Category: review

Teeth and oral health in America is a complex issue, which invariably means class is involved. The mouth is part of the body, but for reasons that remain unclear, dental colleges were created separately from medical colleges. This silo-ed approach to education has been mirrored in the way dentistry is delivered, separate from physical care. The real economic pressures that have created our current healthcare crisis are also shaping the way oral healthcare is delivered. Mary Otto has authored a book investigating the oral healthcare landscape.

TEETH
The Story of Beauty, Inequality, and the Struggle for Oral Health in America
By Mary Otto
291 pp. The New Press. $26.95.

This book was brought to my attention by a recent article on dentistry in The Atlantic. Otto covered oral health for the Washington Post and is now the oral health topic leader for the Association of Health Care Journalists.  She’s contributed to drbicuspid.com and while Teeth is a scholarly work supported by ample notes, it remains highly readable. It was reviewed in the NY Times Sunday Book Review after it’s publication in  2017. The topics it covers are just as relevant in 2019!

The state of one’s teeth says a lot about one’s economic status. The same economic forces that have driven the uptake of cosmetic dentistry also make it harder for oral healthcare to be delivered to under-served populations. Initiatives that could help deliver oral healthcare face opposition from dental associations. These initiatives typically involve allowing dental hygienists to provide (unsupervised by a dentist) cleanings to school children in “dental deserts” or expanded licensing for dental therapists.  These are policy changes that can and do work, but push back from organized dentistry has been hard.

One example given is in the case of Deamonte Driver, whose death from an infected tooth drove the State Children’s Health Insurance Program debates of the aughts and the Affordable Health Care debates of the teens. It seems like the simplest solution to providing access to oral healthcare is expand the pool of practitioners who can provide these services, but the fear that dental hygienists could threaten the dentist’s business model is a powerful block to these kinds of changes.

What role does technology play?  I offer two avenues:

1. Technology providers need to continue to innovate with new products and therapies. Advancements in endodontics, implantology, and (yes!) prosthetic therapies provide avenues for dentists to provider better and more effective care for their patients.

2. Technology must continue to reduce costs. Not only is cost reduction attractive to technology providers, it also creates the margin space for therapies that were first developed for the premium market to be made available to the value market.

What role do providers have in improving teeth and oral health for under-served populations? Tell me about it in the comments!