10 Oral Health

Oral health refers to the overall maintenance of the mouth, teeth, and gums through good oral hygiene practices such as brushing the teeth and gums. The mouth, teeth, and gums are called the oral cavity. The oral cavity is essential to the oral-facial system which allows us to speak, eat, express emotion, and perform various other functions. Poor oral health can be defined (but not limited to) as bleeding or swelling in the gums, toothaches, and physical deformations of the oral cavity. It also encompasses oral health diseases and conditions, which will be discussed in detail in another chapter. Poor oral health can lead to pain, difficulty eating, and changes in speech, which can all be detrimental to physical, social, and mental health. The CDC reports that in the United States alone, 45 billion dollars are lost in productivity annually due to poor oral health (Center for Disease Control and Prevention, 2021). In 2019, the global burden of disease related to poor oral health was estimated to be about 3.5 billion people.  Thus, Oral Health is a key indicator of an individual’s overall health, well-being, and quality of life.

Health behaviors and practices, behavioral risk factors, and lack of health literacy and education are all determinants of an individual’s oral health. Health behaviors are arguably the most important factors to consider. Firstly, health behaviors directly influence oral health, such as daily brushing and flossing. High-risk behaviors, such as tobacco use (smoking, chewing, dipping, vaping), alcohol consumption, and substance use/abuse (Marijuana) are all also significantly detrimental to oral health. Oral Sex is also considered to be a behavioral risk factor because of the possible infection and trauma it poses, such as susceptibility to STDs and STIs. Lack of health education and literacy also have been consistently found as drivers in oral health status.

Avoiding behavioral risk factors, such as the men smoking in the photograph above, can help men in the maintenance of their oral health. Advancing health literacy and educating individuals about risks is key to inhibiting detrimental health behaviors.

“Tableau, cigarette, men, yard Fortepan” by Csoportkep, Wikimedia Commons is licensed under CC BY 3.0

ORAL HEALTH ADVANCEMENTS IN THE UNITED STATES

Oral Health practices in the U.S. can be dated back to times of the colonies, however it wasn’t until the mid-1900s that oral hygiene became a social norm. Prior to WW2, government initiatives were taken to improve oral health habits in immigrants for a multitude of reasons. Educational initiatives were implemented to keep adults at work and children in school, but also to “Americanize” immigrants. Dentists were brought into factories to conduct exams and to give dental hygiene presentations. During World War 2, soldiers were required to brush their teeth as a part of their daily hygiene routine to keep them healthy and on the battlefield. Once they returned home, they brought these practices with them (Oral care, 2022).

GENDER DIFFERENCES

Men’s health is an overall complex field because of the unique physical and social issues men face, such as specific cancer’s, conditions, and social stigmas and constructs. Men are also less likely to attend to their overall health when compared to women. Men’s oral health is equally as complex as men’s overall health . One reason for this complexity is dental attendance, or the frequency of dental visits. Numerous studies have identified males to have lower rates of dental attendance than females (Locker, 2007 and Zhou, et al. 2021). Males also engage in riskier health behaviors (such as smoking or consuming a poor diet). This was confirmed in a study that found women place greater emphasis on their oral health and perceive oral health to have a great impact on their overall health than men (Vanwormer et al. 2018).

EFFECTS OF SOCIOECONOMIC STATUS

Perhaps the most important driver of men’s oral health is socioeconomic status (SES).  The importance of SES as a driver in oral health have been confirmed in multiple studies where poor oral health was associated with low SES populations more than  high SES populations. One study found that individuals from lower socioeconomic statuses with poor oral health had little to no knowledge on oral hygiene (Locker, 2007). Boys and young men of low SES in this study were also found to have the lowest rates of dental attendance. In a prospective study among US Veterans, oral health status was identified as a key marker of socioeconomic status and health behavior (Sabbah et al., 2013). Veterans of lower SES were significantly more likely to have poor oral health or to be edentulous (missing teeth). Another study found that Males of higher SES and lower SES (at or below of the poverty line) were also revealed to have poor oral health through screenings for HPV (Thanh et al., 2013). Lastly, another study found that the nutritional choices and diet of lower SES individuals led to poorer oral health and the onset of oral disease and coronary heart disease (Joshipura, et al. 1996). One constant in the findings of all these studies was that the low and high extremes of SES were associated with negative effects on men’s oral health status, suggesting that SES is a reliable tool in predicting the present and future status of a male’s oral health, and in turn, overall health.

A key to catalyzing change in men’s oral health is to begin oral health education young. Dental professionals should be strategic and precise when communicating with their younger male patients.

“Dentist Patient Dental Care” by Jarmoluk, Pixabay is licensed under a Pixabay License

ORAL HEALTH AND RURALITY

An important driver of men’s oral health is the concept of rurality , or comparisons between rural and non-rural areas (urban, suburban). A Wisconsin study found that rural populations scored lower on oral health literacy tests; these low scores were also associated with low dental attendance (VanWormer et al., 2018). Interestingly, rural women were identified to be more literate in terms of oral health than rural males (Su et al., 2021).  A study that took place across various rural Appalachia regions found that rural residents were also less likely to attend routine checkups and preventative visits than urban and suburban residents. In this study, biological sex was found to be a factor in dental attendance  and rural men identified factors such as cost, distance to office, dislike of the oral health experience, lack of insurance, and lack of availability for time off work as the main factors for lacks in dental attendance. (Zhou et al., 2021).  This study also identified rural men to be more likely to seek dental treatment after a dental trauma (chipped tooth, tooth knocked out), indicating lesser preventative care among rural male populations. The same study found that lack of practicing oral health professionals in rural settings to be a key catalyst of discrepancies between rural and non-rural populations. Several studies also identified access to care as a reason for oral health disparities in rural populations.

