Oral health affects more than just your mouth. Untreated oral disease is a common ailment that increases the risk and severity of chronic illness. Per the National Institute for Health Care Management (NIHCM) Foundation, one in four adults and one in five children under age 11 have untreated cavities. Almost half (46%) of adults over age 30 have gum disease, also known as periodontal disease or periodontitis, a condition that forms when food particles and plaque – a bacteria-laden sticky film – are left to build up on teeth and gums, causing the gums to become swollen, inflamed, and bleed. If left untreated, this inflammation can lead to gum recession (when the gum tissue pulls away from teeth, exposing the roots underneath) and loss of teeth.

Oral health impacts the entire body

The mouth is the gateway to the rest of the body. An infection in the mouth can seep into the bloodstream and spread to other organs throughout the body. Poor oral health can contribute to multiple diseases and conditions, including:

Endocarditis. This heart infection is caused by bacteria and germs from another part of your body, including your mouth, entering the bloodstream and settling in the heart lining (endocardium), valves, or blood vessels.
Cardiovascular disease. Although the connection is not definitively determined, some research suggests gum disease may be a risk factor for heart disease by increasing the body’s burden of inflammation. While acute inflammation is the body’s normal immune response to defend against attacking microbial invaders, long-term chronic inflammation is a culprit in many heart problems, especially atherosclerosis, which can lead to stroke and heart attack.
Alzheimer’s disease. Some studies have suggested inflammation could also serve as a connecting link between poor oral health and Alzheimer’s disease, as inflammation is known to play a role in the development of both diseases.
Pregnancy and birth complications. Periodontitis has been linked to an increased risk of adverse pregnancy outcomes, including gestational diabetes, preterm birth, and low birth weight.
Respiratory disease. Bacteria in your mouth can be aspirated (pulled) into the lungs, causing pneumonia and chronic obstructive pulmonary disease.
Mouth and throat cancer. It is estimated that 30,000 Americans per year are diagnosed with oral or pharyngeal cancer, with approximately 7500 of them dying.

It’s a two-way street, too. Many chronic conditions can worsen periodontal disease, including:

Diabetes. Diabetes reduces the body’s resistance to infection, which can put your gums at risk. It also affects your saliva by increasing glucose in saliva and feeding the bacteria that form plaque.
HIV/AIDS. Human immunodeficiency virus contributes to oral problems, such as painful mouth sores (canker sores, cold sores, and fever blisters) and the fungal infection thrush (candidiasis).
Osteoporosis. Osteoporosis occurs when bone tissue, including the teeth and jaw, thins, weakens, and is absorbed by the body, which can cause periodontal bone loss and tooth loss.
Alzheimer’s disease. Oral hygiene habits often decline as Alzheimer’s disease progresses.

How to prevent gum disease

According to the National Institute of Dental and Craniofacial Research, keep your teeth and gums healthy by:

Brushing your teeth twice a day with a fluoride toothpaste.
Removing plaque from between your teeth after every meal using dental floss, a between-the-teeth (interdental) brush, a wooden toothpick or plastic pick, or a water flosser.
Quitting smoking.
Visiting the dentist routinely for a check-up and professional cleaning.

Barriers to adequate oral health care

While regular care of teeth and gums is vital to maintaining oral health and preventing systemic complications as described above, rural residents often lack adequate oral health care for many reasons, as outlined in a December 2018 policy brief, “Improving Oral Health Care Services in Rural America,” by the U.S. Department of Health and Human Services.

A shortage of dentists and difficulty finding providers willing to treat patients covered by Medicaid contribute to rural residents’ challenges in accessing oral health care. According to 2020 data, Kansas and Missouri rank 37 and 38 out of the 50 states for average patient-to-dentist ratio. While the nationwide average is one dentist for every 1538 people, Kansas and Missouri residents have larger groups – 300 more people per group – attempting to access a single dentist than the national average (Kansas has one dentist for every 1820 people; Missouri has one dentist for every 1858 residents). One in five people in rural areas do not feel their community has enough dentists. Additionally, Americans living in rural counties tend to have higher poverty rates and are more likely to qualify for Medicaid; however, there is no federal requirement for Medicaid to cover adult dental services, so it may be challenging to find dentists who will accept patients with Medicaid insurance.

