Defining what oral health really means

By: Burton Edelstein

The current issue of the Journal of the American Dental Association features a commentary by ADA’s Editor and Senior Vice President for Science and Professional Affairs who assert that defining oral health is a “prerequisite for any health policy.” This claim is both insightful and challenging.

The claim is insightful because governmental policymakers have already shifted their focus from paying systems to deliver healthcare to incentivizing systems that can demonstrate their capacity to deliver improved health. This shift, described as moving payment from volume (measured as fees for services) to value (measured as health outcome per unit cost), has been described by McKessen Health Solutions as a “maelstrom of change,” noting that 90% of medical plans already pay medical providers a mix of value-based-purchasing incentives and fee-for-service.

... patients have come to expect that more dental care results inherently in better oral health outcomes.

The claim is challenging for dentistry precisely because the profession has yet to develop a value proposition for its services – a proposition based on its capacity to improve oral health in ways that are demonstrable, measurable, and meaningful to patients and populations. Because the profession has not previously been called upon to develop a formal approach to defining oral health, patients have come to expect that more dental care results inherently in better oral health outcomes.

We need to adopt measures that assess “oral health quality of life” rather than quality of restorations, essential care rather than elective care, and wellness rather than disease. Doing so will stimulate evolution of new and accountable dental care systems that manage oral health determinants and risks, further enhance the professional roles and responsibilities of dental professionals, and integrate oral health with general health.

After all, oral health is essential to overall health.

Burton Edelstein, DDS, MPH, is a board-certified pediatric dentist who founded the Children’s Dental Health Project in 1997. Dr. Edelstein has served children’s interests as a clinician, teacher, researcher, analyst, advocate, and policy expert. He previously practiced pediatric dentistry in Connecticut, and Dr. Edelstein is now Professor of Dentistry and Health Policy & Management at Columbia University.

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children ages 6-12 suffered a toothache in the previous six months.
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