ORAL HEALTH AND OTHER HEALTH DOMAINS

Poor oral health in men poses additional risks to health. Men classified to have poor oral health (e.g., periodontal disease) were found to be at greater risk of coronary heart disease and all-risk mortality (Joshipura et al., 1996 and Kotronia et al., 2021).  There are also higher rates of HPV among men with poorer oral health. This is significant because HPV infection is linked to a variety of cancers in men, such as mouth, throat, prostate, and penile cancers (Thanh et al., 2013). Another study found that men with poorer oral health were at a higher risk for all-cause and cardiovascular mortality. Despite all these findings, there is still a need for more research to identify sex differences in oral health, especially in comparing the oral health of men of different ages in the same culture while also controlling for confounding variables.

CURRENT AND FURTHER ACTIONS

Oral health initiatives are being taken at a variety of levels. For the past 75 years, the CDC has also funded community water fluoridation initiatives that help maintain strong oral health in both children and adults (Centers for Disease Control and Prevention 2020). The CDC also funds 20 states and territories to implement evidence-based preventative interventions in schools in low-income and rural areas. Despite these achievements, there remains a need to address the factors that contribute to rural-urban dental health disparities aside from access to dental care (Zhou et al., 2022). Lack of health literacy and lack of education have been identified as possible factors (Baskaradoss, 2018) . Disparities were also attributed to a host of factors which include nutrition, oral hygiene, and healthcare utilization.

More action is required in addressing men’s oral health. Further initiatives at the school-based community level can be implemented to emphasize the importance of routine dental care among young boys and men. Expanding school-based sealant programs have proven to be effective, but more must be done to in inhibit lack of dental attendance in men and to encourage preventative care. A possible preventative imitative is to implement fluoride rinses and tablet intakes among rural and low SES populations; these populations are historically undernourished and may not have access to proper fluoridated water sources, which aid in strengthening the tooth’s enamel.

At the policy level, biannual dental visits are largely the standard of care. Males, specifically among low and high SES, as well as rural populations, are notorious for neglecting their own oral health due to barriers such as cost and access to care. New policy levels should aim to eliminate these barriers. For example, Medicare does not normally cover dental care. To combat this, federal funding can be expanded through legislation that can allocate more funds to provide care for populations that utilize Medicare, especially in rural and low SES populations that may require the most aid. Another strategy to ensure biannual preventative dental visits could be for the government to incentivize insurance companies to sponsor free dental checkups throughout the year through tax breaks or other economical rewards.

references

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Joshipura, K., Rimm, E., Douglass, C., Trichopoulos, D., Ascherio, A., & Willett, W. (1996). Poor Oral Health and Coronary Heart Disease. Journal of Dental Research, 75(9), 1631-1636.

Sabbah W, Mortensen LH, Sheiham A, et al. Oral health as a risk factor for mortality in middle-aged men: the role of socioeconomic position and health behaviours. J Epidemiol Community Health 2013;67:392-397.

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Kotronia E, Brown H, Papacosta AO, Lennon LT, Weyant RJ, Whincup PH, Wannamethee SG, Ramsay SE. Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA. Sci Rep. 2021 Aug 12;11(1):16452. doi: 10.1038/s41598-021-95865-z. PMID: 34385519; PMCID: PMC8361186.

Su S, Lipsky MS, Licari FW, Hung M. Comparing oral health behaviors of men and women in the United States. J Dent. 2022 Jul;122:104157. doi: 10.1016/j.jdent.2022.104157. Epub 2022 May 8. PMID: 35545161.

VanWormer JJ, Tambe SR, Acharya A. Oral Health Literacy and Outcomes in Rural Wisconsin Adults. J Rural Health. 2019 Jan;35(1):12-21. doi: 10.1111/jrh.12337. Epub 2018 Nov 23. PMID: 30467897.

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World Health Organization. (n.d.). Oral Health. World Health Organization. Retrieved October 5, 2022, from https://www.who.int/health-topics/oral-health#tab=tab_1

Oral care. Smithsonian Institution. (n.d.). Retrieved October 5, 2022, from https://www.si.edu/spotlight/health-hygiene-and-beauty/oral-care

Centers for Disease Control and Prevention. (2021, January 25). Oral Health Fast Facts. Centers for Disease Control and Prevention. Retrieved October 5, 2022, from https://www.cdc.gov/oralhealth/fast-facts/index.html

Centers for Disease Control and Prevention. (2020, December 10). School sealant programs. Centers for Disease Control and Prevention. Retrieved November 4, 2022, from https://www.cdc.gov/oralhealth/dental_sealant_program/school-sealant-programs.htm