Harlem adult residents say they suffer more from oral health problems than other medical complaints, such as asthma, diabetes and hypertension, according to a study by researchers at Columbia University's School of Dental and Oral Surgery and Mailman School of Public Health
The study, led by Georgina Zabos, DDS, MPH, assistant professor of clinical dentistry and health policy and management, found that 30 percent of the 695 Harlem residents surveyed indicate they suffer from problems with their teeth and gums - the No. 1 complaint among 50 common health conditions listed in the questionnaire. The results are published in the January issue of the American Journal of Public Health.
"The results of this study are surprising, given that adults in Harlem suffer from higher rates of cancer, cardiovascular disease, and HIV/AIDS," says Dr. Zabos. "Very little is known about the prevalence or impact of oral diseases in the population. Clearly, further study is warranted."
The Harlem Health Promotion Center, a joint project of Harlem Hospital Center, the Mailman School of Public Health, and the Centers for Disease Control and Prevention, conducted the Harlem Household Survey between 1992 and 1994 to better understand and address the health problems of adult residents of Harlem.
Trained community residents interviewed 695 adults between the ages of 18 and 65 using a structured questionnaire. Participants indicated if they had experienced any of 50 common symptoms or health conditions on the list in the past 12 months. For each condition identified, participants were asked if they had obtained medical treatment.
More respondents reported oral health problems than other health concerns. Twenty seven percent cited hypertension as a complaint during the study time period. Diabetes ranked lowest with 7 percent indicating the disorder as a problem. It is important to note that while diabetes and hypertension ranked lower than oral health problems, they are nonetheless high for adults of this age group.
Of those who reported suffering from dental problems, one third did not receive care. The researchers suggest the high rates of unemployment, lower household income, and lack of health insurance prevalent in this population may have prevented residents from affording dental care.
Those with public insurance, such as Medicaid, were only slightly more likely to obtain care than participants without insurance, in spite of the fact that Medicaid provides comprehensive dental benefits to adults. The authors feel it is likely that access to care is limited for residents with public insurance, because most private practitioners do not accept Medicaid and those institutions providing treatment for the insured and uninsured are overburdened with too many patients resulting in long waiting times and waiting lists for services.
"Regardless of insurance status, lack of available and accessible care is the largest part of the problem for Harlem residents," says Dr. Zabos, who has maintained a clinical practice in Harlem for the past eight years. "Even though the study was conducted almost a decade ago, conditions have not changed."
The authors also note that older participants in the survey were as likely to report dental problems as younger ones, which seems surprising given that the prevalence of dental caries and periodontal disease increases as people age. They theorize that in Harlem, living with many diseases from an early age becomes the norm, and therefore older residents do not report more oral health problems than younger residents.
Columbia University School of Dental and Oral Surgery helps operate primary care facilities in central Harlem and east Harlem through its community-based DentCare program. A third medical and dental primary care facility will open this spring. The school also operates the "We Care" program, providing preventive dental care to patients with HIV/AIDS two days a week in Harlem.
Dr. Zabos feels a comprehensive action plan needs to be developed so that these patients can get the care they need.
The Surgeon General's report, Oral Health in America, calls for new efforts to eliminate disparities in oral health status and rates of oral disease: http://www.nidr.nih.gov/sgr/sgr.htm .
American Journal of Public Health