Impacts Beyond the Mouth

“So, there's two big things going on with Medicaid right now in Florida and that's obviously the disenrollment that was paused, but then continued on,” van Hoogstraten said.

Growing evidence connects a healthy mouth with a healthy body. Here are some examples showing why oral health is about much more than a smile:

High Blood Pressure

Putting off dental care during early adulthood is linked to an increased risk of having high blood pressure.1 Patients with gum disease are less likely to keep their blood pressure under control with medication than are those with good oral health.2

Diabetes

During Covid-19, the federal Public Health Service Act was implemented. It stipulated that you couldn't roll people off Medicaid, but it ended May 11 of this year. Florida began rolling people off Medicaid who had been on it for a long period of time. Now, people are losing Medicaid because they are not eligible or because they didn't properly complete the enrollment process.”

Untreated gum disease makes it harder for people with diabetes to manage their blood glucose levels.3 Diabetes raises the risk of developing gum disease by 86%.4 van Hoogstraten says for many states, if not all, Medicaid is their largest state expenditure.

Obesity

Brushing teeth no more than once per day was linked with the development of obesity.5

Frequent consumption of sugar-sweetened drinks raises the risk of both obesity6 and tooth decay among children7 and adults.8 tion's core vision is to be a leading advocate for promoting access to quality education, economic opportunity, civic engagement, health, and wellness. The following statistics emerged from the oral health gathering:

It is big money and taxpayer money, so he and fellow advocates are currently talking to government administrations to determine if their process is working well and transparent. He thinks states are generally trying to do the right thing.

1. More than five-million Floridians live in areas that have limited or no access to dental care and more than 23% of third graders in Florida have untreated tooth decay, making Florida sixth in the nation for the highest percent of third-grade children with unfilled cavities.

2. 34% of senior citizens have lost six teeth due to tooth decay or gum disease.

3. In 2019, hospitals in Florida billed more than $630 Million for preventable ER visits and hospital admissions stemming from preventable oral health issues.

4. Poor dental health has been said to be the cause of 57 systemic diseases and illnesses.

5. Patients with serious dental conditions are 25% more likely to suffer from heart disease and have an increased chance of autoimmune diseases, anemia, gastrointestinal disorders, and renal disease.

72(6): 1365-1373. Müller F. Oral Hygiene Reduces the Mortality from Aspiration Pneumonia in Frail Elders. Journal of Dental Research. 2015 Mar; 94(3 Suppl.): 14S–16S.

3. Preshaw PM, Bissett SM. Periodontitis and diabetes. British Dental Journal. 2019; 227: 577–584; Teeuw WJ, et al. Effect of periodontal treatment on glycemic control of diabetic patients: A systematic review and meta-analysis. Diabetes Care. 2010 Feb; 33(2): 421-427.

4. Baranowski MJ, et al. Diabetes in dental practice-review of literature. Journal of Education, Health and Sport. 2019; 9(2), 264-274

5. Furuta M, et al. (2020). Longitudinal associations of toothbrushing with obesity and hyperglycemia. Journal of Epidemiology, JE20190165.

6. Luger M, et al. Sugar-Sweetened Beverages and Weight Gain in Children and Adults: A Systematic Review from 2013 to 2015 and a Comparison with Previous Studies. Obesity Facts. 2017; 10(6): 674-693.

“I also think Medicaid departments are behemoths because of the really large population they serve,” van Hoogstraten said. “The populations are often so hard to reach, and they're constantly shifting and changing. The shortcomings or mistakes are usually not nefarious or ill intentioned, but they're inevitable.”

7. Bleich SN, Vercammen KA. The negative impact of sugar-sweetened beverages on children’s health: an update of the literature. BMC Obesity. 2018; 5(6).

8. Bernabé E, et al. Sugar-sweetened beverages and dental caries in adults: a 4-year prospective study. Journal of Dentistry. 2014; 42(8): 952-958.

Despite the State’s best intent, without Medicaid, Floridians like Lloyd will struggle to find affordable health coverage that includes a dental plan. She is potentially an unwitting contributor to Florida’s state of poor oral health — a precursor to a bevy of extended health diseases.

The Jacksonville Urban League played an integral role in Florida's Oral Health Crisis by hosting a Town Hall meeting in April 2022. The organiza-

The largest burden of disease occurs among marginalized groups such as those living in poverty and members of Black, Indigenous, and People of Color (BIPOC) communities. Low-income families spend 10 times of their total income on dental care than that of wealthier families.

Dementia

Having 10 years of chronic gum disease (periodontitis) was associated with a higher risk of developing Alzheimer’s disease.9 Researchers report that uncontrolled periodontal disease “could trigger or exacerbate” the neuroinflammatory phenomenon seen in Alzheimer’s disease.10

Without dental coverage or the ability to afford care, many adults delay treatment which leads to more expensive and extensive oral care than they would require had they seen a dentist earlier in the disease process.

Respiratory Health

Research shows that improving oral hygiene among medically fragile seniors can reduce the death rate from aspiration pneumonia.11

Patients with ventilator-associated pneumonia (VAP) who engaged in regular toothbrushing spent significantly less time on mechanical ventilation than other VAP patients.12 Improving veterans’ oral hygiene reduced the incidence of hospital-acquired pneumonia (HAP) by 92%, preventing about 136 HAP cases and saving 24 lives.13

Lloyd has valiantly rebounded from being dropped off the Medicaid roll. Her employer offers a Blue Cross Blue Shield of Florida plan and Delta Dental, but cumulative payroll deductions are near $100. Without Medicaid, she will also have to budget co-pays for appointments.

Adverse Birth Outcomes

Gum disease among pregnant women is associated with preterm births, low birthweight babies and preeclampsia, a pregnancy complication that can cause organ damage and can be fatal.14

“My health is already not good,” Lloyd said. “I have high blood pressure, and if I go to the dentist and it’s high, they won’t treat me. I am headof-household. It’s just me, so one entire paycheck goes to rent and the other pays JEA electric and car insurance. With food skyrocketing and two kids, it’s hard, but I am determined to make it work.”

9. Chen CK, et al. (2017). Association between chronic periodontitis and the risk of Alzheimer’s disease: a retrospective, population-based, matched-cohort study. Alzheimer’s Research & Therapy, 9(1), 56.

10. Teixeira FB, et al. Periodontitis and Alzheimer’s Disease: A Possible Comorbidity between Oral Chronic Inflammatory Condition and Neuroinflammation. Frontiers in Aging Neuroscience. 2017 Oct; 9:327

11. Müller F. Oral Hygiene Reduces the Mortality from Aspiration Pneumonia in Frail Elders.

Journal of Dental Research. 2015 Mar; 94(3 Suppl.): 14S–16S.

12. de Lacerda Vidal CF, et al. Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC Infectious Diseases. 2017 Feb 27; 17(1): 173.

13. Munro S, Baker D, 2018. Reducing missed oral care opportunities to prevent nonventilator associated hospital acquired pneumonia at the Department of Veterans Affairs. Applied Nursing Research, 2018; 44: 48-53.

14. Daalderop LA, et al. Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews. Journal of Dental Research Clinical and Translational Research. 2018; 3(1): 10–27.

Penny Dickerson is innovation and entrepreneur reporter for the Jacksonville Business Journal. Reporting for this story in ONYX Magazine was made possible by a health equity fellowship sponsored by The Commonwealth Fund and Association of Health Care Journalists.

Suggested Citation: CareQuest Institute for Oral Health. Impacts Beyond the Mouth. Boston, MA; June 2020. DOI: 10.35565/CQI.2020.4002

Copyright © 2021 CareQuest Institute for Oral Health, Inc.