Investing in Oral Health is Good for the Economy

A year on, the World Economic Forum’s white paper “The Economic Rational for a Global Commitment to Invest in Oral Health” continues to provide food for thought.

Making the Case for Oral Health Investment

The paper lays out a series of steps that provide a nice summary of the rationale for increasing investment in oral health. Each step is presented as a section offering detailed insights that develop the authors’ argument.

1. Oral health: Critical for overall health and well-being
2. Better oral health lowers overall healthcare costs
3. Oral health is a key driver of economic well-being
4. The global burden of oral disease is growing
5. Oral health stands out among unmet healthcare needs
6. The cost of oral disease to the global economy is substantial
7. The high level of unmet oral healthcare needs is rooted in policy choices
8. Moving forward: The need for a global commitment to investing in oral health

In essence, the argument of the paper flows from the premises that oral health is connected to people’s overall health (1), oral health care makes economic sense (2)(3), policy decisions do not adequately check the burden of oral disease (4)(5)(6)(7), and the solution is to invest in oral health care.  

Healthcare Costs and Personal Wellbeing

The premise that oral health is related to overall health is not new, and many health-related economic benefits come from addressing gum disease. Diabetes, heart disease, dementia, respiratory health, and adverse birth outcomes have all been linked to gum disease, and the authors point to evidence suggesting that specific populations see savings with improved oral health. In many cases, the results of this evidence are worth exploring in depth.

For example, periodontal interventions for patients with diabetes have been associated with lower healthcare costs. Notably, at least one study did not find this to be the case among individuals who initiated drug treatment within the first 2 years after their diagnosis: Trends within this group were toward savings but not statistically significant. Others have produced similar results, and there is some indication of greater benefits to Medicaid insured populations. As such, studies on this topic suggest potential nuances that policymakers should consider when funding targeted diabetes related oral health interventions.

The authors of the white paper also discuss other studies on the relationship between healthcare costs, chronic disease, and periodontal care. Following a look into chronic disease, they point to literature indicating that Medicaid eligible individuals with dental visits had lower chances of being diagnosed with diabetes and heart disease, and they are also less likely to wind up in the emergency room. In Georgia, untreated dental conditions resulted in just under 56,000 ER visits in 2023.

Beyond healthcare costs, better oral health is linked to higher earnings. Over a third of low-income adults report that the condition of their mouth and teeth affects their ability to interview for a job. Studies into the labor market effects of community water fluoridation suggest that low-income women in communities with fluoridated water see a 4% increase in earnings compared to those without. One study looking at Swedish registry data found an average increase in earnings of 4.4%, or the equivalent of a half a year of additional education, with effects concentrated among individuals of “low socioeconomic background.”

Several reasons for observable earnings bumps related to healthy teeth have been proposed. For example, consumer and employer discrimination may play a role. Within-workplace productive comparisons of similar workers suggest that the income premium is highest in sectors where workers have high levels of customer contact. People working as hairdressers, beauty consultants, travel agents, entertainers, hotel staff, and salespersons are just some who see a productivity boost tied to good oral health. In the Swedish study, the authors also observed that certain subgroups of workers used fewer sick days with access to water with optimal fluoride levels. Both papers referenced above caution that their results are exploratory.

However, their work, along with others’, provides a window into the downstream consequences of worse oral health. The notion that a person’s oral health influences their social relationships and individual behaviors is not new. The American Dental Association’s Health Policy Institute surveys suggest that around 29% of low-income adults in the United States believe that the appearance of their mouth and teeth affects their ability to interview for a job. Caries are negatively associated with academic achievement and school absenteeism. Unfortunately, there is still a substantial amount of work needed to shed light on this area of study.

One striking chart in the white paper is Figure 6, a look at estimated oral health related treatment costs and productivity losses across the world. High-income countries report costs of $259.96 per capita and productivity losses of $184.69 per capita. Meanwhile, surveys conducted by CareQuest Institute for Oral Health estimate that Americans lose about $45 billion each year. In either scenario, Georgia’s share of this exceeds $1.4 billion.

Responding With Effective Policy

Policy recommendations from the white paper are broad. For example, the paper suggests that governments should focus on improving the affordability of dental care, ensuring sufficient oral health workforce capacity, and improving oral health literacy. The paper also emphasizes the integration of oral healthcare services into primary healthcare services at several different points. Other sectors received their own recommendations, but in general, the perspective of the paper’s authors is that oral health deserves investment because it makes a meaningful difference to people and to society.

More robust explorations of different policy options would be welcome, and if the paper highlights anything, it highlights the need for more research dedicated to understanding the economic consequences of poor oral health. For example, a 2021 scoping review found virtually no studies on the economic costs of poor oral health among older adults. In the meantime, cost-effective investments can be made to combat a preventable problem.

Promising policy options that are applicable at the state level include community water fluoridation, community-based group oral health education, targeted teledentistry oral health education, taxing sugar sweetened beverages at an appropriate level, and targeted pre/primary school based dental check-up programs. Other revenue generating policies can also have an impact on oral health: For example, reductions in smoking from raising excise taxes on tobacco affect the mouth as well as the lungs.

Shaping the Future of Dentistry in Georgia

Participating in advocacy designed to promote a bright future for dentistry remains the number 1 member benefit mentioned when dentists discuss the value of a GDA membership. Even the smallest bit of support or insight from GDA’s members can significantly advance the profession. To help contribute to ongoing advocacy, sign up as a contact dentist, give to GDAPAC, and attend events like district legislative receptions and LAW Day.