The Dental Care Gap: Exploring Barriers and Facilitators to Dental Care Access Among Uninsured and Underinsured Patients in Durham, North Carolina

Introduction

Oral Health: a critical component of overall health

In 2011, the American Dental Association released a statement titled “Breaking Down Barriers to Oral Health for all Americans: Repairing the Tattered Safety Net”. The report analyzed the failure of the U.S. healthcare system that fails to deliver affordable dental care to millions of Americans, as well as the causes and impacts of this failure The report concluded with a warning about current attitudes towards oral health in the United States: virtually every shortcoming in the safety net has at its root a failure to understand or value oral health.

Although dentistry is often viewed as separate from medicine, lack of access to adequate dental care significantly impacts patients’ quality of life and overall health. Every year, employed adults miss an average of 164 million working hours as a result of complications from dental issues, while children across the country miss thousands of hours of school time due to dental problems (Henry J. Kaiser Family Foundation, 2012). Those with dental decay and missing teeth encounter difficulties obtaining proper nutrition, as food options become limited with impaired chewing. In fact, research shows that many Americans suffer from lack of sleep due to dental pain, and visible decay can even prevent individuals from getting jobs and negatively impact self-esteem. (Griffin, S.O., Jones, Brunson, Griffin, P.M., & Bailey, 2012).

Perhaps even more alarming is the link between oral health and other major health issues; over 125 diseases may be directly linked to oral health. While ways to prevent and treat dental decay are well understood, it is often these seemingly minor problems that, when left untreated, have the potential to impact overall health. For example, individuals with HIV are more susceptible to infections of the mouth that can subsequently spread to the rest of the body. Endocarditis, a heart complication that occurs when bacteria from the mouth spreads to the heart through the blood, is an avoidable yet well-documented result of a lack of regular dental care (Mayo Clinic, 2013). Diabetes is also closely linked to oral health. Dental decay makes it more difficult to regulate blood sugar levels; treating periodontitis in diabetic patients has been shown to improve glycemic control (Simpson, Needleman, Wild, Moles, & Mills, 2010).

It is worth noting that the World Health Organization highlights dental health as a public health issue that ought to be included in general health, as poor oral health can have both physical and psychological complications that affect patient quality of life (Sheiham, 2005). Many scales have been developed to quantitatively measure this impact, such as the Social Impacts of Dental Disease Scale (SIDD), which measures physical, social, and psychological factors associated with dental issues (Slade, 1997). Bearing in mind these consequences of poor oral health, the argument can be made that dental care is an often overlooked but critical human rights issue in both the United States and globally.