If the eyes are the windows of the soul, then the mouth is certainly a place where important discoveries can be made. Routinely performing a thorough mouth examination should include evaluating your patient's teeth and gums. This is also an opportunity to assess dental health, beginning with the question: “Are you getting regular dental checkups?” According to Gallup-Healthways' 2008 poll of more than 355,000 Americans, 34% of Americans did not visit a dentist last year.1 Using another yardstick to measure the decline in dental visits, a February 2009 survey of more than 1,700 dentists by the American Dental Association (ADA) found that 51% of dentists reported declining income in the third quarter of last year.1

As the economy continues to wobble, going to the dentist for a regular visit may seem like a luxury to some families, especially those with children. With the cost of a checkup, a couple of radiographs, cleaning, and a fluoride application averaging around $100, following the ADA recommendation of twice-yearly cleanings and checkups for a family of four—you do the math. What about the influence of dental insurance? Based on data from the 1989 and 1999 National Health Interview Surveys regarding dental visits and private dental insurance among those older than 2 years, the percentage of private dental insurance fell from 40.5% to 35.2%.2 Yet Matthew Messina, consumer adviser for the ADA and a dentist from Cleveland cautioned, “If people consider dental care a luxury item, they're shorting themselves. Prevention's always cheaper than fixing problems later.”1 Easy to say but understandably not always a top priority in times of financial distress.

Regular dental care leads to more than just a healthy smile; numerous reports in the literature link systemic conditions to oral health.3 In fact, more than 2,000 years ago, Hippocrates suggested that arthritis could be cured by removing infected teeth. Periodontal disease has been associated with the development and exacerbation of heart disease, stroke, pneumonia, preterm births, low-birth-weight babies, osteoporosis, osteopenia, and diabetes.4

One of our most vulnerable populations is children. The grim reality of poor or no access to dental care became a public tragedy when 12-year-old Deamonte Driver died of a toothache. His mother had no insurance, and she couldn't find a Medicaid dentist. What could have been an $80 tooth extraction that might have saved her son's life became a fatal brain infection from his abscessed tooth. Added to this profound loss was the cost of his care, which totaled more than $250,000.5 In the 2000 landmark report Oral Health in America, then-Surgeon General David Satcher called untreated oral disease a “silent epidemic,” making it the single most common chronic disease of childhood—five times more common than asthma.6 In addition to a lack of awareness of the importance of oral health among the public, the report found a significant disparity between racial and socioeconomic groups with regard to oral health and ensuing overall health issues. Based upon these findings, the Surgeon General called for action to promote access to oral health care for all Americans, especially the disadvantaged and minority children who were at the greatest risk for severe medical complications resulting from minimal oral care and treatment.6

The importance of an alliance between health care and dental care providers was stressed by Robert Genco, DDS, at a February 2006 meeting of the AMA and the ADA, “Oral & Systemic Health: Exploring the Connection.” Dr. Genco remarked that “both dentists and physicians work hard to care for their patients and keep them healthy. By working together, they will be able to provide the appropriate integration of medical and dental care that best serves all of their patients' health care needs.”7

PAs can have a major impact on the oral health of their patients. If you haven't already, get to know your local dentists and explore ways to develop partnerships. Become more knowledgeable about the relationship of diseases of the mouth to systemic disease. Be a voice for the importance of dental insurance coverage, especially for children. Include, as part of your early intervention efforts, counseling families, identifying high-risk children, and initiating timely dental referrals. Finally, ask yourself this question: “When was the last time I went to the dentist?” JAAPA

Sarah Zarbock, PA-C, is the editor in chief of JAAPA.

REFERENCES

1. Marcus MB. Many Americans say they forgo routine dental care. USA Today Web site. http://www.usatoday.com/news/health/2009-03-10-dental-skip_N.htm. Accessed May 1, 2009.

2. Wall TP, Brown LJ. Recent trends in dental visits and private dental insurance, 1989 and 1999. J Am Dent Assoc. 2003;134(5):621-627. http://jada.ada.org/cgi/content/full/134/5/621. Accessed May 1, 2009.

3. The oral-systemic relationship. American Dental Hygienists' Association Web site. http://www.adha.org/CE_courses/course13/systemic_relationship.htm. Accessed May 1, 2009.

4. Glick M. Exploring our roles as health care providers: The oral-medical connection. J Am Dent Assoc. 2005;136(6):716, 718, 720. http://jada.highwire.org/cgi/content/full/136/6/716. Accessed May 1, 2009.

5. Head start dental home initiative: Deamonte Driver's story. American Academy of Pediatric Dentistry Web site. http://www.aapd.org/headstart/driver.asp. Accessed May 8, 2009.

6. Oral health in America. A report of the Surgeon General. May 2000. US Department of Health and Human Services Web site. http://www.surgeongeneral.gov/library/oralhealth/. Accessed May 1, 2009.

7. Infectious periodontitis is more than just teeth and gums. http://perioseal.com/AMAInfectiousPeriodontis.pdf. Accessed May 1, 2009.