Recently I attended a social event where I was asked why I reversed from 4 days a week of clinical practice and 1 day of academia to 4 days of academia and 1 day of clinical practice – a decision I made almost 10 years ago. I began to answer with “I reduced my days of practice because…” and a fellow guest completed my sentence for me – “…..because it’s just teeth! It must have got boring.”
Dear Guest, it isn’t just about teeth and that isn’t why I moved into academia. It was a growing recognition of how complex and nationally important oral health is, and my interest to contribute to research and policy that would change the nation’s healthcare system for the better. Nobody seems to know the current research that is in conflict with the “just teeth” argument! Nobody seems to know that, when periodontal disease is uncontrolled, a stem cell transplant has hospital charges $85,991 more than when periodontal disease is controlled. Nobody seems to know that when gingival disease is treated, a patients’ annual diabetic costs reduce by $2,840; a patients’ stroke costs reduce $5,681; and a patients’ pregnancy complication costs reduce $2,433. Nobody seems to know that when periodontal disease is controlled, cardiac valve surgery is more successful and associated with hospital charges that are $26,000 less.
In fact, nobody seems to know that about 1.4 million emergency room visits per year are due to common dental problems and incur hospital charges of about $1 billion. Moreover, about $1.2 billion of hospital charges are incurred when 51,000 of those 1.4 million get hospitalized with an average length of stay of 3.44 days – remember, they came to hospital with “just” a dental problem. And it should be recognized this does not include oral cancer or trauma – this is just caries, pulpal disease, periodontal disease or resultant cellulitis. If you’re interested to know, there is another 17,000 hospitalizations per year for oral cancer with hospital charges of over $1 billion. And, jaw fractures result in about 22,000 fracture reduction procedures in US hospitals with charges of another $1 billion.
It’s not “just” all of the above either – we have found that obesity increases hospital charges among those who were hospitalized for a dental condition. And the presence of mental health conditions increases hospital charges for those attending the hospital with a dental condition. To summarize, we have underestimated the impact of oral health on the human body and the healthcare system. Oral disease is increasing the hospital complications in non-oral surgeries, reducing their success rates and increasing length of stay. And it’s all attributable to the same problem as the dinner guest – we didn’t know any better.
Society has pigeon holed dentistry much to it’s own detriment. It’s difficult for society to think about oral health in terms other than “just teeth,” but, failing to evolve society’s understanding of the importance of oral health will worsen the health of our nation and the efficiency of our healthcare system.