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MyView: Putting out the welcome mat for adults

August 19, 2013

By Kevin J. Hanley, D.D.S.

A decline in dental visits by adults does not bode well for dentists or the overall general health of the American population.

In speaking with dentists over the past few years, I get the impression that dental visits are dropping. People are putting off going to the dentist in far greater numbers than ever before. It is an alarming trend, particularly when studies show that good oral health usually leads to good general health.

A recent study showed that medical costs incurred by patients with rheumatoid arthritis and women who are pregnant were less than those for patients who were treated for periodontal disease. Since March 2012, United Concordia has released data showing lower annual health care costs for patients with chronic disease processes such as diabetes and heart disease if these patients had been treated successfully for periodontal disease and continued to maintain their periodontal health. The savings noted were significant.

This should lead every adult to the dentist. But it doesn't, hence, the decline in the number of adult visits to the dentist since 2000. And the declines have been across all income groups. Lower-income adults were the least likely to visit the dentist regularly, followed by middle-income adults and then higher-income individuals. That higher-income individuals would be more likely to visit the dentist regularly should come as no surprise. However, even these individuals recorded a 3 percent drop in dental visits from 2000-2010. The biggest drop, however, was recorded among lower-income patients, whose dental visits declined from 54 percent to 48 percent over that period. The utilization rate for middle incomers dropped 4 percent from 2003 to 2010.

Conversely, over the same period, child visits to the dentist increased—and not only among middle- and upper-income groups. The gap between higher- and lower-income children seeing the dentist shrank from 2000 to 2010. This has been attributed to states improving dental coverage for children, as dental care utilization increased in 47 states over that time period. And there has been increased awareness of the importance of good dental care for children.

A grown-up problem

Why not for adults? Adults suffer from chronic conditions that would be helped by good oral health. Study after study has shown that good oral health leads to good overall general health. It seems to me that emphasis should be placed on this aspect of dentistry. By maintaining good oral health, an individual has a better chance of surviving his or her chronic condition, leading to a better quality of life.

It certainly isn't because the public is unaware of the dentist. We are exposed constantly to advertisements for dentists. Recently, while listening to a local radio station, I heard seven dental advertisements in a single hour. They were all touting the latest and the greatest in dental implants, or sedation dentistry or veneers, with the emphasis on making an individual's smile look great. This is fine as far as it goes, but there is so much more to dentistry than that. Regular checkups are an integral part of good oral health, but you never hear this in a commercial for a dentist.

This problem has been around for as long as there have been dentists. I remember sitting in class in dental school and the professor telling me what portion of the population regularly visits the dentist. It was about 45 percent at that time, if memory serves. I remember thinking that meant there were a ton of people who didn't regularly visit the dentist. Of course, I also remember what I often heard from people when I told them I was studying to be a dentist: "Nothing personal, but I hate the dentist."

It seems that opinions really haven't changed much over the years. People still hate going to the dentist. We must change the attitude of the American population as to the necessity of good oral health. If people went to the dentist regularly, any dental problem could be caught early and intensive dental treatment could be avoided.

A bigger, better message

The ADA is currently running an ad campaign aimed at children's dental health, "Kids' Healthy Mouths." It is designed to teach parents, caregivers and children about the importance of oral health. The ADA teamed with 35 other groups in the dental community to form Partnership for Healthy Mouths, Healthy Lives and worked with the Ad Council to produce the campaign. It will expose listeners to the importance of brushing for two minutes, twice a day, to maintain good oral health.

Something like this should be directed at adults, as well. Instead of inundating the airwaves with commercials about implants, veneers or sedation dentistry, tell the public that regular checkups and proper oral care will benefit their overall health as well. Implants, veneers and sedation dentistry are important aspects of modern dentistry. These should be promoted, but not at the expense of the message of good oral health and its impact on overall health.

Regardless of a person's socio-economic status, good oral health is vital to good general health. One reason for the increase in the number of lower-income children being seen by dentists is the willingness of states to fund programs for poor children to see the dentist and the large number of dentists signing up to provide such care. This is a movement that must extend to adults as well. Here in New York State, we have Medicaid dental coverage for adults, largely due to NYSDA's persistence in fighting to keep that coverage as part of the state budget. Fortunately, it is a fight we continue to win.

We have to get our message out so the public can hear it and respond appropriately. We are health care providers. Our duty is to help preserve the health of our patients. All the fancy dentistry in the world won't be worth anything if the mouth it is in is not maintained properly. If we can convince the public of the importance of good oral health, then, maybe, the numbers of adults visiting the dentist will increase in coming years. And that would be a very good thing.

Dr. Hanley is the editor of the New York State Dental Journal, a publication of the New York State Dental Association. His comments, reprinted here with permission, originally appeared in the April issue of that publication.

Editor's note: The past decade has indeed seen some important changes in dental care utilization patterns in the United States. Utilization among adults, especially young adults aged 19-34 has been declining steadily since the early 2000s. Among seniors, utilization has been stable. For children, particularly low-income children, significant gains have been made. As the Health Policy Resources Center has shown in several Research Briefs (available at ADA.org/1442.aspx) these patterns have little to do with economic cycles. Much more is at play, including structural changes in the dental care sector. Since 2000, a bigger and bigger share of adults have either no dental benefits or are in Medicaid where dental benefits are very limited in most states. More and more adults, especially young adults, are reporting that they cannot get needed dental care because of cost. Together with the sharp increase in emergency room visit for dental conditions, these data suggest some troubling trends for access to dental care among younger adults. As HPRC has shown in two analyses, the Affordable Care Act, unfortunately, will do little to reverse the trends among adults. But states still have many policy levers at their disposal, including expanding dental benefits to adults in Medicaid, simplifying administrative procedures and reimbursing providers closer to market levels. In May, the ADA launched Action for Dental Health: Dentists Making a Difference, a nationwide campaign aimed at addressing the dental health crisis facing America in three areas: by providing care to those who are more likely to visit an emergency room for relief from dental pain, the elderly in nursing homes, and children from low-income families; strengthening the dental safety net with more private practice dentists working with health centers and participating in Medicaid; and emphasizing prevention and education through community water fluoridation, Community Dental Health Coordinators and stronger collaboration between dentistry and medicine. See more details online.