Poor oral health is associated with cardiovascular disease and dementia. Potential pathways include sepsis from oral bacteria, systemic inflammation, and nutritional deficiencies. However, in post-industrialized populations, links between oral health and chronic disease may be confounded because the lower socioeconomic exposome (poor diet, pollution, low physical activity) often entails insufficient dental care. We assessed tooth loss, caries, and damaged teeth, in relation to cardiovascular and brain aging among the Tsimane, a subsistence population living a relatively traditional forager-horticulturalist lifestyle with poor dental health, but minimal cardiovascular disease and dementia. Dental health was assessed by a physician in 739 participants aged 40-92 years with cardiac and brain health measured by chest computed tomography (CT) (n=728) and brain CT (n=605). A subset of 356 individuals aged 60+ were also assessed for dementia and mild cognitive impairment (n=33 impaired). Tooth loss was highly prevalent, with 2.2 teeth lost per decade and a 2-fold greater loss in women. The number of teeth with exposed pulp was associated with higher inflammation, as measured by cytokine levels and white blood cell counts, and lower body mass index. Coronary artery calcium and thoracic aortic calcium were not associated with tooth loss or damaged teeth. However, aortic valve calcification and brain tissue loss were higher in those that had more teeth with exposed pulp. Overall, these results suggest that dental health is associated with indicators of chronic diseases in the absence of typical confounds, even in a population with low cardiovascular and dementia risk factors.

Cross-sector collaborations are alliances among partners from various sectors, including health, education, and business, working together to address complex issues. These alliances are key to addressing inequities in maternal health outcomes. The seven chapters in this section outline examples of successful collaborations, provide information on barriers to, and facilitators of, successful collaboration, or describe opportunities to engage with traditional or nontraditional stakeholders invested in maternal health. Community engagement is also important in building cross-sector collaborations aimed at addressing inequities. The chapters of this section will give readers a better understanding of models for collaborations and community engagement that can be adapted and employed to address inequities in maternal health.

OBJECTIVES: Federally Qualified Health Centers (FQHCs) may be well positioned to facilitate dental visits during pregnancy for low-income women. We sought to compare receipt of dental visits during pregnancy for women who received prenatal care at an FQHC versus a non-FQHC setting.

METHODS: We analyzed Michigan Medicaid administrative data for all live birth deliveries between April 2018 and December 2020. We used billing data to categorize the predominant setting for prenatal care as occurring at a FQHC or a non-FQHC and claims data to identify dental visits during pregnancy (in the 9 months prior to delivery). We employed bivariate and multivariate analyses to explore the relationship between setting for prenatal care and dental visits during pregnancy.

RESULTS: Women who received prenatal care at an FQHC versus non-FQHC had a higher proportion of dental visits during pregnancy (31.85% vs. 19.37%, p < 0.0001). In multivariate analyses, the strongest predictors of having a dental visit during pregnancy were FQHC prenatal care setting, having a dental emergency visit, having ≥3 prenatal visits, and having Medicaid coverage throughout pregnancy. Hispanic or Black race/ethnicity and 2020 delivery year were predictors of a lower likelihood of a dental visit. These predictors were consistent for the overall population and for the subset who had no dental visits pre-pregnancy.

CONCLUSION: Medicaid-enrolled women who receive prenatal care at an FQHC are more likely to have a dental visit during pregnancy than their counterparts who receive prenatal care in a non-FQHC setting.

IMPORTANCE: Oral health is fundamental to health and well-being across the life span. Dental caries (cavities) and periodontal disease (gum disease) are common and often untreated oral health conditions that affect eating, speaking, learning, smiling, and employment potential. Untreated oral health conditions can lead to tooth loss, irreversible tooth damage, and other serious adverse health outcomes.

OBJECTIVE: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in adults.

POPULATION: Asymptomatic adults 18 years or older.

EVIDENCE ASSESSMENT: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults.

RECOMMENDATIONS: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults. (I statement).

Oral health is a vital component of overall health. In a pair of Recommendation Statements published by JAMA on November 7, 2023, the US Preventive Services Task Force (USPSTF) announced that current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions and providing preventive interventions by primary care clinicians for children aged 5 to 17 years and in adults. The current state of scientific knowledge is reflected by the USPSTF’s I statements (“insufficient evidence” to support the recommendation) in each Recommendation Statement. This demonstrates the need for further research to better understand the effect of these services on health outcomes. The lack of data should not unduly influence primary care clinicians to stop considering oral health during routine medical examinations or checkups.

INTRODUCTION: Research shows there is a significant increase in gingival inflammation during pregnancy. This study was conducted to determine if an oral health intervention (OHI), including oral hygiene education delivered by nurse-led staff and an advanced over-the-counter (OTC) oral home care regimen, improved gingival inflammation in pregnant women with moderate-to-severe gingivitis compared with a standard oral hygiene control group.

METHODS: This was a multicenter, randomized, controlled, single-masked, parallel group clinical trial conducted in obstetrics clinics of 2 medical centers. A total of 750 pregnant women between 8 and 24 weeks of pregnancy with at least 20 natural teeth and moderate-to-severe gingivitis (>30 intraoral bleeding sites) were enrolled. Participants were randomized to either the OHI group, which included oral hygiene instructions supplemented with an educational video and advanced OTC antibacterial/mechanical oral hygiene products, or the control group receiving oral hygiene instructions and standard products. Both groups received oral hygiene instructions from nurse-led staff. Experienced, masked examiners measured whole mouth gingival index (GI) and periodontal probing depths (PDs) at baseline and months 1, 2, and 3.

RESULTS: Participants enrolled in this study presented with moderate-to-severe gingivitis at baseline. Both the OHI and control groups exhibited significant reductions in GI (P < .001) and PD (P < .03) from baseline that persisted throughout the study period. The OHI group exhibited modest, yet statistically greater, reductions in GI (P ≤ .044) compared with the control at all time points. The reduction in PD directionally favored the OHI group, but between-group differences were small (<0.03 mm) and not statistically significant (P > .18).

DISCUSSION: Significant gingivitis was prevalent among participants in this study and identifies an opportunity to improve gingival health during pregnancy by providing oral health education during the course of prenatal care when coupled with an advanced OTC oral hygiene regimen.