HJAR Sep/Oct 2022

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2022 51 living in poverty have five times the amount of untreated or undiagnosed dental decay compared to children from higher income households. 11 It’s logical to conclude oral health is af- fected by all foods that enter the oral cavity, since the mouth is the entry portal of our di- gestive system. Soft drinks high in acidic PH levels and vending machine types of snacks are damaging to the oral cavity if allowed to linger with little to no hygiene occurring. Science-based evidence persistently shows dietary sugar is the single most important nutritional factor in developing caries. 11 Eating behaviors are influenced by the household budget. 12 Let’s face it, when you are worried about having enough food to feed your family, you are most likely not pri- oritizing making an appointment to see the dentist. Cariogenic foods on the nutritional scale tilt toward lower income communities. The rate of undiagnosed and untreated car- ies in children of low-income families con- tinues to increase. 11 This fact should be key in why oral health advocacy must remove bar- riers of accessing dental care and decrease oral health disparities among the poor. For the pregnant patient facing food in- security, the news is not good. In general, pregnant women are vulnerable to peri- odontitis, gingivitis and gingival hyperpla- sia. Increased secretion of estrogen during pregnancy along with hormonal changes has been linked to periodontal disease dur- ing pregnancy. 13 It has been well established that the bidirectional interaction of peri- odontal disease and systemic conditions exist, which lead to an array of issues. 14 A recent study published in the Journal of the American Dental Association revealed evi- dence of the link between food insecurity and adverse oral health in pregnant women. The summary of the findings included the food insecure pregnant patient had worse oral health, decreased knowledge of oral Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas 5 Rao, M.; Afshin, A.; Singh, G.; Mozaffarian, D. “Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis.” BMJ Open 3, no. 12 (2013). https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3855594/ 6 Cena, H.; Calder, P. “Defining a Healthy Diet: Evidence for the Role of Contemporary Dietary Patterns in Health and Disease.” Nutrients 12, no. 2 (Feb. 2020): 334. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC7071223/ 7 Santin, G.; Pordeus, I; Martins, C.; et al. “Food Insecurity and Oral Health: A Systemic Review.” Brazilian Research in Pediatric Dentistry and In- tegrated Clinic 14, no. 4 (2014): 335-346. http:// dx.doi.org/10.4034/PBOCI.2014.144.08. https:// www.researchgate.net/publication/278158545_ Food_Insecurity_and_Oral_Health_A_System- atic_Review 8 Chi, D.L.; Masterson, E.E.; Carle, A.C.; et al. “So- cioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examina- tion Survey, 2007-2008.” American Journal of Public Health 104, no. 5 (Sept. 19, 2013): 860-864. doi: 10.2105/AJPH.2013.301699 9 Silva, C. “Food Insecurity In The U.S. By The Numbers.” NPR, Sept. 27, 2020. https://www.npr. org/2020/09/27/912486921/food-insecurity-in- the-u-s-by-the-numbers 10 Mehta, R. “Nutrition and Oral Health – Do our mouths hold the key?” American Society for Nutrition, Nov. 1, 2018. https://nutrition.org/ nutrition-and-oral-health-do-our-mouths-hold- the-key/ 11 Huff, Q. A. “A Perfect Smile Comes at a Cost: How Poverty and Food Insecurity Cement Dis- parities in Oral Health.” Campaign for Dental Health, July 8, 2015. https://ilikemyteeth.org/ a-perfect-smile-comes-at-a-cost-how-poverty- and-food-insecurity-cement-disparities-in-oral- health/ 12 van der Velde, L.A.; Zitman, F.M.; Mackenbach, J.D., et al. “The interplay between fast-food out- let exposure, household food insecurity and diet quality in disadvantaged districts.” Public Health Nutrition 25, no. 1 (January 2022): 105-113. doi: 10.1017/S1368980020004280. 13 Wu, M.; Chen, S.; Jiang, S.Y. “Relationship be- tween Gingival Inflammation and Pregnancy.” Mediators of Inflammation, March 22, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4385665/ 14 Kim, J.; Amar, S. “Periodontal disease and sys- temic conditions: a bidirectional relationship.” Odontology 94 (September 2006): 10-21. doi: 10.1007/s10266-006-0060-6 15 Testa, A.; Ganson, K.T.; Jackson, D.B.; et al. “Food insecurity and oral health care experiences dur- ing pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System.” The Journal of the American Dental Association 153, no. 6 (June 2022): 503-510. doi: 10.1016/j.adaj.2021.12.010. 16 Cena H, Calder PC. “Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease.” Nutrients 12, no. 2 (Jan. 27, 2020): 334. doi: 10.3390/nu12020334 17 “Arkansas Economic Contribution and Impact Research.” University of Arkansas, Division of Agriculture and Extension. https://economic- impact-of-ag.uada.edu/arkansas/ care for pregnancy, did not receive dental care while pregnant, and had increased oral care needs compared to women who were not facing food insecurity. 15 Obviously, unborn children are dependent on their mothers for nutrition, and food in- secure pregnant patients are limited in their food options from a socioeconomic stand- point. Measures to promote health equity and campaigns to remove barriers for ac- cessing healthy foods and quality healthcare for pregnant women should ensue. The subject of food insecurity is another avenue that associates oral health to over- all health. It is not possible to have good overall health without good oral health. The proverbial saying of “you are what you eat” promotes what studies have proven: that in order to be fit and healthy, one needs to eat healthy and eat quality food. 16 For a nation that is rich in resources and a state that generated $8.2 billion in agricul- tural cash products in 2020, it seems this initiative of removing barriers of provid- ing quality food access is not only possible, but also crucial. 17 No citizen should have to worry about obtaining enough quality food to feed their family in the U.S. n REFERENCES 1 “Hunger and Food Insecurity.” Johns Hop- kins Center for a Livable Future. Accessed Au- gust 2022. https://www.foodsystemprimer.org/ food-and-nutrition/hunger-and-food-insecurity/ 2 “Food Insecurity.” America’s Health Rankings, Health of Women and Children, U.S. Food Inse- curity General Population 2021. Accessed Au- gust 2022. https://www.americashealthrankings . org/explore/health-of-women-and-children/ measure/food_insecurity_household 3 “Dental Visit.” America’s Health Rankings, An- nual Report, Arkansas Dental Visit General Popu- lation 2021. Accessed August 2022. https://www. americashealthrankings.org/explore/annual/ measure/dental/state/AR 4 “Access to Foods that Support Healthy Eat- ing Patterns.” HealthyPeople.gov, Office of Disease Prevention and Health Promotion. Ac- cessed August 2022. https://www.healthypeo- ple.gov/2020/topics-objectives/topic/social- determinants-health/interventions-resources/ access-to-foods-that-support-healthy-eating- patterns