COVId-19 Impact On Health Inequity · CV risk by 9%. •Visiting the dentist for a teeth cleaning ≥1 year associated 14% lower risk for heart events vs. never went to the dentist.

COVID-19IMPACT ONHEALTH INEQUITYDentaQuest Partnership Continuing Education Webinar

June 11, 2020

DOI: 10.35565/DQP.2020.3009

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Learning Objectives

By the end of this webinar, participants will be able to:

1. Identify the health inequities and barriers to oral health care by race and

income.

2. Discuss cardiovascular disease disparities by race/ethnicity and

socioeconomic status impacted by COVID-19.

3. Discuss oral health and cardiovascular link.

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Housekeeping

• All lines will remain muted to avoid background noise.

• A copy of the slides and a link to the recording will be shared after the webinar

concludes.

• In order to receive CE credit you must fill out the webinar evaluation, which

will be shared at the end of the presentation. The evaluation must be

completed by EOD Friday, June 19 to receive CE credit. CE certificates will

be distributed a few days after the webinar takes place.

The DentaQuest Partnership is an ADA CERP Recognized Provider. This presentation

has been planned and implemented in accordance with the standards of the ADA CERP.

*Full disclosures available upon request

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5

Q&A Logistics

After the presentations we hope to have some

time for Q&A

We will be monitoring the chat box through the

entire presentation and we will do our best to

answer all questions.

• Type your question in the chat box

and make sure you send it to all

panelists.

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Presenters:

DENTAQUEST RESPONSETO COVID-19 IMPACTON HEALTH INEQUITYMyechia Minter Jordan, MD, MBA

President & CEO, DentaQuest Partnership for Oral Health

Advancement & Catalyst Institute

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NEW ORAL HEALTH DATA REFLECTS INEQUITIES & BARRIERS

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TOP REASONS FOR UNPLANNED DENTAL VISITS

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UNMET DENTAL NEEDS ARE COMMON AND HAVE A PROFOUND IMPACT

https://public.tableau.com/profile/dentaquest.partnership#!/vizhome/NHANESInfographicbyYear/Dashboard

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UNMET DENTAL NEEDS ARE COMMON AND HAVE A PROFOUND IMPACT

https://public.tableau.com/profile/dentaquest.partnership#!/vizhome/NHANESInfographicbyYear/Dashboard

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LACK OF DENTAL INSURANCE COVERAGE MATTERS

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LACK OF DENTAL INSURANCE COVERAGE MATTERS

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Access to DQP’s Infographic & Dashboardhttps://www.dentaquestpartnership.org/research

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CVD/Oral Disease Linkage

6/11/2020

COVID-19 on Health Inequity Webinar Keith C. Ferdinand,MD, FACC,FAHA,FASPC,FNLA

Gerald S. Berenson Endowed Chair in Preventive Cardiology

Professor of Medicine

Tulane University School of Medicine

New Orleans, LA

Keith C. Ferdinand, MD

Has disclosed the following affiliations. Any real or apparent COIs related to the presentation

have been resolved.Speaker’s Bureau- NoneConsultant- Amgen, Sanofi, Boehringer Ingelheim,

Novartis, Quantum GenomicsStocks- NonePatents- None

OBJECTIVES

• Discuss oral health and

cardiovascular link

• Discuss cardiovascular disease

disparities by race/ethnicity and

socioeconomic status impacted by

COVID-19

Introduction: the Past is Prologue

• Health, life expectancy, and care improved dramatically for Americans over last century

• Distribution of benefits not occurred equitably

– Current mortality gap between black & white persistent since 1960

• African Americans: higher risk for HTN, DM, obesity, MI, stroke, CKD, ESRD, and CV mortality, especially premature cardiac death

Smedley et al [eds]. Unequal treatment: Confronting racial and ethnic disparities in

health care. National Academies Press, 2002

Civil Rights Act

of 1964

7/02/64

President Lyndon B. Johnson signs Voting Rights Act. with Martin Luther King

8/6/1965

https://politicalcharge.org/

Atherosclerotic Plaque Development

Identification Subclinical Atherosclerosis Will

Supplement Current Risk Stratification

Strategies.

