HJAR Jan/Feb 2024

44 JAN / FEB 2024 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH TIME is often considered one of the most valuable commodities people have, if not the most valuable. One can always make more money or acquire more material things, but time cannot be bought or manufactured. Why is it, then, that we intentionally delay impor- tant health visits? As reported in 2020, approximately half of Americans delayed going to the dentist or seeking dental care, with the reason being the COVID-19 pandemic. 1 According to the National Institutes of Health, utilization for dental care decreased more drastically than medical care and rebounded more slowly since the pandemic. 2 What makes people put off necessary dental care when time is not on their side? The biggest issue with delaying routine dental visits is that small problems are not identified and can grow into bigger problems. TheAmerican Dental Association lists the top reasons people avoid going to the dentist are cost, fear, and the convenience of location or appointment times. 3 Procrastination is a human behavior most exhibit at one time or another, but postponing doctor visits can result in little to no options being available for optimal treatment. 4 It is well established that good overall health is not possible without good oral health. 5 Intentional delay or neglect of den- tal appointments can have serious repercus- sions resulting in poor health outcomes. As with any other health topic, knowledge is powerful medicine. Scientific studies often cite various sys- temic illness involvements with oral health. 6 DIALOGUE COLUMN ORAL HEALTH in the oral cavity have a predilection for heart tissue. When periodontal disease is not con- trolled, these bacteria can enter through the bloodstream and travel to the heart and other parts of the body, which activates inflamma- tory responses. 13 Before heart surgery can be performed, dental clearance is often required to make sure no infection is present in the oral cavity. 14 When teeth are regrettably lost and not re- placed timely, drifting and shifting can occur. Simple space maintainers can hold the space until the tooth or teeth can be replaced. Teeth adjacent to the lost space can drift into the space, resulting in a bigger problem to cor- rect if space maintainer treatment is delayed. This is especially the case in younger patients but can also happen in adults. This dental is- sue can disrupt the teeth from aligning cor- rectly; complicate occlusion, which leads to crowding and/or bite problems; and in se- vere cases, cause jaw misalignment. Tooth structure lost to decay can result in space lost, which leads to necessary orthodontic treat- ment. The recap is that correcting these drift- ing and space issues could require lengthy and costly orthodontic treatment when treat- ment is postponed. When undiagnosed dental decay occurs and is free to progress due to a delay in treat- ment, it can be painful and costly. The genesis of tooth decay begins on the outer layer of the enamel of teeth, which is the surface the den- tist examines both visibly via the oral exam and radiographically to see in between teeth. When small lesions are not detected and are allowed to progress due to not maintaining When patients have active periodontal dis- ease and diabetes, there is a bidirectional as- sociation. 7 Since both illnesses are inflamma- tory in nature, one disease cannot improve without the other being controlled. Diabetic patients are more susceptible to periodon- tal disease and the complications associat- ed with it. Furthermore, in the uncontrolled diabetic state, glycemic levels can worsen the severity of periodontal disease. When periodontal disease is not diagnosed by the dentist, the chronic inflammation caused by this health state can affect insulin resistance, which makes it more difficult to control in the diabetic patient. 8 As physicians discuss treatment with their diabetic patients, it is very important that oral health should be a key topic. Untreated periodontal disease can not only result in loss of bone and teeth, it can have ill effects on many areas of life. 9 When bone loss is severe, partials and dentures can be difficult to wear comfortably. Sometimes, the bone loss is so severe, dental implants cannot be placed. 10 When artificial teeth are not pleasant or even possible to wear, peo- ple can become depressed and are affected by their mental health. 11 Losing teeth affects one’s ability to eat, speak, smile, andmaintain proper oral function. Loss of teeth is associ- ated with poor self-esteem, inability to get a job, and low self-confidence, which can lead to social and psychological concerns. Our cardiovascular system can also be at risk, due to bacteria being present in the bloodstream in patients with active peri- odontal disease. 12 Specific bacteria that live ORAL HEALTH: The Consequences of Delaying Dental Treatment