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SDM faculty plays key role in Surgeon General's report

By Hope Green

If the prospect of bad teeth and bad breath isn’t enough to keep Americans brushing and flossing, a report released in May by U.S. Surgeon General David Satcher provides a new incentive. Poor oral health, it says, may contribute to other health problems, such as diabetes and heart disease. The report also reveals that about 108 million Americans, including more than half of all children in this country, lack dental insurance.

	Raul Garcia, chairman of the department of health policy and health services research at the Goldman School of Dental Medicine (SDM) (left), and Judith Jones and Aljernon Bolden, both SDM associate clinical professors of pediatric dentistry. Photo by Fred Sway

The Surgeon General’s report is the first ever on oral health, and it is a compendium on the subject, created by the country’s top dental professionals, including key contributions by BU faculty members.

Raul Garcia, chairman of the department of health policy and health services research at the Goldman School of Dental Medicine (SDM), and Steven Perlman, an SDM associate clinical professor of pediatric dentistry, helped edit the report. Two SDM associate professors of health policy and health services research, Judith Jones and Aljernon Bolden, contributed data. Bolden is also director of the school’s Community Health Programs.

“A lot of the key issues ad- dressed in the report are things that people at the dental school have been working on,” says Garcia. “One major area is how oral health affects the entire body.”

The report says that poor oral health can contribute to lung disease, stroke, and low birth weight among babies, as well as diabetes and heart disease. In a long-term study of patients at the Boston Veterans Administration (VA) Outpatient Clinic completed in 1998, Garcia and his colleagues discovered a potential link between gum disease and heart disease. Garcia suggested then that gum disease produces bacteria that may exacerbate arterial clogging if it enters the bloodstream.

“There is growing evidence that links poor oral health to all sorts of other bodily problems, but it’s an issue that few people know much about, and has been the subject of very few studies,” Garcia says. “We could make a dramatic impact on the nation’s public health by achieving good oral health.”

Another alarming aspect of the report concerns the widespread lack of access to dental care in this country. The problem extends to many working families, the report says, as Americans without dental insurance outnumber those without medical coverage by about two and one-half to one, and children lacking dental insurance are two and one-half times less likely to receive dental care than children with coverage.

“A lack of access to dental care is generally considered a poor peoples’ problem, which in many ways it is, because those who have no dental insurance are disproportionately of ethnic and racial minorities,” says Garcia. “But there are also many working families, many children, and many elderly who lack preventative care.”

Jones, who specializes in geriatric dentistry and is also a senior research associate at the VA Center for Health Quality Outcomes and Economics Research at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Mass., says dental insurance often stops at retirement. In many states, she adds, Medicaid funding for elders’ care is so paltry that dentists may get about a third to a half of what they get for treating a patient with private insurance. “What Medicaid pays doesn’t cover the costs dentists incur while providing treatment,” she says. “So there is a dramatic disincentive for dentists to treat them.” Jones currently is researching the potential link between gum disease and diabetes.

In industrial cities like Spring-field, Lawrence, or Haverhill, according to Garcia, Medicaid patients may have to travel to Boston to find a health center that will treat them. Satcher’s report found that this is also the case nationwide — 80 percent of children eligible for dental care under Medicaid don’t receive treatment, the report estimates, in part because few dentists will take them.

Bolden, who previously directed dental services for the nonprofit Boston Health Care for the Homeless, contributed to the report information about the obstacles homeless people face in receiving dental care. Garcia says that Satcher’s report should alert policy-makers to the importance of oral health, and make it easier for researchers to secure funds for future studies on the subject.

“The issue hasn’t been on anyone’s radar screen, partly because our society’s view has been that your mouth doesn’t relate to important things happening to the rest of your body,” he says. “That attitude is reflected in the way people get dental care and the fact that dental coverage is not an integral part of many health insurance plans. More employers need to offer dental coverage, and there needs to be more money put into Medicaid for dental care. In Massachusetts, those funds are pitifully small.”

14 July 2000
Boston University
Office of University Relations