Inflammation plays a major role in heart attack and stroke

A B

C D

(A) Normal abdominal aorta, (B) Normal coronary arteries, (C) Abdominal aorta with severe atherosclerosis ,

(D) Coronary artery total occlusion

High Density Lipoproteins, Dyslipidemia, and Coronary Heart Disease, Springer (2010)

Rheumatoid arthritis: A Systemic Disease

African Americans: a High Risk Population

CRTOnline.org

•

Mortality rates: Higher in Non-Hispanic Blacks vs. Whites

Sidney, S.,et al. (2016). Recent trends in cardiovascular mortality in the United States and public health goals.

JAMA cardiology, 1(5), 594-599.

Life expectancy, by race and sex: U.S., 2006–2017

JAMA April 26, 2016 Volume 315, Number 16

Circulation Volume 125(20):2520-2544 May 22, 2012

Periodontal Disease and ASCVD

• A link between oral health and CV disease has been proposed for more than a century.

• Observational studies to date support an association between PD and ASCVD independent of known confounders.

• They do not, however, support a causative relationship. • The 2 disorders share several common risk factors,

including cigarette smoking, age, and DM

Circulation Volume 125(20):2520-2544 May 22, 2012

Periodontal Disease and ASCVD

• Periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies and

• May prevent ASCVD or modify its outcomes.

• Poor oral health remains linked to poor CV health

Circulation Volume 125(20):2520-2544 May 22, 2012

Periodontal anatomy in health and disease inflamed and

swollen gingival papilla and loss of alveolar bone.

Peter B. Lockhart et al. Circulation. 2012;125:2520-2544

loss of a

mucosal

barrier

between

plaque

bacteria

and

↑gingival

circulation

How oral health can affect systemic health

Fiorillo L. Oral Health: The First Step to Well-Being.

Medicina (Kaunas). 2019;55(10):676.

Age-adjusted prevalence of physician-diagnosed

DM ≥20 years of age by race/ethnicity and sex

NHANES 2011-2014 Benjamin,E. et al; AHA STATISTICAL UPDATE Circulation. 2017;135

DM and periodontal

disease share a

pathogenesis that

includes elevated

inflammatory

response

2019 DentaQuest doi:

10.35565/dqp00002

Poor oral health and

dietary intake- negative

impact

↓Hemoglobin A1c

between 0.29-0.71 with

oral health intervention

Immune dysfunction including deficiencies in lymphocytes and monocytes.

Altered cellular immunity along with malnutrition contributes to an immunodeficient state

2019 DentaQuest doi: 10.35565/dqp00002

Poor oral health and

renal disease

(characterized by

uremia)

Race/Ethnicity and CVD

• Race/ethnicity is a social construct

with little biological or genetic basis.

• Concepts of implicit bias and

stereotype threat are a real

phenomena

• Affect health and disease and may

be root causes of disparate care.

Circulation. 2015;132:00-00. DOI: 10.1161

Fiorillo L. Oral Health: The

First Step to Well-Being.

Medicina (Kaunas).

2019;55(10):676.

Oral health

can affect

systemic

health

Features of racial gaps in oral health

• Disadvantaged racial categories show the greatest

burden of negative oral health outcomes,

• Gaps between privileged and disadvantaged racial groups

are large,

• Racial health differentials persist across time and space,

• Individual-level SES explains a considerable proportion of

racial inequalities in oral health.

Journal of Dental Research 2018, Vol. 97(8) 878–886

Frequent tooth brushing and dental visits

could reduce risk for heart disease.

• National registry N=247,696 healthy Korean adults,

• All underwent oral health screening and free of heart disease.

• Self-reported data: nearly half brushed 2X a day.

• Remaining 40% brushed ≥3X day ;15% brushed ≤1X a day.

• Roughly one in four had at least one professional teeth

cleaning each year and

• 20–30% had gum disease, cavities or tooth lossEur Heart J, Volume 40, Issue 14, 07 April 2019, Pages 1138–1145

Frequent tooth brushing and dental visits

could reduce risk for heart disease

• Brushing one extra time/day reduced

CV risk by 9%.

