Reconnecting the Mouth to the Body of Public Health

This month’s cover image of children learning from their peers the proper way to brush their teeth was photographed in San Antonio, Texas, by Magda A. de la Torre, RDS, BS. A native of the border town of Eagle Pass, Texas, as a child she migrated north with her family to harvest crops of beets, cherries, and cucumbers. Ms. de la Torre, a dental hygienist for over 15 years, is completing her MPH at the Texas A&M School of Rural Public Health. She uses photography to connect to people, especially children, and to advance community, migrant worker, and oral health.

The focus on oral health is critical. Two research reports in this month’s Journal merit special attention. The first deals with children in a rural setting, while the second deals with adults in an urban community. Both document the pressing oral health needs of underserved populations. According to Dr. Mahyar Mofidi and his colleagues in North Carolina, dental disease is the most common health problem of children in the US, yet fewer than 1 of every 5 children enrolled in Medicaid use preventive services in a given year (page 53). The results of their focus groups with caregivers of Medicaid-insured children provide needed insight into the perceived barriers faced by some in obtaining dental care. Participants complained of excessive waits, demeaning interactions with front office staff, lack of time with dentists, and discrimination because of Medicaid. “You have to hold back your tears,” said one mother.

Dr. Georgina Zabos and her colleagues in New York City found that adults on Medicaid also are in dire need of preventive oral health care (page 49). Indeed, the most common self-reported health complaint among adults in Central Harlem was problems with their teeth or gums, with almost a third of respondents reporting problems. Dr. Zabos is working with others in Harlem to address the severe oral health needs of adults living with HIV/AIDS. At the Harlem United Community AIDS Center (Harlem United), a primary care team consisting of Dr. Zabos and other dentists, dental technicians, physicians, nurse practitioners, nutritionists, nurses, and others provide treatment education, adherence and nutritional counseling, primary health care, and preventive dental care. Services are designed to eliminate the barriers that adults living with HIV/AIDS experience when accessing health care. Harlem United has a single mission: to provide 100% access to care and achieve zero disparity in health outcomes caused by racial and economic barriers.

Finally, in their thoughtful commentary in this month’s issue, Dr. Stephen Beetstra and his colleagues in New Mexico call for creative, broad-based, and collaborative solutions to alleviate the pressing oral health needs in rural states (page 12). “Health commons sites” are enhanced, community-based, primary care practices that offer medical, behavioral, social, public, and oral health services. Such approaches respond to the Surgeon General’s call to “reconnect the mouth to the rest of the body in health policies and programs,” and may thus be able to overcome certain barriers that far too many of the public face in obtaining dental care.