack of consistent access to enough food to sustain every person in a household to live an ac- tive and healthy life. It can be transient or long-term. Food insecurity is determined by the economic and social status of the house- hold level. It is different from hunger but can lead to hunger, which is defined at a personal level and involves physiological symptoms of discomfort, weakness, and pain caused by lack of food. 1 According to America’s Health Rankings regarding food insecurity, New Hampshire is ranked first, as the most food secure state in the nation. Mississippi is ranked the least food secure at 50th, andArkansas is ranked 44th. 2 Could this be a factor in whyArkansas is last in the nation regarding oral health? 3 The topic of food insecurity is a multifacto- rial one and involves the social determinants of health. The Healthy People 2020 initia- tive organized the social determinants of health into five categories: economic stability, education, health and healthcare, neighbor- hood and built environment, and social and community context. Aperson’s neighborhood and built environment is the category that has the most influence in obtaining healthy foods. 4 In other words, when it comes to your health, the ZIP code you are born into has great significance in determining your health outcomes. In general, healthy foods are costlier than nonhealthy foods. 5 Behavioral and learned habits in dietary and lifestyle choices enter into the equation when opting for certain foods. 6 Food insecurity is not only about food quantity but includes food quality to ensure proper growth and nutrition. When there are limited options of buying quality food, as in a food desert, one cannot buy or has few to no choices in obtaining fresh, high-quality food. For the food insecure patient, inadequate food intake and denial of essential nutrients can affect oral health. A lack of vitamin D has been associated with enamel hypoplasia and chronic periodontal disease. A vitamin C de- ficiency is associated with scorbutic gingi- vitis in scurvy, and dental caries thrive in a diet rich in simple carbohydrates. If the food insecure patient has poor oral habits, this is a formula for poor oral health outcomes. 7 For households that reside in ZIP codes of food deserts, fast food, poor-quality food lacking in essential nutrients, high sugar and simple carbohydrate-based diets become the norm. These elements predispose children to developing plaque and dental decay. 8 It also sets a behavioral habit, which can be difficult to break, even with education. Before the pandemic, the USDA reported 13.6% of households with children were food insecure. This equates to more than 5 mil- lion children living in these homes. Once the coronavirus emerged, the numbers jumped to 27.5% of households with children and 13.9 million food insecure children. 9 It is essential for children to receive the proper diet in order to grow properly and achieve their healthy status. Beginning proper oral health habits in early childhood is paramount in estab- lishing good nutrition and oral hygiene into adulthood. 10 If you combine these food insecurity sta- tistics with the fact that tooth decay is the most prevalent disease worldwide and the most common pediatric disease in the U.S., it’s a formula for poor oral health outcomes, as well as poor overall health. The socioeco- nomic forces that play a role in food insecu- rity not only place children at risk for being in a household that is dependent on food banks or other types of nongovernmental supplements, but also increase their risk of developing childhood caries as well. Children Oral Health of the FOOD-INSECURE PATIENT