Healthy smiles, Healthy lives: The importance of integrating oral health and social drivers into community pediatrics
By: Arturo Brito, MD, MPH, President and CEO, CHF, and External Advisor, Delta Dental’s Driving Greater Diversity in the Oral Health Workforce Campaign; Chanya Holness, MPA, Senior Coordinator, Policy and Advocacy, Children's Health Fund (CHF); and Pernell Brice, III, MPA, Vice President, CHF
Deamonte Driver was only 12 years old when he began feeling ill from a “headache.” His grandmother drove him to the hospital, where they eventually discovered that it wasn’t a headache that was the cause of his pain, but a dental abscess. A couple of days later, Deamonte returned to the hospital, where doctors discovered that the bacteria in his abscessed tooth had spread to his brain. After six weeks in the hospital and two brain surgeries, Deamonte tragically passed away in February 2007. And just as tragic is the fact that it all could have been prevented.
No child — regardless of race, ethnicity, socioeconomic status, or geographic location — should ever die from an oral health issue. The only way to prevent the disproportionate burden of health and oral health inequities on under-resourced communities is to integrate oral and social drivers of health into pediatric healthcare. By utilizing a comprehensive approach, we create a future where all children have the opportunity to thrive and succeed regardless of their background.
Oral health is integral to a child’s overall health and well-being. However, far fewer children have access to a dental provider than to a pediatrician. In 2021, while 9 in 10 U.S. children had a routine well-child visit in the previous year, only half had seen a dentist.
According to the National Institutes of Health, dental caries (cavities) is the most common chronic disease amongst both children and adults in the United States—about five times more common than asthma in children and adolescents. Dental issues can lead to chronic pain, infection, and reduced ability to eat, speak, and thrive in social settings. Due to dental caries and other oral health challenges, children miss more than 51 million hours of school per year, on average. Thus, addressing oral health is not merely a dental concern; it is critical in ensuring a child’s development and future success.
Yet, oral health issues do not affect all children equally. American Indian and Alaskan Native children are the populations with the highest rates of dental caries in the United States. Black and Hispanic children two to eight years old experience dental caries at nearly twice the rate of white children of the same age range. Further, youth 12 to 19 years old who live in low-income communities experience untreated cavities (23%) at more than twice the rate of children and adolescents from higher-income households (11%).
But it does not have to be this way. Children have the best chance of being healthy when policymakers, advocates, providers, and other stakeholders pass policies and take action to integrate oral and social drivers of health into community pediatrics. Integrating oral health and social drivers of health into community pediatrics allows providers to gain a more comprehensive understanding of a child’s health. By collaborating with families, schools, social services, and community organizations, providers ensure children have the resources they need to support their health. Through this collaboration, dentists and medical providers can be better equipped to identify, manage, and prevent disease amongst their patients, address significant barriers to care, such as lack of child care, transportation, or insurance, and provide services that best suit their patients’ needs.
Pediatricians and dentists alike must look beyond clinic walls to understand the environments in which children live — and providers in Children’s Health Fund’s (CHF) national network do just that. At CHF, we lead a national network to bring comprehensive healthcare to children growing up in under-resourced communities. This includes integrating dental care and incorporating social drivers of health into community pediatrics, as is the practice of our partnering programs.
Our partners at the Southern Arizona Children’s Health Project and Idaho Children’s Health Project, for example, use mobile dental clinics for low-income children living in rural areas where transportation is particularly challenging. Both programs serve as patient-centered medical homes, providing primary care, mental healthcare, case management, health education, and telehealth services alongside dental care. Their patients are mostly living in low-income homes. Many are uninsured migrants. Uniquely, both programs have had great success using dental services to increase vaccine confidence and access for their patients, highlighting one way they practice integrative care.
This comprehensive approach not only serves to improve health outcomes but also to increase access to comprehensive medical, mental, dental, and other health services. By understanding the broader social context in which children live, providers and other stakeholders can better address health inequities and support children’s health and social needs. All children need and deserve to have their comprehensive health and social needs met in order to thrive and succeed. That is only possible when medical, mental, oral, and social drivers of health services are seen as the same side of the same coin.