Disparities in Rural Healthcare:

Nursings Role in Oral Health Promotion and

Management of Systemic Disease
Leslie Rush & Sara Young
Fer r is State Univer sity

Purpose
Examine oral health disparities and access within rural communities
Explain the relationship between dental health and systemic disease
Explore nursings role in oral health assessments and promotion in
rural settings
Identify implications and consequences in nursing related to
educating the rural community of the values of holistic care
Discuss recommendations to improve inter-professional collaboration
to improve health outcomes in rural communities

Environmental Assessment
Minority and poor children are more likely to lack dental insurance;
routine dental care is excluded from traditional Medicare benefits
(Dolce, 2014)

Prevalence of gum disease and dental decay increases as poverty

levels increase and education levels decrease (Dolce, 2014)
Bacteria found in periodontal disease is linked systemically to
coronary heart disease, diabetes, respiratory disease, kidney
disease and low birth-weight babies (Duley, Fitzpatrick, Zornosa, & Barnes, 2012)

Over 47% of adults 30 years+ have periodontal disease

(Dolce, 2014)

Environmental Assessment

The right side of

the graph
demonstrates the
nonreceipt of
needed dental
care due to cost
among percentage
of adults aged 1864, by percent of
poverty level: U.S.,
2002-2012.

NOTE: In the past 12 months.

SOURCE: CDC/NCHS, Health, United States, 2013, Figure 18. Data from the National Health Interview Survey

Environmental Assessment
Dental visit in the past 12 months, 20072011
Increase Desired for Healthy People 2020

The proportion of persons aged 2 years

and over who reported a dental visit in
the past 12 months decreased 6.1%
between 2007 and 2011, from 44.5% to
41.8% (age adjusted). The likelihood of
a dental visit in the past 12 months
varied by education. For example, in
2011, 54.6% (age adjusted) of persons
aged 25 years and over with some
college education reported a dental visit
in the past 12 months, more than one
and a half times the likelihood among
those who were high school graduates,
34.4%, and more than three times the
likelihood among those who had less
than a high school education, 16.8%

SOURCE: Medical Expenditure Panel Survey (MEPS), AHRQ.

NOTES: Data are for the proportion of persons aged 2 years and over who
reported a dental visit in the past 12 months and are age adjusted using the year
2000 standard population. Data by education are for persons aged 25 and over.

Environmental Assessment
In 2012, only 66.2% of those 2 years and older had visited a dentist in the
past year (U.S. Dept. of Health and Human Services, 2013)
There has been a nationwide increase of emergency room visits related to
preventable dental conditions that has placed added financial burdens on
hospitals (Dolce, 2014)
Since 1978, the World Health Organization (WHO) has promoted effective
collaboration of partners from various disciplines and sectors of society for
coordinated and affordable healthcare (Bowes, McConnel, & Horst 2010)

Seventeen of the Healthy People 2020 objectives relate directly to oral

health and a number of others reflect the connection between oral disease
and other chronic illnesses such as diabetes and cancer (CDC, 2014)

Root Cause Analysis: Oral Health and

Associated Conditions in Rural Populations
-Poverty

Increased risk for

coronary heart
disease, diabetes,
kidney and
respiratory
complications, low
birth weight babies

-Delays in
treatment with
increased oral
bacteria and
periodontal disease
-Poor oral hygiene

No dental check
ups

-Socioeconomic
status
-Rural communities
-Transportation

Lack of knowledge
and education

Lack of Insurance
and/or resources

Implications for Rural Communities

Lack of access and finances for dental health care puts rural
communities at an increased risk for serious medical conditions and
reduced outcomes
Lack of knowledge and education related to oral-systemic health has
been associated with poor outcomes
Poor oral hygiene can translate to loss of teeth which in turn may affect
nutritional intake needed for optimal health
Regular dental exams, cleanings and restorations decrease harmful
bacteria and infections implicated in heart disease and diabetes

Implications for Nursing

A thorough knowledge and understanding about the relationship between
oral disease and associated medical conditions by nursing can have a
positive effect on health care outcomes among rural communities
Nurses should be proactive in performing oral assessments, promoting
good oral hygiene, and regular dental check-ups for their patients to
reduce disease risks
Professional nurses understand the health benefits of collaborating with
multiple disciplines: dental health should not be excluded

Nurse leaders and educators must advocate and strive for education
that incorporates the importance of oral health in relation to systemic
disease

Consequences
Hospitals and doctors offices are often the only point of entry for
health services in vulnerable and rural populations. Nurses are in a
pivotal position to be the front line of dental health promotion

Lack of oral assessments masks potential systemic inflammation,

infections, lesions, and cancersall of which can be contributors to
diabetes, poor healing, heart disease, kidney complications, respiratory
infections and even low-birth rates

Recommendations in Nursing:
A Call to Action
Inquire about last dental check-up
Complete an oral screening upon admission, in hospitals, doctors offices,
and healthcare facilities in rural communities
Advocate for regular dental screenings in rural communities to improve
health outcomes

Educate about the importance of good oral health in relation to chronic

disease

Recommendations in Nursing:
A Call to Action
Be knowledgeable about resources in the rural area: local clinics, dental
offices, dental schools
Promote use of dental plans available through the Affordable Health
Care Act or Marketplace
Promote collaboration with all health care providers to improve health
care outcomes among rural communities
Promote integration of oral health education within nursing curriculum:
incorporate education on the benefits of inter-professional collaboration
to reduce disparities in rural health

Health Prevention
Preventative health care in todays society requires
providers to focus on education and thorough risk
assessments. Collaboration among the various disciplines of
health care is crucial in providing optimal continuity of
care among underserved and rural populations. Nurses
spend countless hours educating and promoting the values
of taking care of ones well-being. Oral health promotion is
no exception. Ask: When was your last dental check-up?

References
Bowes, D.L., McConnell, H. & Horst, M.L. (2010). Case report: Interprofessional collaboration- A nursing-dental hygiene

experience. Canadian Journal of Dental Hygiene, 44, 217-220.

Centers for Disease Control (CDC). (2014). Healthy people 2020: Oral health objective. Retrieved from
http://www.cdc.gov/oralhealth/healthy_people/index.htm
Dolce, M.C. (2014). Integrating oral health into professional nursing practice: An interprofessional faculty tool kit.

Journal of Professional Nursing, 30, 63-71. doi: 10.1016/j.profnurs.2013.06.002

Duley, S.I., Fitzpatrick, P.G., Zornosa, X., & Barnes, W.G. (2012). A center for oral promotion: Establishing an
interprofessional paradigm for dental hygiene, health care management and nursing education. The Journal of

Dental Hygiene, 86, 63-70.

United States Department of Health and Human Services. (2013). Health, United States, 2013 . Retrieved from
http://www.cdc.gov/nchs/data/hus/hus13.pdf#091