Transportation to the dentist and the distance required to get there can be another stumbling block to receiving consistent oral care for rural residents. On average, rural residents drive 23 minutes to reach a general dentist, compared to 18 minutes for suburban and city dwellers. Visits to specialists like orthodontists and oral surgeons require an even longer commute: 37 minutes from rural communities compared to 25 minutes for urban/suburban residents.

Tobacco use is associated with multiple adverse oral health outcomes, and rural residents are more likely to use tobacco in all forms. Data from the 2021 National Survey on Drug Use and Health indicate that 28.9% of rural adults over age 18 smoke cigarettes compared to 20.3% among the general adult population. Smokeless tobacco (“chew” or “dip”) use in rural adults was more than double (7.5%) that of the general population (3.7%). Electronic nicotine delivery systems (e-cigarettes or “vapes”) found the slightest rural-urban difference, with 2.8% of rural residents and 2.1% of urban residents currently using e-cigarettes, according to a 2020 study. Per a 2022 JAMA Network study, cigarette use and vaping contribute to loose teeth, gum bleeding, and loss of teeth. Per the Centers for Disease Control and Prevention, smokeless tobacco (“chew” or “dip”) can cause cancer of the mouth, esophagus, and pancreas.

Drinking from community water sources with fluoride added is a well-established method of oral care. This practice has reduced cavities in both children and adults by about 25%, according to the Centers for Disease Control and Prevention. However, residents in sparsely-populated regions of the country with no access to community water systems, who must rely on well water for their drinking water, do not benefit from this vital infrastructure classified as one of the ten great public health achievements of the 20th century.

An individual’s level of health literacy can be a strong predictor of behavior and the quality of health outcomes. The American Dental Association defines oral health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions.” Lower health literacy leads to a lack of utilization of preventive services, delayed diagnoses, nonadherence to medical instruction, poor health outcomes, and higher health care costs. A 2009 study found that health literacy is lower among rural populations, though a 2020 study concluded that “rurality alone does not explain rural-urban health literacy differences and that sociodemographic factors play important roles.”

How to improve barriers to care

The Healthy People 2020 Law and Health Policy Project outlines several measures to improve oral health access nationwide. Decreasing financial barriers to care is essential, as affordability is often a primary determinant of whether individuals can utilize the oral health care system.

Several public programs make provision for the oral care of children. Medicaid is the most common form of public insurance, and states are mandated to cover oral care for children under 21 who are on the program. The Children’s Health Insurance Program (CHIP) provides health insurance coverage for kids under age 19 with family incomes too high to qualify for Medicaid. The Indian Health Service also has oral care programs for American Indian and Alaskan Native children.

However, public coverage of oral care for adults is much more limited. As of 2019, only 34 states cover dental services beyond emergency care for adults (including Kansas and Missouri). Twelve states cover only emergency dental services, and four offer no dental benefits through Medicaid. In addition, Medicare – the federal health insurance program for people 65 and older – excludes most oral care services for adults. Widening income disparities coupled with an increasingly aging population mean that many uninsured patients will continue to fall through the cracks without a governmental safety net program that includes oral health care benefits for adults.

Other objectives of the Healthy People 2020 program related to oral health include:

Increasing the number of dental care workers (dentists and hygienists, physicians, and nurses) through federally funded training programs.
Employing dentists to care for underserved populations through agencies such as Indian Health Services and encouraging dental providers to practice at federally qualified health centers (FQHCs) to reach low-income patients better.
Authorizing nontraditional providers such as primary care physicians, pharmacists, and community health workers to collaborate with dentists and hygienists to provide a comprehensive oral health care system.
Addressing the issue of transportation burdens for rural residents by expanding teledentistry. It’s also important to note that Medicaid covers transportation to medical appointments, including dentist appointments, and states are responsible for ensuring that Medicaid recipients have necessary transportation arrangements. This can include reimbursing mileage, cost of lodging and meals, or contracting with taxis and transportation companies.
Implementing culturally competent care through training in cultural sensitivity, using plain, easily understood language, and providing interpretation services.

Find a Medicaid dentist in your area:
Kansas (KanCare): https://www.oralhealthkansas.org/KanCare.html
Missouri (MO HealthNet): https://health.mo.gov/living/families/oralhealth/low-cost.php