Dominick P. DePaola

A national imperative: Oral health services in Medicare

Harold C. Slavkin, DDS; for The Santa Fe Group D ental benefits are not included in Medicare despite the reality that more Americans are living well beyond their 65th birthdays. In the United States, 10,000 people turn 65 every day, which drives the increasing cohort of seniors. Today, the number of seniors—47 million—essentially will double by 2050 according to demographers, and there is no doubt that oral health and general well-being are inextricably bound together. Many conditions that plague the body are manifested in the mouth, a readily accessible vantage point from which to view the onset, progression, and management of numerous systemic diseases. Periodontal diseases are generated by microorganisms that readily can enter the general circulation and cause bacteremia, resulting in adverse systemic effects that can promote conditions such as atherosclerosis. Study investigators assert that adverse cardiovascular effects from periodontal diseases are due to a few highrisk oral microorganisms associated with the pathogenesis of atherosclerosis via increased lipoprotein concentrations, endothelial permeability, and binding of lipoproteins in the arterial intima. In this guest editorial we assert that oral bacteria influence the pathogenesis of atherosclerosis and a number of other chronic degenerative diseases. We argue that sufficient scientific and health economic evidence support providing oral health benefits to older adults through the Medicare mechanism. Oral chronic degenerative diseases, such as periodontal diseases, often cause tooth mobility and tooth loss and serve as a portal for microorganisms, their by-products, and host-generated inflammatory mediators to enter the bloodstream, and they are associated with conditions in other parts of the body—pulmonary disease, type 2 diabetes, and cardiovascular diseases. Furthermore, periodontal diseases share genetically determined risk factors with other chronic degenerative diseases with an inflammatory response such as ulcerative colitis, juvenile arthritis, and systemic lupus erythematosus. These conditions are associated closely with increased production of proinflammatory cytokines that serve as indicators of susceptibility to severe chronic degenerative diseases. The same cytokines expressed in inflammation in type 2 diabetes, cardiovascular diseases, and obesity also are expressed within periodontal diseases. It is now evident that there is a confounding relationship among oral infections, host inflammatory response, and host genetic characteristics. Major scientific discoveries support the thesis that oral health care begins during prenatal care and extends over the human life span. Authors of a number of reports highlight significant benefits of prevention interventions in early childhood and thereafter. Despite these advances, according to