9 Oral Diseases

In the United States, a large proportion of adults have experienced some form of oral disease. Oral diseases refer to diseases that are located in the mouth. Oral cavities and oral cancer are two of the main oral diseases that can cause physical pain, negatively impact quality of life, and can even lead to other diseases (Chapter 10).

About 1 in 4 adults have had one or more untreated cavities (CDC, 2022). Oral cavities are permanently damaged hard tissues of the tooth. The hard tissues of the tooth, which include the enamel and dentine, are located on the surface of the tooth. Cavities are caused by bacterial plaque, which can progress deep into the dental pulp and cause tooth loss (Peres et al., 2019). Surface level cavities decay the surface of the tooth’s enamel. Root cavities penetrate deeper into the gumline, can cause intense pain, and usually require a surgical root canal (Cleveland Clinic, 2020). Risk factors for developing cavities include improper oral hygiene (smoking, eating excess amounts of sugar, etc), pre-existing conditions such as diabetes and heart disease, and irregularly visiting the dentist (Chapter 10).

 

“Blausen 0864 Tooth Decay” by KDS4444 is licensed under CC BY-SA 4.0

Roughly 1.7% of men and 0.71% of women in America are at risk for developing oral cancer during their lifetime (American Cancer Society, 2022). Oral cancer can form anywhere in the mouth, including the tongue, lips, and gums. The most typical category of oral cancer is squamous cell carcinoma, which involves rapid growth of dividing flat shaped cells within the mouth (Peres et al., 2019). General risk factors for oral cancers include smoking, alcohol abuse, and forgoing oral cancer screenings.

Prevention and treatment strategies to aid individuals in achieving healthier oral disease outcomes are increasing access to dental cleanings, oral hygiene education in schools, expanding access to dental insurance, and making oral cancer screening more accessible. While it is important to improve oral disease outcomes among all populations, one population of interest is males.

Gender Differences in Oral Disease Risk

Research indicates that women are biologically more prone to cavities than men. This is largely due to women’s genetics and changes in hormones, especially during pregnancy (Lukacs & Largaespada, 2006). While ample evidence has explained the biological differences between male and female cavity risks, there is insufficient data about the behavioral and accessibility differences between men and women. One behavioral difference between men and women is accessing dental care. Men may have different priorities and obligations to their family, therefore they might delay or forgo spending money on dental care. Additionally, men might face more societal pressures to deal with the oral pain and tough it out. However, more research is still needed to establish these gender differences.

Men are at higher risk of developing oral diseases due to visiting the dentist less often. Research suggests that most men tend to seek dental care only when they start experiencing pain, rather than focusing on preventative dental visits (University of Illinois at Chicago, 2017). One study shows that only 44.7% of men visited the dentist in the past 6 months, compared to 54.3% of women (Su et al., 2022). This study also found that men are less likely to follow through with routine dental checkups and participate in screenings. Thus, the men experienced greater incidences of root and coronal cavities (Su et al., 2022). Men are also more likely than women to develop cancerous growths in the mouth due to engagement in risky behaviors such as smoking (Auluck et al., 2016).

 

“Dental care: Keeps Him on the Job” by U.S. Public Health Service : U.S. G.P.O is in the Public Domain

Neighborhood Income Impacts on Oral Diseases

External factors such as average neighborhood income, availability of dental clinics, and affordability of dental insurance affect oral disease status in men. The location and wealth of neighborhoods both impact one’s ability to access dental care. One study showed that men in wealthy neighborhoods were more likely to survive oral cancer (72.5%), compared to only 66.6% of men living in underserved areas (Auluck et al., 2016). Among Black men, those living in urban areas with less than 10 dental offices were 2.4 times more likely to report difficulties in finding dental care compared to those living in areas with more dental offices (Akintobi et al., 2016). This is linked to the finding that 68.8% of the sample did not possess dental insurance, which almost tripled the likelihood of having negative oral disease outcomes. One possible reason for differences in men’s access to oral care is the availability of dental clinics that accept government sponsored dental insurance. The American Dental Association found that about 21 states had less than 50% of dentists who accepted Medicaid patients (Vujicic et al., 2021). Individuals without any dental insurance would need to spend out of pocket for dental services, which poses a serious barrier for underserved low-income men.