• Visiting the dentist for a teeth cleaning

≥1 year associated 14% lower risk for

heart events vs. never went to the

dentist.

Eur Heart J, Volume 40, Issue 14, 07 April 2019, Pages 1138–1145

Eur Heart J, Volume 40, Issue 14, 07 April 2019, Pages 1138–1145,.

Frequent tooth brushing and dental visits could

reduce risk for heart disease.

Conclusion

• Oral hygiene care such as frequent tooth brushing and

regular dental visits for professional cleaning reduced the

risk of future CV events in healthy adults.

• This study also suggests that improved oral hygiene

behaviour may modify the association between oral health

and CVD.European Heart Journal (2019) 40, 1138–1145

Visualizing

What

COVID-19

Does to the

Bodyhttps://www.neurodiem.com/

• HISTORY CORONAVIRUS COVERAGE APRIL 2020

• African Americans struggle with disproportionate COVID

death toll

• Creating a toxic storm of death and illness, the

pandemic is devastating black communities across

the United States and revealing the deadly legacy of

inequality

https://www.nationalgeographic.com/history/2020/04/coronavirus-

disproportionately-impacts-african-americans/

Numerous variables making African Americans more vulnerable to COVID-19

…. “a mixture of the many

difficulties faced by African

Americans which may compound

or even extend the burden for the

coronavirus risk factors,” …Ferdinand,KC

https://www.nationalgeographic.com/history/2020/04/coronavirus-

disproportionately-impacts-african-americans/

Numerous variables making African Americans more vulnerable to COVID-19

• Working in service industries or “essential

jobs” exposing themselves to infection;

• Using public transportation to get to work;

• Lack of access to early testing; and

• A historical distrust of the health-care

system because of previous bias. https://www.nationalgeographic.com/history/2020/04/coronavirus-

disproportionately-impacts-african-americans/

Chicago’s West Garfield Park neighborhood for more than nine years. Mail carriers are ‘essential’ employees.

A woman and child wait at the Rockaway Avenue transit stop in Brooklyn, New York’s Brownsville neighborhood

Chicagoans and essential workers must continue to take public transit to get to work and meet their basic needs.

“…….sentinel event as an unexpected occurrence resulting in death or

serious physical or psychological injury, or the risk thereof. Conventionally

identified sentinel events, such as unintended retention of foreign objects

and fall-related events, are used to evaluate quality in hospital care.

Similarly, disparate AA COVID-19 mortality reflects longstanding,

unacceptable U.S. racial/ethnic and socioeconomic CVD inequities and

unmasks system failures and unacceptable care to be caught and

mitigated.”

“…….sentinel event as an unexpected occurrence resulting in death or

serious physical or psychological injury, or the risk thereof. Conventionally

identified sentinel events, such as unintended retention of foreign objects

and fall-related events, are used to evaluate quality in hospital care.

Similarly, disparate AA COVID-19 mortality reflects longstanding,

unacceptable U.S. racial/ethnic and socioeconomic CVD inequities and

unmasks system failures and unacceptable care to be caught and

mitigated.”

- Martin Luther King, Jr. Medical Committee for Human Rights Chicago March 1966

“Of all the forms of

inequality,

injustice in health care

is

the most inhumane.”

Conclusions: COVID-19 and Public Health

Health disparities by race/ethnicity and SES

–Exist

–Are sizeable

–Are likely multifactorial

–COVID-19 reveals and exacerbates

long-standing inequities

Thank You!

QUESTIONS?

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Webinar Evaluation

https://www.dentaquestpartnership.org/node/205989

*Must complete by EOD Friday, June 19 in order to receive CE credit

Upcoming Webinars:

• Best Practices for Re-Opening Dental Clinics: A Living Document (June 18th

at 1:00 PM – 2:00 PM)

• Bringing Teledentistry Into Practice Series – Webinar 3: Directing Patient

Care in a New and Innovative Format (June 22 at 1:00 PM – 2:00 PM)

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