Why Oral Health Matters

Oral health is an important part of a person’s overall health and well-being.  Pain caused by tooth decay (cavities) and other oral health problems can dramatically affect an individual’s everyday activities and reduce their quality of life.  Further, evidence-based studies have shown the link between oral health and various health conditions, including diabetes and heart disease.  Although oral disease is one of the most common and preventable health problems, achieving oral health requires effective prevention measures and access to treatment.  In the United States, cost and limited access to dental care heavily impact the poor and other underserved populations. It also underscores the “silent epidemic” of oral health problems affecting these vulnerable populations.[i] 

Migrant and seasonal farmworkers (MSFWs) are a medically underserved population with limited access to dental care.[ii]  Oral health is ranked as one of the major health problems of the farmworker community; yet, it is also one of the unmet needs in farmworker health services.[iii]  The lack of access and cost of dental services are reported to be the primary barriers to oral health care for farmworkers.  These barriers often result in farmworkers seeking care for emergencies, rather than prevention services.  Since oral health education is not normally provided during emergency care, opportunities are being missed where information on prevention could be shared such as those given during a routine visit with a dental provider.[iv]  Thus, more efforts to promote oral health and prevent oral disease are needed for the farmworker community. 

Given the scope of community health centers reach within communities, their outreach programs, especially the outreach workers, can play a crucial role in providing prevention information on oral health and linking farmworkers and their families to dental services.  Outreach workers are viewed as a trusted resource in the community. An outreach program that integrates oral health into its clinical model can serve to encourage oral hygiene and other healthy lifestyle behaviors, increase the use of prevention services, and lessen the risk of oral disease among the farmworker population.

 

Oral Health

Oral health allows us to eat, speak, swallow, smile, and engage in other daily activities and social interactions that are important to our overall well-being and quality of life.  According to the U.S. Surgeon General’s Report: Oral Health in America, oral health means more than having healthy teeth, and includes being free of pain in the mouth and face, tooth decay, tooth loss, oral infections, sores and cancers, and other diseases and disorders.  Additionally, research has shown the link between oral health and other chronic diseases, such as heart disease and diabetes.[v]  As a result, the World Health Organization (WHO) integrated oral health into its prevention efforts for chronic diseases.  Oral exams can also help to detect nutritional deficiencies, microbial infections, and some cancers.[vi]   

Prevention is one of the most important strategies to achieve oral health.  By adding fluoride to the public water supply, the U.S. saw a significant decrease in the rates of cavities in the general population.  Individuals can also take preventive measures such as: maintaining daily oral hygiene, including brushing and flossing; engaging in healthy lifestyle behaviors, such as reducing the amount of sugar intake and stopping smoking; and getting routine dental exams and cleanings.  Health providers can provide oral health education and work to ensure that patients have access to dental services.

 

Oral Health Disparities

Public health efforts in the United States have resulted in improving the oral health of the general population.  However, disparities in oral health still remain a major public health problem today, especially for poor and underserved populations.  Although 73.9% of the U.S. population receives fluoridated water, there are still about 104 million people who do not.[vii]  More than 40% of poor adults (20 years and older) have at least one untreated decayed tooth compared to 16% of non-poor adults.[viii]  Data from the National Health and Nutrition Examination Survey, 2009-2010 (NHANES) show that approximately one in four children aged 3-9 years living in poverty had untreated dental caries (tooth decay or cavities).  For every adult 19 years or older with medical insurance, there are three without dental insurance.[ix] 40% of Latino adults reported not seeing a dentist within the last year, and Latino adults are less likely to have visited a dentist within the past five years than White and African American adults.[x] 

For migrant and seasonal farmworkers, research shows worse oral health outcomes than compared to the general population.  In the U.S., 31% of all adults (18 years and older) reported not seeing a dentist in the last year.  Of farmworkers surveyed in North Carolina, 80% reported not receiving dental services within the last year; yet various oral health problems were frequently reported such as tooth decay (52.3%), sensitivity (40.4%) and missing teeth (32.5%).[xi]  In a study of farmworkers in southern Illinois, the majority of farmworkers have never or inconsistently received oral care.[xii]  From the collective data about farmworkers and oral health, the barriers most cited have been cost, time, transportation and limited access to dental services.  Additionally, there are not enough comprehensive oral health services available to serve the needs of farmworkers. Often times, migrant health centers that offer some type of dental services may not be adequately staffed, have limited clinic hours, and/or long waiting lists for care.[xiii]  Emergency care was identified as the most typical response to oral health problems.  Thus, farmworkers are seeking care only when they have pain or other severe symptoms.  Children of farmworkers generally have better oral health than their parents, but in comparison to the U.S. child population, they suffer from worse oral health outcomes.[xiv]  In many cases, oral health problems remain untreated, which results in chronic pain and in some cases, lead to severe health outcomes in the future.  Further, the adverse effects of oral health problems can also impact farmworkers’ ability to work, which results in the loss of hours of work.

 

The role of outreach in promoting oral health 

For community health centers, outreach workers can play an important role in providing health education on oral health and linking farmworkers and their families to dental services.  In Salinas, CA, Clínica de Salud del Valle de Salinas developed an integrated clinical outreach model where three full-time staff members provide health education classes, chronic disease management, oral health screenings, and vaccinations in outreach settings. Through this expanded clinical outreach model, farmworkers and their families receive much-needed oral health care in addition to other preventive health services in the fields, at schools, and during community events. Further, many oral health problems can be addressed by basic prevention measures, such as daily brushing and flossing, maintaining a healthy diet, and getting routine check-ups with the dentist.  As outreach workers are viewed as a trusted resource in the community, they are in a good position to promote prevention. Finally, studies show that farmworkers will utilize oral health services when they are affordable and available. In one study, the availability of comprehensive dental services showed better oral health for farmworker children.[xv]  The outreach program of Cherry Street Health Center in Grand Rapids, MI worked with the health center to develop an affordable after-hours dental clinic, including extended emergency dental walk-in hours during the weekdays.  By expanding dental clinic hours, Cherry Street responded to the needs of the farmworker community and ensured that oral health services are available.  Outreach is integral in ensuring that oral health services can be accessed by farmworkers and their families, and outreach workers can encourage healthy lifestyle behaviors, increase the use of prevention services, and lessen the risk of oral disease among the farmworker population.

 

Conclusion

Although oral diseases are a major public health problem, oral health often gets overlooked when setting health priorities.  Even at the individual level, oral health may not be seen as important as other health or daily life needs.  However, evidence continues to grow showing the impact of oral health on the overall health and well-being of the population.  In fact, the Department of Health and Human Services (HHS) has selected oral health as one of the 12 Leading Health Indicators (LHIs) for Healthy People 2020, the 10-year national objectives for improving the health of all Americans.  Thus, oral health needs to be continually included in health promotion and prevention efforts with particular attention to underserved populations, such as migrant and seasonal farmworkers.  Outreach workers can help to bridge the gap and increase the use of prevention measures and oral health services.

 

HOP Tip: For more details on the outreach practices mentioned in the article, please visit HOP’s website for our resources on Innovative Outreach Practices available at: http://web.outreach-partners.org/resources/iop .