Health Care Access & Coverage
Oral Health in the Global Push for Universal Health Coverage
Reducing the Dental-Medical Divide
The essential nature of dental care was evident when many dental clinics across the United States closed in Spring 2020 due to the pandemic. Patients with dental emergencies (commonly tooth infections with painful orofacial abscesses) were triaged via telemedicine or given temporary solutions, such as antibiotics and analgesics, until dental offices could be reopened and provide more permanent solutions (i.e., root canal treatment or extraction). The intense pain and discomfort, as well as the negative effects on long-term oral health that arose from the suspension of dental services made clear that dental care is not an auxiliary or luxury health care service.
In the Bulletin of the WHO recently, my colleagues Manu Mathur, Harald Schmidt, and I discuss the perception of oral health as a non-essential health care service and its subsequent exclusion from conceptions of Universal Health Coverage (UHC) around the world. UHC is broadly defined as individuals having access to necessary health services without undue financial burden. The push for UHC gained considerable momentum over the last decade, particularly as a priority item in the UN General Assembly’s Sustainable Development Goals (SDGs). In our piece, we contend that the failure to include oral health in the current push for UHC undermines meaningful pursuit of UHC, needlessly deprives vulnerable populations of critical care, and is counterproductive to progress towards several key Sustainable Development Goals.
We recommend incorporating oral diseases into global and national mainstream efforts to counter noncommunicable diseases in tandem with engaging local populations and fostering grassroots-level demand for oral health services. A basic package of dental services can be incorporated into primary health care initiatives to leverage pre-existing medical infrastructure to reduce the burden of oral diseases. The WHO could also include oral health in its next iteration of its Core Health Indicators, and the United Nations and the World Bank could integrate oral health in their monitoring frameworks for assessing UHC progress. Ultimately, integrating oral health into UHC is essential to improving the health and equity of vulnerable populations.
The exclusion of oral health from the conceptual framework of “universal” health coverage is particularly relevant for US health care. There is a long historical precedent that divides dentistry and medicine. Since the early 1900s, the two fields have developed parallel training institutions and insurance schemes. For example, when Medicaid and Medicare were established, public dental coverage was provided only to children from low-income families and subsequently extended to low-income adults voluntarily by some states. The exclusion of dental services during this prominent expansion of the social safety net for health care conveys a message, intentionally or otherwise, that oral health is separate from the rest of the body.
However, the health of the mouth cannot be separated from that of the rest of the body. Oral diseases share common risk factors, including tobacco, alcohol, diet and stress, with other major noncommunicable diseases such as cardiovascular disease and diabetes. Poor oral health also lowers quality of life by limiting the ability to chew and reducing self-esteem. Furthermore, the mouth can be viewed as a window into the health of rest of the body; many systemic illnesses, ranging from lead poisoning to the Human Immunodeficiency Virus infection, have unique oral manifestations that can lead to timely diagnosis. As such, we hope that our work can help stimulate additional discussions about the critical importance of integrating dental and medical care, as well as the inclusion of dental services in universal health coverage initiatives in the United States and around the globe.