Oral Health Position Statement

I.  ASTHO Supports State and Territorial Efforts Toward Improving Oral Health

The Association of State and Territorial Health Officials (ASTHO) supports federal and state/territorial health agencies in improving access to oral health by enhancing state public health infrastructure. Improved oral healthcare access will also improve overall health by reducing the burden of disease.

II.  Within This Context, ASTHO Recommends:

• Defining minimum oral health system standards for all Americans.
1. Focusing on prevention, access to care, and state/territorial public health infrastructure to address oral health needs and health disparities.                      
2. Increasing funding for oral health infrastructure development at all levels.
3. Promoting and leveraging funding for the expansion of school-based sealant programs.
4. Collaborating with federal, state/territorial, and local resources to support the dental safety net.
• Using evidence-supported public health policies to promote oral health for the entire population with a particular focus on health inequity or systemic disparities in health.¹
1. Promoting and using evidence-based preventive approaches such as community water fluoridation and school-based dental sealant programs.²
2. Promoting collaboration with state/ territorial oral health programs and the Oral Healthcare Prevention and Education Campaign to tailor health education campaigns.
• Utilizing a full array of public health, healthcare and oral healthcare providers to address oral health workforce shortages and increase access to oral health services.
• Promoting and leveraging funding for the expansion of oral health surveillance measures through the Pregnancy Risk Assessment Monitoring System survey, National Health and Nutrition Examination Survey, Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and National Oral Health Surveillance System oral health indicators.
• Supporting public health-medical-dental collaboration at all levels.
• Supporting improvements in oral health literacy efforts that use culturally competent materials at the appropriate literacy level.

III.  Background:

ASTHO’s members are responsible for ensuring the health of the residents in their states/territories. Dental diseases affect not just oral health but also general health status. Studies show some associations between oral infections and heart disease, diabetes, respiratory infections, and the birth of premature, low-birth-weight babies.³ Oral healthcare is an integral component of healthcare that affects overall health. Use of the oral healthcare system is one of the 12 leading indicators for Healthy People 2020.⁴

Dental caries, which results in tooth decay, is the most common chronic childhood disease and becomes more prevalent with increasing age. Approximately 51 million school hours are lost due to oral disease, likely affecting children’s readiness to learn in school.⁵ In addition to having a higher occurrence of dental problems, more than one-third of low-income children have untreated tooth decay; low-income children are also half as likely to have access to dental services as children whose families have higher incomes. Many infants and toddlers develop “bottle caries” due to falling asleep with a bottle in their mouth; this can be prevented by oral health education for new parents. Children of ethnic minorities and children whose primary caregivers have limited education are less likely to have access to dental services than white children and children whose primary caregivers have had more education.⁶ Social determinants, including income, education, cultural beliefs, and occupation, therefore, are strongly related to both child and adult health and oral health outcomes such as tooth decay, oral cancer, and tooth loss.⁷

Dental sealants and community water fluoridation are proven methods to prevent dental caries, which can lead to chronic oral health problems. Dental sealants have been found to effectively reduce dental caries by 87 percent after 12 months.⁸ State Medicaid programs have demonstrated cost savings if sealants are appropriately used for children at high risk for dental caries; however, research has shown that sealants are underutilized.⁹

The oral health workforce is a changing environment due to new professions, such as advanced dental hygienist practitioners and other mid-level dental workforce. Dental hygienists and advanced dental hygienist practitioners are often the providers of preventative services to individuals. The scope of practice for mid-level oral health professionals varies by state law. This portion of the workforce is sometimes considered a cost-effective response to the oral health crises. 

Poor oral health seriously affects adults as well. Some oral diseases, such as periodontal (gum) disease, may be associated with diabetes, respiratory disease, and adverse pregnancy outcomes.¹⁰ More than 40 percent of low-income adults (20 years and older) have at least one untreated decayed tooth compared to 16 percent of non-low-income adults.¹¹ Most adults show signs of gum disease. Severe gum disease affects about 14 percent of adults aged 45 to 54 years.¹²  

There is a notable social and economic burden associated with inadequate access to oral healthcare. Employed adults lose more than 164 million hours of work each year due to oral diseases and conditions.¹³ On average, customer service industry employees lose two to four times more work hours than executives or professional workers.

Oral health surveillance systems funded by state and federal dollars support states and territories’ efforts to collect and disseminate accurate data about the health of their residents. These systems contain qualitative and quantitative data that allow health officials to identify areas for improvement. Because these data are used to support policy changes, it is important that they are accurate and up to date.

Approval History

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Executive Committee. Position statements are not voted on by the full ASTHO membership.

Access Policy Committee review and approval on October 22, 2012.
Board of Directors review and approval on December 3, 2012.
Policy expires December 2015.

For further information about this Position Statement, please contact ASTHO Prevention Policy staff at access@astho.org.

Related ASTHO Documents

Community Water Fluoridation Position Statement (2009)

Notes

1. Braveman P, Gruskin S. “Defining equity in health.” Journal of Epidemiology and Community Health. 2003. 57:254-258.
2. The Community Guide. “Oral Health: Dental Caries (Cavities).” Available at www.thecommunityguide.org/oral/caries.html. Accessed 02/15/2012. 
3. Academy of General Dentistry. Position Paper on Increasing Access to and Use of Oral Health Care Services. Available at http://www.agd.org/files/newsletter/7025accesstocarewhitepaper7-31-08.pdf. Accessed 11/10/2011. 
4. Healthy People 2020. “Leading Health Indicators.” www.healthypeople.gov/2020/LHI/default.aspx. Accessed 11/22/2011:.
5. U.S. Department of Health and Human Services. National Call to Action to Promote Oral Health. Rockville, MD: National Institute of Dental and Craniofacial Research. 2003.
6. Stanton MW, Rutherford MK. Dental care: improving access and quality. Rockville, MD: Agency for Healthcare Research and Quality. 2003. Research in Action, No.13.
7. Dye B, and Thornton-Evans G. “Trends in oral health by poverty status as measured by Healthy People 2010 objectives.” Public Health Reports. 2010.  125(6):817-830.
8. Institute of Medicine. Advancing Oral Health in America. Washington, DC: The National Academies Press. 2011.
9. Center for Disease Control. “Preventing Chronic Diseases: Investing Wisely in Health. Preventing Dental Caries with Community Programs.” Available at www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/oh.pdf. Accessed 02/25/2012.
10. Institute of Medicine. Advancing Oral Health in America. Washington, DC: The National Academies Press. 2011
11. Center for Disease Control. “Fact Sheet: Oral Health for Adults.” Available at www.cdc.gov/OralHealth/publications/factsheets/adult.htm. Accessed 11/22/2011.
12. Ibid.
13. Ibid.