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Roundtable: Health literacy important in linking oral, overall health

August 13, 2019

By David Burger

Washington — The National Academies of Sciences, Engineering and Medicine in July published the outcomes of a December 2018 roundtable workshop co-sponsored by the ADA on the crucial role health literacy can play in the furtherance of oral and overall health.

 Roundtable cover
The 122-page proceedings, titled “Integrating Oral and General Health Through Health Literacy Practices,” can be downloaded for free at

More than 40 health professionals including dentists, dental hygienists, community dental health coordinators, physicians, nurses, educators, policy experts, social workers and industry leaders gathered in Washington, D.C., to discuss the ways health literacy can lead to improving the integration of oral and general health care and providing coordinated, patient-centered care for patients.

“The premise of this workshop focused on how health literacy can be used as a catalyst to integrate oral health and general health,” said Dr. Nicole Holland, a member of the ADA Council on Advocacy for Access and Prevention’s National Advisory Committee on Health Literacy in Dentistry and assistant professor at the Tufts University School of Dental Medicine. “It is exciting to see oral health prioritized and once again given a platform in our nation’s ongoing health care discussion.”

ADA policy defines oral health literacy as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions. It also recognizes that by improving health literacy, patients are better stewards of their own health.

 Dr. Holland
Dr. Holland
Dr. Holland said that the speakers presented examples of health care organizations with various levels of care integration involving health-literate interventions.

Those examples, recounted in the proceedings, illustrated the urgent need for collaboration, Dr. Holland said. “We know that oral health is an integral part of overall health,” she said. “We also know that dentistry and medicine have historically been two siloed systems of care. The navigation of separate systems can prove difficult for many.”

Alice Munkhoff Horowitz, Ph.D., a research associate professor at the University of Maryland School of Public Health, an honorary member of the ADA, and a member of the National Advisory Committee on Health Literacy, said the workshop highlighted ways in which physicians and dentists could work together.

“For example, this can include collaborations to gain and maintain community water fluoridation in a community,” Dr. Horowitz said. “Or this can include dental and medical groups jointly encouraging a city or sales tax on sweetened beverages to decrease their consumption which impacts dental caries and obesity.”

Dr. Dushanka V. Kleinman, chair of the National Advisory Committee on Health Literacy in Dentistry and associate dean for research and professor at the University of Maryland School of Public Health, said the workshop’s proceedings outline guidelines and best practices that dentists could employ in their own practices.

 Dr. Dushanka Kleinman
Dr. Kleinman

“During the patient’s visit the dentist and their team have the opportunity to clearly answer the patient’s questions and provide them with clear, usable messages and demonstrations of the daily care practices needed to manage their health,” Dr. Kleinman said. “If this exchange is done in a manner that the patient understands, accepts and ideally recalls and shows what they will do, then the patient will be in the best position to follow through on their self-care. This is important since well over 99.99% of the time the patient is on their own managing their health. By using health literacy, this partnership is a win-win for the patient and for the dentist and their team. Happy patient, happy dentist and dental team, and oral health wins overall.”

Dr. Horowitz was specific about what dentists can do.

“Dentists and their team members can begin by taking courses on health literacy,” she said. “For example, the Centers for Disease Control and Prevention offers an online free course that provides CE credits ( This initial step would allow office members to have the same basic background and be aware of health literacy skills and practices. In addition, they could identify a volunteer in their office to be the lead on the health literacy activities and provide support to all staff who have patient contact to ensure they are using messages that are science-based and in plain language.”

Dr. Horowitz added, “Dentists can and should provide a pro-human papillomavirus vaccine environment in their practices.” Patients with diabetes should also be monitored for periodontal disease, she said.

 Dr. Horowitz
Dr. Horowitz
The workshop and its proceedings were starting points, not end points, Dr. Holland said.

“Although more research on integration practices is certainly needed, dentists play a key role in shaping the future of an integrated health system — one that will minimize system burdens and maximize health outcomes for our patients,” she said.

The ADA also offers health literacy resources online at