Household Income Impacts on Oral Diseases

Since oral diseases develop over time, it is also important to understand barriers that the young males face to promote a healthier oral disease status earlier on. While there is little research about income and oral disease status solely in boys, there is evidence about children’s household income and oral disease rates. Children from low-income households generally have greater incidences of cavities than children from higher income families (Vasireddy et al., 2021). This is largely because lower-income households usually have public insurance, whereas high income families usually have private insurance. Results about the effect of different types of dental insurance on disease rates are however variable. One study found that children with governmental public insurance or without any insurance had higher cavity prevalence rates compared to their privately insured counterparts (Vasireddy et al., 2021). In a different study of Head Start preschool students, researchers found no correlation between cavities rates in low income uninsured, privately insured, and publicly insured children. This study also did not observe significant gender differences in cavities rates between preschool girls and boys (Heima et al., 2017). More research is needed to determine if boys and girls have different rates of cavities and to understand household income-related reasons behind any differences.

Ethnicity and Oral Diseases

Minorities tend to directly experience worse oral disease outcomes. In one study, White individuals lost an average of 12.9 teeth, whereas Black individuals lost 17.6 teeth (Liang et al., 2013). Black individuals are also more likely to suffer mortality from oral cancer due to being diagnosed at later stages compared to Whites (Yu et al., 2019). Such trends in Black populations are likely due to the disadvantages that Black populations face when taking action to prevent oral diseases. Black men report facing barriers such as lack of oral healthcare access, unavailability of Black oral healthcare providers, systemic racism, medical mistrust, and hypermasculinity pressures to tough out the oral pain (Smith et al., 2022). Experiencing racism and discrimination may cause Black males to feel mistrust towards the oral healthcare system. However, there is limited evidence showing the correlation between these specific barriers and oral disease status.

Other minority groups such as immigrants and Hispanics face further barriers to oral healthcare. People migrating to America from Spanish-speaking countries may experience difficulties assimilating into society for fear of discrimination and stigma due to their ethnicity or immigration status. Therefore, minorities are usually less likely to possess insurance coverage, less likely to seek dental care, and more likely to have decayed teeth (Han, 2019). Among the Hispanic population, those who primarily speak Spanish experience the worst oral health outcomes compared to Whites and are least likely to visit the dentist to receive preventative treatments (Han, 2019). Such trends are possibly due to language and cultural barriers between the oral healthcare workforce and underrepresented populations. Lack of workforce cultural competency and diversity to meet the needs of various populations is a main driver of oral disease differences among many racial and ethnic groups, especially in men.

Prevention and Treatment Strategies

To decrease rates of oral diseases among men, more action needs to be taken to reduce risk factors that men may face. Different ways to reduce oral disease prevalence rates include increasing affordability and accessibility of dental care, as well as eliminating barriers for minorities.

National organizations, such as the American Student Dental Association (ASDA) have recently made policy changes to address oral health inequities. In 2018, ASDA helped pass the Action for Dental Health Act, which increased the scope of dental care to reach socioeconomically and racially disadvantaged populations. In 2022, dental students met at a national conference to discuss the passing of the Medicaid Dental Act. If passed, the bill will expand public dental insurance coverage to adults across all states (ASDA, 2022).

As previously stated, it is also important to focus on educating and treating children, including adolescent boys, since oral diseases develop over time. Multiple strategies can be implemented to improve the oral disease status of children earlier in life. One preventative strategy is a school-based dental sealant program to provide free or low-cost care to children who otherwise may not be able to access dental services. Dental sealants are thin protective coatings over the tooth that, when applied to children’s teeth, can prevent cavities later in life. School-based sealant programs have proven to be a cost-effective method for preventing cavities in low-income children (Griffin et al. 2016). Another recommendation is to involve male parents and caregivers in these programs so that they may receive dental checkups alongside their child.

Additionally, hospitals and dental offices need to implement institutional level interventions that target men. Programs that increase diversity and cultural competence among healthcare providers can address the ethnic and cultural barriers existing for minority males who have difficulty accessing oral care. (Han, 2019). Moreover, providing access to translators in the dental office, promoting providers who speak multiple languages, being respectful of cultural norms, and understanding the oral health needs of special populations can all help create a more inclusive oral healthcare system.

References

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