Abstract

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. As a result, poor oral health serves as the national symbol of social inequality. 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. 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.

Highlights

  • The title of this review is key to understanding its scope

  • This inconsistency serves to underscore the difficulties faced in providing age-appropriate oral health care services to adolescents, who are confronted with critical life choices before they are developmentally and emotionally mature

  • This review has focused on US disparities in access to oral health care across the life course

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Summary

INTRODUCTION

The title of this review is key to understanding its scope. The importance of oral health cannot be overstated for physical, emotional, psychological, and socioeconomic well-being, at the individual level and at the interpersonal (e.g., family, friends), community, and societal levels [48, 89, 104, 130]. 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). The concluding section reaffirms previous calls to action for public health to claim oral health care as a social justice issue that merits concerted programmatic, research, and health policy support [128, 130, 133]

SEPARATE SYSTEMS OF ORAL HEALTH AND MEDICAL CARE PROVISION
CONCEPTUAL MODEL FOR CLOSING GAPS IN HEALTH CARE DISPARITIES
LIFE COURSE PERSPECTIVE ON ORAL HEALTH PROMOTION
Universal and Targeted General and Oral Health Interventions
Trajectories of Oral Health Development
REDUCING DISPARITIES IN ACCESS THROUGHOUT THE LIFE COURSE
Pregnancy
Infancy and Childhood
Adolescence
Adulthood and Older Age
CONCLUSIONS
Findings
DISCLOSURE STATEMENT

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