Oral Health is a Women’s Health Issue

Oral health is essential to a woman’s health through her lifespan and particularly during pregnancy. But far too many women —even pregnant women — lack access to comprehensive and affordable dental insurance. Receiving regular dental care is even more difficult for low-income women and women of color.

Women and Oral Health

Women face unique risks for oral health problems that can undermine their general health and pregnancy. Fluctuating sex hormone levels during the menstrual cycle, pregnancy, and menopause, as well as from oral contraceptive use, can lead to severe gum disease.[1],[2] Morning sickness and acid reflux can also break down the protective barrier against tooth decay. [3] Common oral health problems during pregnancy include cavities, loose teeth, gum disease, and pregnancy oral tumors.[4] A growing body of research has confirmed that severe gum disease increases the likelihood of preterm birth and low birthweight.[5],[6] Oral health problems can also increase the risk of other health problems for women, including diabetes,[7] heart disease,[8] Alzheimer’s disease,[9] pneumonia and chronic obstructive pulmonary disease,[10] and osteoporosis.[11]

Disparities in Women’s Oral Health Access

Many women in the United States often go without necessary dental care. Having trouble getting to or affording dental care isn’t an isolated problem. It is connected to and made worse by other access challenges, such as finding transportation, taking time off work, and arranging childcare. These barriers widen disparities in oral health and general health.

  • In 2016, about 12 percent of women across all ages reported an unmet dental need due to cost.[12]
  • From 2011–2014, approximately 30 percent of women aged 20–44 years, 23 percent of women aged 45–64 years, and 19 percent of women aged 65 years and over reported having untreated cavities.[13]
  • From 1999–2004, for both pregnant and nonpregnant women, women of color and women with low incomes or less education were less likely to report visiting the dentist in the previous year. [14]
  • In 2004–2006, Hispanic and non-Hispanic black women were less likely to report receiving dental care during their pregnancy and to report ever receiving a teeth cleaning, even after accounting for differences in age, income, education, insurance status before pregnancy, adequacy of prenatal care and smoking.[15]

Policy Landscape of Oral Health Access

While the Affordable Care Act (ACA) has significantly increased health care access, it has not achieved similar progress in oral health care access. The ACA has led to a big drop in the uninsured rate among women — from 18 percent in 2013 to 12 percent in 2017.[16] Despite the efforts of health activists, the ACA did not make comprehensive dental coverage an essential health benefit for adults.[17] In 2014, about 13 percent of nonelderly adults had no health insurance compared to 35 percent of nonelderly adults who lacked dental insurance.[18],[19]

States could do more to expand dental coverage through Medicaid, but without a federal mandate to do so, they haven’t. Only 17 states offer comprehensive dental benefits to Medicaid enrollees. [20] Some states offer comprehensive dental benefits to pregnant women, but women also need dental coverage before and after their pregnancy.

Given the pervasive barriers to dental care for people with low incomes, state efforts are not enough to close disparities in oral health access.

  • Nearly 63 million people live in more than 5,800 dental health professional shortage areas across the country.[21]
  • Relatively low dentist participation in Medicaid makes it even more challenging for Medicaid enrollees to obtain dental care. As of 2015, approximately 38 percent of dentists accept Medicaid or the Children’s Health Insurance Program.[22]
  • In 2014, only 7 percent of adult Medicaid enrollees had dental benefits compared to 58 percent of privately insured adults. [23]

The stark disparity in dental coverage and use between Medicaid and private insurance reveals an unjust reality. Not only are individuals without the means to pay unable to access dental care, they are also less likely to receive financial assistance to do so.

Time to Reunite the Mouth with the Rest of the Body
The growing evidence makes clear that the U.S. health care system can no longer care for a person’s teeth separately from the rest of the body. Now is the time to advocate for affordable and comprehensive dental coverage. Dental care is health care.

 

[1] Mariotti, A., & Mawhinney, M. (2013). Endocrinology of sex steroid hormones and cell dynamics in the periodontium. Periodontology 2000, 61(1) 61-98. https://doi.org/10.1111/j.1600-0757.2011.00424.x

[2] Martelli, M.L., Brandi, M.L., Martelli, M., Nobili, P., Medico, E., & Martelli, F. (2017). Periodontal disease and women’s health. Current Medical Research and Opinion, 33(6), 1005-1015. https://doi.org/10.1080/03007995.2017.1297928

[3] Silk, H., Douglass, A.B., Douglass, J.M., & Silk, L. (2008). Oral health during pregnancy. American Academy of Family Physicians, 77(8)1139-1144. https://www.aafp.org/afp/2008/0415/p1139.html

[4] Silk, H., Douglass, A.B., Douglass, J.M., & Silk, L. (2008). Oral health during pregnancy. American Academy of Family Physicians, 77(8)1139-1144. https://www.aafp.org/afp/2008/0415/p1139.html

