Oral health, a pandemic, and an institute launch:
reflections on year one…and what a year it has been!
By Vivian Vasallo, Executive Director of the Delta Dental Institute
There are many lessons to be learned from 2020. For me, as I reflect on my first year as the Executive Director of the Delta Dental Institute, it strikes me that never before has the impact of health disparities and social injustice on people and communities been so apparent.
The opportunity to accelerate social change and build healthier lives attracted me to this role, along with the opportunity to shine a spotlight on oral health, a vital component of overall health. Even during the chaos of 2020, I could not be prouder of our steadfast dedication to our mission and our contribution to supporting healthier lives and communities. A year ago, I welcomed the opportunity to join the Delta Dental Institute in order to bring greater attention to oral health. Over the past year, we have continued to tackle issues including lack of access to care and the impact of social determinants of health on oral health.
There are four topics that truly define my first year at the Delta Dental Institute and best capture the interconnectedness of our systems and the work that is still yet to be done.
Access to care
This pandemic has exposed what many of us in public health know all too well: far too many people still lack access to care, especially for oral health. According to the CDC, only 50.2 percent of adults aged 18–64 with private health insurance had dental care coverage from May 2018 to May 2019. The pandemic has resulted in increased unemployment, contributing to an even greater widening gap between those with health insurance and those without.
And even those who have dental insurance may not have access to care. As of September 2019, over 56 million Americans lived in dental deserts, areas which lack sufficient dental health care professionals to ensure that all who live in the community can receive oral health care. Addressing inequities in access to care is crucial to ensuring better oral health for all.
Value of prevention
2020 has also reminded us of the value of prevention, with evidence ranging from healthier people experiencing fewer risks from coronavirus to the negative health consequences of postponing routine medical care. Oral health is a prime example of the positive health impact of an emphasis on prevention. As the U.S. Department of Health and Human Services' Office of Disease Prevention and Health Promotion states, "the significant improvement in the oral health of Americans over the past 50 years is a public health success story. Most of the gains are a result of effective prevention and treatment efforts." Good oral health can lead to good overall health. A recent poll conducted by the Delta Dental Institute found that 69 percent of Americans agree the benefits of a routine dentist appointment during COVID-19 outweigh the potential risks of delaying preventive care.
As a champion of healthy aging, it has been important to me to continue to highlight the needs of the older adult population. Each day at least 10,000 people cross the age 65 threshold, with the baby boomer population currently estimated at 73 million. Healthy living is synonymous with healthy aging, and unfortunately, those who do not have access to care over their lifetimes face greater challenges. The older Americans with the poorest oral health tend to be those who are economically disadvantaged, lack insurance, and are racial or ethnic minorities. Among adults aged 65 years and older, racial and ethnic minorities are about half as likely to report a dental visit during the past year and about twice as likely to have at least one tooth with a cavity in need of a restoration compared to their non-minority counterparts. Research has also shown correlations between oral health and heart disease, diabetes, oral cancer, and even Alzheimer's. Good oral health translates to improved heart and brain health for older adults too.
Social determinants of health
Prior to coming to the Delta Dental Institute, I worked on programs that addressed the social determinants of health, which can drive as much as 80 percent of health outcomes. Specifically, I helped promote affordable housing as a prescription for better health.
How is oral health connected to housing and community? Access to clean water is still a struggle faced in low-income communities. Some indirect evidence of the economic effects of poor oral health comes from a study of water fluoridation, which protects teeth from decay. It found that fluoridation increased the earnings of women by 4 percent on average, with an even greater effect on women of low socioeconomic status.
Moreover, oral health can impact a child's education and an adult's ability to work. According to a 2018 study, in 2008 an average of 320.8 million work or school hours were lost annually for dental care in the United States, of which 92.4 million hours were for emergency (unplanned) care. A 2016 Delta Dental survey found that American children miss more than nine million full school days each year due to oral health problems. A healthy smile represents more than just good oral health; it represents the opportunity to attain better education and employment, two critical pillars in building a more equitable and just society.
Hindsight Is 2020
These complex problems require integrated solutions. The Delta Dental Institute is uniquely able to weave research, community engagement, and advocacy together. Looking ahead, the Delta Dental Institute will pursue more data-driven research examining the correlations between medical and dental outcomes, scale evidence-based community programs to narrow disparities in oral health, and continue advocating for oral health.
My journey of learning continues, and I am honored to be part of an organization that is purpose-driven and has been dedicated to serving its communities for over 65 years. Our commitment to our mission has been reinforced because the need to bring greater access to oral health care is more evident than ever. It is the principle that we were found upon and to which we double down in pursuing. Because smiles matter.