Up to one-third of Americans, including college-age students, lack access to oral health services.33 Use of annual dental services, including school-based care, significantly reduces young adults’ risk for tooth loss.34 From early adulthood on, poor dental health is associated with cardiovascular and respiratory disease, cerebral ischemia, diabetes, difficulty with chewing and oral pain, and poor self-image.24
PCPs should emphasize the importance of preventive services as they examine the oral structure during routine health care encounters. Adding the question, “When did you last have a dental exam?” can launch an effective discussion about the importance of good dental health.
Tooth surfaces with pits and fissures are the most vulnerable to decay. Dental sealants can protect these vulnerable areas, reducing decay by 60% to 82%.2,32,35 Sealants are the most effective preventive measure for reducing cavity formation; they are not harmful to fillings and can actually reduce the progression of decay when applied over small existing carious lesions.35 Currently, however, only 30% and 38% of children and adolescents, respectively, have undergone application of sealants.36 Thus, it is vital for PCPs to recommend dental sealants to all their patients.35,37,38
Young adults should also be questioned about their exercise patterns. While daily exercise is of benefit to good health, young adults who engage in too-frequent, overly vigorous exercise have been found vulnerable to dental erosion.39 This irreversible condition can result from the rapid breathing, sweat-induced dehydration, and decreased salivary flow associated with strenuous exercise. Reduced salivary flow disrupts the protection against erosive acids afforded by bathing of teeth with saliva, leading to a fivefold greater risk for developing erosions. Patients should be encouraged to hydrate before exercise to reduce these risks.39
Dental Health Notes for Young Women
For female patients of childbearing age like Breanne, dental health is important not only for the patient, but for her future children as well. Poor maternal dental health has been associated with preterm births and low birth weights.40-43 Women who have health insurance, who are in good general health, and who regularly visit a primary care medical provider are also the most likely to see a dental care provider during pregnancy.40
Pregnancy is associated with a risk for poor dental care in any population.42,44 During pregnancy, Medicaid-enrolled women are 30% less likely to see a dentist than women with private health insurance, and women with no health insurance are 70% less likely to see a dentist.44 Among pregnant women who experience a dental problem, less than half will schedule a dental appointment. Postponing dental care till after delivery incurs additional risk, as the new mother will be busy with her child and may have lost her health care coverage in the interim.
Dental concerns commonly encountered during pregnancy are listed in Table 3.41,42 There is also evidence that maternal transmission of mutans streptococci can lead to early childhood caries,42,45 further highlighting the importance of dental care during pregnancy (eg, use of chlorhexidine rinses in pregnant women with dental caries42). The association between periodontal disease and preterm delivery and lower birth weights40-43 makes it critical to reduce maternal periodontal inflammation through timely dental referrals.
SAUL, AGE 42
Saul, a lifelong resident of Mississippi, has worked in construction since age 18. He has never had health or dental insurance and thus he rarely seeks preventive services. As he recalls, he has had “two fillings in my jaw teeth since I was a kid,” but otherwise has had no dental care. He brushes daily to avoid having to see a dentist. He is presenting today as a new patient only because he has a rash.
SAUL, AGE 42