[5] Corbello, S., Taschierri, S., Fabbro, M.D., Francetti, L., Weinstein, R., & Ferrazzi, E. (2016). Adverse pregnancy outcomes and periodontitis: A systematic review and meta-analysis exploring potential association. Quintessence International Periodontology, 47(3), 193-204. https://doi.org/10.3290/j.qi.a34980

[6] Papanou, I. M., (2013). Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes — systematic review. Journal of Clinical Periodontology, 40(Suppl. 14), S181–S194. https://doi.org/10.1902/jop.2013.134009

[7] Gurav, A., & Jadhav, V. (2011). Periodontitis and risk of diabetes mellitus. Journal of Diabetes, 3(1), 21-28. https://doi.org/10.1111/j.1753-0407.2010.00098.x

[8] Dietrich, T., Webb, I., Stenhouse, L., Pattni, A., Ready, D., Wanyonyi, K.L., White, S., & Gallagher, J.E. (2017). Evidence summary: the relationship between oral and cardiovascular disease. British Dental Journal, 222, 381–385. https://doi.org/10.1038/sj.bdj.2017.224

[9] Teixeira, F.B., Saito, M.T., Matheus, F.C., Prediger, R.D., Yamada, E.S., Maia, C.S.F., & Lima, R.R. (2017). Periodontitis and Alzheimer’s disease: A possible comorbidity between oral chronic inflammatory condition and neuroinflammation. Frontiers in Aging Neuroscience, 9(327). https://doi.org/10.3389/fnagi.2017.00327

[10] Bansal, M., Khatri, M., & Taneja, V. (2013). Potential role of periodontal infection in respiratory diseases-a review. Journal of Medicine and Life, 6(3) 244–248. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786481/

[11] Choi, J.K., Kim, Y.T., Kweon, H.I., Park, E.C., Choi, S.H., & Lee, J.H. (2017). Effect of periodontitis on the development of osteoporosis: results from a nationwide population-based cohort study (2003-2013). BMC Women’s Health, 17(77). https://doi.org/10.1186/s12905-017-0440-9

[12] National Center for Health Statistics. (2016). National Health Interview Survey. Table A-19a. Age-adjusted percent distributions (with standard errors) of unmet dental need due to cost in the past 12 months and of length of time since last visit with dentist or other dental health care professional among adults aged 18 and over, by selected characteristics: United States, 2016. Retrieved from https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2016_SHS_Table_A-19.pdf

[13] National Center for Health Statistics. (2017). Health, United States, 2016: With Chartbook on Long-term Trends in Health. Table 60. Untreated dental caries, by selected characteristics: United States, selected years 1988–1994 through 2011–2014. Retrieved from https://www.cdc.gov/nchs/data/hus/hus16.pdf#060

[14] Azofeifa, A., Yeung, L.F., Alverson, C.J., & Beltrán-Aguilar, E. (2014). Oral health conditions and dental visits among pregnant and nonpregnant women of childbearing age in the United States, National Health and Nutrition Examination Survey, 1999–2004. Preventing Chronic Disease, 11(E163), 1–10. https://doi.org/10.5888/pcd11.140212

[15] Hwang, S.S., Smith, V.C., McCormick, M.C., & Barfield, W.D. (2011). Racial/ethnic disparities in maternal oral health experiences in 10 states, pregnancy risk assessment monitoring system, 2004–2006. Maternal and Child Health Journal, 15(6), 722–729. https://doi.org/10.1007/s10995-010-0643-2

[16] Kaiser Family Foundation. (2018). Women’s Coverage, Access, and Affordability: Key Findings from the 2017 Kaiser Women’s Health Survey. Retrieved from https://www.kff.org/womens-health-policy/issue-brief/womens-coverage-access-and-affordability-key-findings-from-the-2017-kaiser-womens-health-survey/

[17] 42 U.S.C. § 18022(b)(1)(J)

[18] Kaiser Family Foundation. (2018). Uninsured rate among the nonelderly population, 1972–2017. Retrieved from https://www.kff.org/uninsured/slide/uninsured-rate-among-the-nonelderly-population-1972-2017/

[19] Nasseh, K., & Vujicic, M. (2016). Dental benefits coverage increased for working-age adults in 2014. American Dental Association. Health Policy Institute. Retrieved from https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1016_2.pdf?la=en

[20] Center for Health Care Strategies, Inc. (2018). Medicaid adult dental benefits: An overview. Retrieved from https://www.chcs.org/media/Adult-Oral-Health-Fact-Sheet_011618.pdf

[21] Kaiser Family Foundation. (2017). Dental care health professional shortage areas (HPSAs) [As of December 31, 2017]. Retrieved July 19, 2018 from https://www.kff.org/other/state-indicator/dental-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[22] American Dental Association Health Policy Institute. (2017). Dentist Participation in Medicaid or CHIP. Retrieved from http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIGraphic_0217_1.pdf?la=en

[23] Nasseh, K., & Vujicic, M. (2016). Dental benefits coverage increased for working-age adults in 2014. American Dental Association. Health Policy Institute. Retrieved from https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1016_2.pdf?la=en