Slavkin Harold C, Dubois Peter A, Kleinman Dushanka V, Fuccillo Ralph
Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA.
California Dental Association, California Dental Association Holding Company, Inc., Sacramento, California, USA.
J Healthc Leadersh. 2023 Mar 16;15:43-57. doi: 10.2147/JHL.S363657. eCollection 2023.
Oral, dental and craniofacial (ODC) health has a profound impact on general health and welfare throughout life, yet US dentists and physicians operate across misaligned silos. This protracted division limits access to optimal health, supports fee for services, and exacerbates health disparities. Early in the 20th century, the most frequent dental therapy was tooth extraction: removed infected teeth were substituted by prosthetic appliances - commonly, dentures or nothing. Most adults assumed becoming edentulous was a normal corollary of aging. With the discovery of penicillin and other antibiotics, healthcare professionals and policy makers predicted infectious diseases would become irrelevant. However, given numerous health threats, including SARS-CoV-2, HIV, multidrug-resistant bacteria, Zika virus, Ebola virus, and now monkeypox, public and professional awareness of transmissible infectious diseases has never been more evident. Ironically, little attention has been paid to unmet transmissible, infectious, common oral diseases - dental caries and periodontal diseases. Therefore, these persist within "the silent and invisible epidemic". The preventable death of a young boy in 2007 from an infected untreated tooth that produced bacterial meningitis is a profound reminder that our nation has vast inequities in education, health, and welfare. The impact of oral infections on hospital-acquired pneumonia, post-operative infection in cardiac valve surgery, and even academic performances of disadvantaged children displayed through sociodemographic characteristics and access to care determinants also are profound! This paper asserts that current and emerging ODC health knowledge and science will inform health policies and advance equity in access to care, affordable costs, and optimal healthcare outcomes. We recommend that legal and regulatory systems and public health programs be required to ensure health equity. A fair healthcare system that addresses holistic healthcare must be transparent, accessible, integrated and provide a standard of oral healthcare based upon scientific evidence for all people across the lifespan.
口腔、牙科和颅面(ODC)健康对人一生的总体健康和福祉有着深远影响,但美国的牙医和医生却在各自为政的孤立体系中开展工作。这种长期存在的分隔限制了人们获得最佳健康的机会,助长了按服务收费的模式,并加剧了健康差距。在20世纪初,最常见的牙科治疗是拔牙:拔除感染的牙齿后用假牙装置替代——通常是假牙,或者就不做处理。大多数成年人认为牙齿脱落是衰老的正常结果。随着青霉素和其他抗生素的发现,医疗保健专业人员和政策制定者预测传染病将不再构成威胁。然而,鉴于包括新冠病毒、艾滋病毒、多重耐药细菌、寨卡病毒、埃博拉病毒以及现在的猴痘病毒在内的众多健康威胁,公众和专业人士对可传播传染病的认识从未像现在这样明显。具有讽刺意味的是,人们很少关注未得到解决的可传播的常见口腔传染病——龋齿和牙周疾病。因此,这些疾病仍存在于“无声无形的流行病”之中。2007年一名小男孩因一颗未经治疗的感染牙齿引发细菌性脑膜炎而死亡,这一可预防的悲剧深刻提醒我们,美国在教育、健康和福利方面存在巨大的不平等。口腔感染对医院获得性肺炎、心脏瓣膜手术术后感染的影响,以及通过社会人口统计学特征和获得医疗服务的决定因素所显示的对弱势儿童学业成绩的影响也非常深远!本文认为,当前和新出现的ODC健康知识与科学将为健康政策提供信息,并促进在获得医疗服务、可承受的成本和最佳医疗结果方面的公平性。我们建议要求法律和监管体系以及公共卫生项目确保健康公平。一个解决整体医疗保健问题的公平医疗体系必须是透明的、可及的、综合的,并基于科学证据为所有年龄段的人提供口腔医疗保健标准。