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To improve health disparities, focus on oral health
That’s the recommendation on a new blog from the Robert Wood Johnson Foundation. How so? well, here’s an argument.
Let’s begin by recognizing chronic diseases such as diabetes and COPD have a much higher prevalence in poorer communities than rich ones. For example, about 4 in 100 adults in Rosedale (high income) in Toronto have diabetes, whereas, 3 kilometers away in St. Jamestown (low income), 12 in 100 are diabetic.
Healthcare savings via prevention of chronic disease
A new study which examines why American spending on healthcare has shown little growth over the past few years, reports that a key reason is healthier hearts among Seniors.
Between 1999 and 2012, American per capita spending on cardiovascular and cerebrovascular diseases (heart attack, cardiac arrest, stroke, etc.) declined by $827 per person. Spending on a related category called cardiovascular risk factors (high blood pressure, high cholesterol, diabetes) also fell $802 per person below the trend line.
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Rewriting the job description
Sometimes new science and discoveries come along to rewrite the job description for an industry or profession. Think of the Internet and its redefinition of the community library, for example.
A similar situation may well be emerging in hygiene– er, let’s call it oral healthcare for reasons given below.
Recently, the bidirectional linkage between oral health and cognitive decline has heated up. If your patients haven’t already asked you about it, read this article.
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Targeting preventive services
The Cochrane Library recently updated its evaluation about the merits of a hygienist cleaning above and below the gum line. Its conclusion: target these procedures for those at very high risk of poor oral health because there is little evidence of clinical merit or cost-effectiveness for these hygiene procedures for adults at little or no risk.
While this makes sense, the reality is our dental insurance schemes in Canada do not recognize risk in their reimbursement for oral health services. Someone who is low risk has the same entitlements as those at high risk. Your gums are healthy — you get 10 units of scaling each year. Your gums are bleeding and inflamed — you get the same.
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The physician and oral health
“If balance is symbiosis then the loss of balance is dysbiosis… you can call it disease. Asthma, obesity, rheumatoid arthritis, colitis, even depression and autism, can be understood in terms more familiar to ecologists than doctors.”
This is an excerpt from a recent opiotn letter published in the British Medical Journal, January 14, 2019. It was written by a physician who understands that the vast populations of microbes in the human body play a vital role in the onset and management of chronic diseases.
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Pay for performance in oral healthcare
Value based care and pay for performance contracts are quickly seeping into healthcare. Here’s an example. In 2019, a large Dutch insurer decided to pay its doctors and psychiatrists treating depression and mood disorders, on how much better the patient feels, rather than on the number of counseling sessions. (Not surprisingly, the Dutch Association of…
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Cognitive Function and Oral Health
The connection between oral health and cognitive function is intriguing, and seemingly is getting clearer. For example, a new prospective Japanese study of seniors living in the community reports that those with fewer teeth, were 3 times more likely to have a decline in cognitive function over 4 years, than those with more teeth. In…
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Improving Diabetes Management by Improving Oral Health
Several intervention studies now show that a dental cleaning below the gum line leads to improved glycemic control (HbA1C) in Type 2 diabetics for up to 6 months. There are about 3 million Type 2 diabetics in Canada and another 5 million who are pre-diabetic. It is an expensive chronic disease largely driven by age…
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Managing Oral Inflammation – What Gives?
Periodontal (gum) disease is one of the most common chronic diseases – it affects 7 in 10 adults. Severe gum disease, as indicated by extensive and repetitive inflammation/bleeding and even teeth which wobble, is experienced by 1 in 10 adults. Gum disease is now considered to have a bidirectional relationship with Type 2 diabetes and…
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