Dental Health and Social Work: Is Oral Health a Social Justice Issue?

by Amr A. Azhari, DDS, ABD, CAGS, MSBI

     Through the years, the perception of oral health has undergone many changes. Recently, the term oral health has broadened beyond being viewed simply as the absence of diseases in the oral cavity and the teeth. It is now included as an indication of general health and well-being. Based on this definition, dental health is significant because it presents as essential to physical, psychological, and social wellness (Chávarry et al., 2009; Petersen, 2009).

     Moreover, evidence from population-based studies increasingly points to a connection between oral health status and profound physical, mental, and psychosocial effects (Arunkumar et al., 2015; Yap, 2017). In fact, oral diseases are linked to overall general health (Kane, 2017). The consequences of missing teeth (Xie & Ainamo, 1999) and the accumulation of bacteria in the mouth resulting from poor oral hygiene can significantly impact the general health of individuals (Kane, 2017; Petersen, 2008). For instance, such conditions can lead to an increased risk of diabetes, nutritional deficits, and cardiovascular diseases. Also, poor dentition, such as missing, discolored, or broken teeth, can create related behavioral, cognitive, and social problems, such as depression, low self-esteem, self-consciousness, unemployment, chronic pain that can lead to addiction, social anxiety, stigma, and shame (Northridge et al., 2017).

     Although increasing evidence demonstrates a link between oral and systemic medical health, oral health care is less available and accessible than physical health care (Taylor et al., 2014). Identified barriers to oral hygiene, such as lack of knowledge about its importance, fear, and unavailability of affordable quality dental care, leave a significant portion of individuals in the U.S with unmet oral health needs (Bloom et al., 2010; Edelstein & Chinn, 2009).

     The Grand Challenges for Social Work identified priorities for social justice in the 21st century, and among them is the need to reduce health disparities and increase access to medical care and disease prevention (Barth et al., 2014). Although debates about affordable and accessible health care dominate the political discourse, little attention is paid to dental care as part of the health service spectrum. Social workers are unique in addressing oral health inequities as a social injustice and ensuring that marginalized and impoverished Americans receive services and advocacy (MacDougall, 2016).

     Social work practitioners are uniquely positioned to provide health promotion, preventive information dissemination, and resource identification as part of their role with organizations that serve vulnerable populations, marginalized groups,  and impoverished communities. Social work practitioners have unique capabilities to communicate the importance of oral health by focusing on it as part of the biopsychosocial continuum of assessment and routinely providing resources for care. Since many social workers, dentists, and health care professionals have mutual clients, it is crucial to understand the connection between oral health, mental health, and general health. Social workers can partner with dentists to provide clients with the tools (knowledge, access, and resources) to take responsibility for their oral health.

     Finally, attention to oral health care has implications for preventing chronic disease and disability, improving mental health, and reducing health care costs. The inclusion of a focus on oral health by social work practitioners is consistent with social work's mission, and thus, should feature more prominently in social work practice and education. Social justice advocacy should include working collaboratively with allied professionals and lawmakers to improve access to affordable quality dental care as part of a wholistic effort to enhance primary prevention and biopsychosocial wellness.

References

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Bloom, B., Cohen, R. A., & Freeman, G. (2010). Summary health statistics for US children: National Health Interview Survey, 2009. Vital and health statistics. Series 10, Data from the National Health Survey(247), 1-82.

Chávarry, N. G. M., Vettore, M. V., Sansone, C., & Sheiham, A. (2009). The relationship between diabetes mellitus and destructive periodontal disease: a meta-analysis. Oral health & preventive dentistry, 7(2).

Edelstein, B. L., & Chinn, C. H. (2009). Update on disparities in oral health and access to dental care for America's children. Academic pediatrics, 9(6), 415-419.

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MacDougall, H. (2016). Dental disparities among low-income American adults: A social work perspective. Health & Social Work, 41(3), 208-210.

Northridge, M. E., Estrada, I., Schrimshaw, E. W., Greenblatt, A. P., Metcalf, S. S., & Kunzel, C. (2017). Racial/ethnic minority older adults’ perspectives on proposed Medicaid reforms’ effects on dental care access. American Journal of Public Health, 107(S1), S65-S70.

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Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298.

Xie, Q., & Ainamo, A. (1999). Association of edentulousness with systemic factors in elderly people living at home. Community Dentistry and Oral Epidemiology, 27(3), 202-209.

Yap, A. (2017). Oral health equals total health: A brief review. Journal of Dentistry Indonesia, 24(2), 59-62.

Dr. Amr Azhari was born in the United Kingdom and grew up in Jeddah, Saudi Arabia. He attended dental school at King Abdulaziz University, SA, and graduated in the top five of his class. Dr. Azhari completed a three-year training in the postgraduate operative dentistry residency program and held a Master of Biomedical Informatics degree from Nova Southeastern University, USA. He also achieved the highest honors and received the outstanding award for the Class of 2016. Currently, Dr. Azhari has chosen to enhance his professional work as a dentist by becoming a social work doctoral student at Barry University to help social workers in oral health assessment, promotion, and advocacy. Dr. Azhari would like to acknowledge his faculty mentor, Dr. Jill Levenson.