Lakhasly

The Surgeon General’s 2000 Report notes that oral health is an essential component of the
general health and well-being of all Americans (1). Oral health influences productivity, quality
of life, and systemic health (2,3). Dental conditions such as periodontal (gum) disease, a source
of chronic infection and inflammation in the oral cavity, have been associated with
atherosclerosis, diabetes, adverse pregnancy outcomes, and increased risk of myocardial
infarction and stroke (1,4,5). This may be a result of common pathophysiologic pathways
involved in inflammation and altered host response (6). Tooth decay is the most common
chronic disease in childhood, occurring five to eight times more often than asthma (7,8).
Many oral health conditions can be detected early and are preventable with appropriate care
(9). However, researchers have identified dental care as the most frequently reported unmet
health need in national studies of both adult and youth populations (9,10). Although annual
dental examinations are an important form of preventive care, approximately 44% of
Americans lack dental insurance and may therefore experience difficulties accessing
nonemergency dental services (9,11). Researchers have also documented disparities in access
and use of dental care for rural populations (12-16). Compared to their urban counterparts,
rural residents of all ages are more likely to have unmet dental needs and to report that their
last dental visit was because something was “bothering or hurting” (13).
Healthy People 2010 objectives indicate a need to increase the proportion of adults who use
the oral health care system annually and to increase the proportion of low-income children and
adolescents who receive preventive dental services (3). The availability of dental providers
and primary care is associated with healthier teeth (17). Because of the linkage between oral
health and chronic illness, experts encourage collaborative approaches between dental
providers, public health, and other health care professionals to address oral health disparities
(18-22).
Many consider primary medical care as a venue for reaching children who do not traditionally
make dental visits (23,24). Primary care medical practices in rural Oregon communities report
few resources for patients presenting with dental health needs (25). Rural clinicians in our
primary care research network (the Oregon Rural Practice-based Research Network, ORPRN)
wanted to confirm their impression that many patients present to their practices with dental
health issues. In addition, local community leaders in medicine, dentistry, and public health
sought baseline data regarding the prevalence of unmet dental needs to determine how to best
address this local health concern.
We undertook this cross-sectional study to quantify unmet dental needs and oral health
conditions in a rural primary care practice. The study emerged as a community-based
participatory research project involving members of the county Community Health
Improvement Partnership (26), local medical and dental providers, and representatives from
two practice based research networks (PBRNs) at Oregon Health & Science University
Davis et al. Page 2
J Am Board Fam Med. Author manuscript; available in PMC 2010 November 22.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
(OHSU). One PBRN focused on oral health (PROH – Practice-based Research in Oral Health)
and the second on rural primary care (ORPRN). Though an increasing body of literature is
exploring pediatric partnerships to address childhood oral health, there is little work addressing
the prevalence of oral health conditions among all patients presenting to a family medicine
practice for routine medical care (22,27-30). We hypothesized that there would be a high
prevalence of dental conditions and unmet dental needs as identified by family physicians in
routine primary care practice. We also hypothesized that the conditions would be distributed
in predictable ways, with caries most common in children, and varying degrees of edentulism
most common in the elderly