Renée Joskow Discusses the Importance of Oral Health to Overall Health

August 16, 2017|10:49 a.m.| ASTHO Staff

Renée Joskow, DDS, MPHOral health is fundamentally linked to the overall health and well-being of both the individual and the community. Improved population health will require integration between many sectors, including oral health, primary medical care, public health, human services, social services, and behavioral health services. ASTHO spoke with Renée Joskow, DDS, MPH, Chief Dental Officer for the Health Resources and Services Administration (HRSA), about federal efforts to support this work, emphasizing the importance of oral health integration with other public health and clinical care activities.

Joskow provides the overall direction and guidance for HRSA’s oral health investments and portfolio, and serves as liaison for facilitating and maintaining communication and relationships across the U.S. Department of Health and Human Services, as well as with external stakeholders. Joskow has also served on HHS’s multi-agency Oral Health Coordinating Committee (OHCC) for over a decade, representing various agencies. The OHCC serves to promote the oral health of the American people by coordinating across federal partners, as well as with the public and private sectors.

Often, people see oral health as separate from traditional physical healthcare. How do you explain the connection between the two and the importance of oral health?

Historically, oral healthcare has been distinct from overall healthcare due to a three-legged stool of separate health professional education, the separate practice settings of dentistry and medicine, and – more importantly – completely separate payment systems. Yet, when we address the importance of oral health to overall health, I think the Surgeon General’s 2000 report on Oral Health in America says it quite well: We cannot have good overall health without good oral health.

It is particularly important to frame the issue by saying that the mouth is a window into the health of the rest of the body. For example, there is growing evidence that links oral health with cardiovascular disease, stroke, and low birth weight. A dental visit can be the early detection and prevention point for other diseases and conditions.

Public health agencies also know that oral health can have economic and lifelong achievement impacts. Billions of dollars are spent on emergency department visits for non-traumatic dental complaints, when people show up at the emergency department because they don’t have a usual source of dental care or a dental home. In addition, poor oral health can have an economic and social impact on individuals, as it is associated with lost days of school and work, poor scholastic achievement, and lower employability.

Has oral health integration received attention in recent years? Have you noticed any increased momentum and, if so, are there reasons for growing interest?

There is evidence of integration between medical and dental schools dating back to the 1970s, but there has been an exponential increase in momentum and success that we have seen in the past several years. In addition to the Surgeon General report in 2000, there were two 2011 Institute of Medicine (IOM) reports (Advancing Oral Health in America and Improving Access to Oral Health Care for Vulnerable and Underserved Populations), which served as an impetus for this increased momentum. One recommendation issued in the reports was for HRSA to convene key public and private stakeholders to develop a core set of oral health competencies for non-dental healthcare providers. HRSA Community health centers have also piloted initiatives to use these competencies to integrate oral health in clinical and school-based settings.

In addition, HHS now has an Oral Health Strategic Framework, published by OHCC, which has created a new benchmark in taking HHS’s strategies beyond those issued in the IOM recommendations. The first goal is to integrate oral health and primary care practice, and you can see examples of that work taking place across the entire department. This describes a clear recognition that oral health integration is critical to improving the overall health of the people of our nation.

What actionable steps can state and territorial health officials take to promote oral health in primary care and public health settings?

It is important to note that most states allow the provision of dental health services in primary care practices, especially during well child visits. Again, early detection of both oral and systemic diseases can facilitate the delivery of interventions and referrals and improve overall population health.

State health officials can identify champions and partner with different groups to help promote oral health integration. One great resource is the Association of State and Territorial Dental Directors, which represents the dental side of the state health agency. You may also want to reach out to any dental schools, health professional schools, or community colleges with community health worker programs in your state. In addition, there are great educational resources that are designed to help the public improve their oral health literacy and improve their own health and the health of their children. There are a number of professional organizations with state representation, who would be eager to help disseminate materials to educate the state legislature, healthcare professionals, and the public.

Are there state examples you believe are good models of oral health being integrated into primary care settings?

I’ll give two examples, but really these are just two among many states doing great work. The first is the Colorado Cavity Free at Three program, which approaches the issue by training medical and dental professionals to provide preventive services for children and pregnant women to reduce oral health disparities among at-risk populations. This program illustrates that it is not just about putting oral health into primary care; it is important to have bidirectional referral and collaboration.

Another good example that has been evaluated and widely published is North Carolina’s Into the Mouths of Babes/Connecting the Docs program, which trains primary care physicians to deliver preventive oral health services for early childhood populations insured by the state Medicaid program. Medicaid reimburses the provider for evaluation and risk assessment, parent and caregiver counseling, fluoride, and referral to a dental home for children from when teeth first come into the mouth to age three-and-a-half. The program has contributed to a statewide decline in dental cavities since 2004 and has reduced disparities in early childhood tooth decay.

Renée W. Joskow is a Captain in the U.S. Public Health Service and is both a dentist and a medical epidemiologist. She serves as the Chief Dental Officer for the Health Resources and Services Administration (HRSA), where she provides leadership across HRSA on issues and activities related to oral health.