The challenge of creating an integrated system of oral health and primary care delivery with a focus on equity of services is then critically considered ( 13), along with the policy implications to address this challenge that would entail in the US context ( 89). The following section introduces the life course perspective ( 14, 15), which serves as an organizing framework for the subsequent section that details strategies to reduce disparities in access to oral health care from pregnancy through older adulthood ( 99). Then, a conceptual model for understanding factors that influence disparities in access to care and quality of health care services, by level, is presented ( 115), along with applications to oral health care per se ( 44, 58, 98, 101). Moreover, this history forms the background of current disparities and thus is briefly reviewed next ( 89). This review is restricted largely to the United States, as the historical and continued separation of the oral health care delivery system from the medical care delivery system in this country is comprehensive and reinforced by the fact that dentists, dental hygienists, and dental assistants are separated from other health care professionals in virtually every way: where they are trained, how their services are reimbursed, and where they provide oral health care ( 13, 96 see the sidebar titled Oral Health Services Provision Worldwide). Moreover, the incidence of oropharyngeal cancer related to infection with human papillomavirus (HPV) is rising, making it now the most common HPV-related malignancy in the United States, with no approved approaches for prevention and early detection of the disease ( 126). Nevertheless, the US oral health care delivery system has failed to protect vulnerable populations from dental caries (i.e., tooth decay or cavities) and periodontal disease (i.e., an inflammatory condition that affects the soft and hard tissues that support the teeth), which consistently remain among the most prevalent of all chronic diseases over time, despite being largely preventable ( 65, 66, 89). ![]() ![]() Disparities need to be more fully investigated in all aspects of oral health care, including the allocation of resources for oral health care ( 11, 66), the actual receipt (utilization) of oral health care services ( 95, 139), the quality of oral health care services ( 31, 32, 34), the oral health care workforce ( 90, 125), and the financing of oral health care, particularly with respect to the burden of payment on individuals and households ( 9, 65, 66, 132, 138, 142).Ĭommunity water fluoridation is rightfully considered one of the greatest disease-preventive measures of the twentieth century ( 25, 63, 91). While the imperative to eliminate disparities in oral health has long been recognized ( 65, 66, 132), the vital role of access to quality oral health care for people who are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations has heretofore received insufficient attention in the public health literature ( 23, 37, 77, 129). Disparities in oral health care are differences that are both unnecessary and avoidable and also considered unfair and unjust ( 16, 17, 132, 146, 147 see the sidebar titled Oral Health Care Disparities and Equity in Oral Health Care). The importance of oral health cannot be overstated for physical, emotional, psychological, and socioeconomic well-being, not only at the individual level but also at the interpersonal (e.g., family, friends), community, and societal levels ( 48, 89, 104, 130). The title of this review is key to understanding its scope. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. As a result, poor oral health serves as the national symbol of social inequality. In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care.
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