Oral health affects more than just your mouth. Oral health issues are associated with an increased risk of many other health conditions including cardiovascular disease, preterm birth and low birth weight, and cognitive decline. And the risks of poor oral health don’t affect everyone equally. Disparities in financial resources, insurance coverage, accessibility of dental services, and provider decision-making mean that some population groups are disproportionately affected by poor oral health.
“The consequences of poor oral health affect the entire life course, and that fact is generally underappreciated,” says Brenda Heaton, PhD, associate dean for research in the University of Utah School of Dentistry. “What’s especially infuriating is that the occurrence and impacts of poor oral health are largely preventable. It has a lot to do with whether or not one can access and effectively utilize dental care.”
What drives oral health inequity is a complicated question, thanks to a complex web of factors that interact with each other over time. Current understanding of the root causes of oral health inequity—a necessary prerequisite to informed interventions—is fragmented, often addressing each cause in isolation. Developing an integrated, comprehensive picture of oral health equity is a significant undertaking.
Heaton is up for the task.
“Complexity doesn’t scare me.”
She will lead an eight-year project to investigate the root causes of oral health inequities, powered by $8 million in federal funding from the National Institute of Dental and Craniofacial Research. Her award, the Sustaining Outstanding Achievements in Research (SOAR) Award, is granted to only one researcher in the country each year—specifically, a mid-career researcher who has an outstanding record of research productivity, mentorship, and professional service to the research community.
Revealing complex interactions
Heaton’s research will investigate the factors that influence oral health equity on multiple levels. At the population level, the project will look into how large-scale factors, like oral health policies such as Medicaid and the geographic dispersion of dental providers, affect people’s access to dental care. At the patient level, researchers will focus on what causes fear and anxiety related to dental visits, which can dissuade or delay people from getting the care they need.
Heaton is especially interested in evaluating influences at the provider level by investigating how patient-provider interactions and clinical decision-making affect care, which has been understudied until now. By learning how factors at the population, patient, and provider levels contribute to oral health disparities, scientists can find the best targets for effective interventions.
But the key innovation of Heaton’s proposed research is the acknowledgement of the complex interactions between these different factors.
For instance, people without access to dental care services may need more complicated dental treatment, like tooth extractions, that may not be well understood by the patient or explained by the provider. These stressful experiences could make them more likely to avoid oral health care due to anxiety, even if their access to dental care improves. Heaton will develop computer simulation models to study these interactions.
By studying how these factors influence each other, Heaton and her collaborators will be able to generate a more comprehensive view of how to design and target interventions (at the policy level vs. patient or provider education, for instance) to address oral health inequities.
Powered by data
U of U Health’s system of medical and dental records and its clinical focus on underserved populations is uniquely well-suited to help address these questions, Heaton says. While dental records in most health systems are separate from a more general electronic health record, U of U Health stores medical and dental health records in the same system.
This lets researchers find connections between dental visits and other medical visits, providing a full picture of someone’s overall health. “We have this opportunity for a fully integrated clinical database, an opportunity that just doesn’t exist in a lot of systems,” Heaton says.
She adds that she’s especially excited by the flexibility the eight-year grant allows to develop new research approaches. “A huge advantage of this grant is the creative freedom that it allows,” Heaton says. Instead of being tied to a narrow research plan or approach, she and her collaborators will be able to adapt their strategies based on what they learn in the earlier stages of their work.
Wyatt Hume, DDS, PhD, dean of the School of Dentistry, says, “This achievement is a singular recognition not only of Dr. Heaton’s personal eminence in her scientific field, but also of the great strengths of U Health’s research enterprise, and the School of Dentistry’s growing contributions to that strength.”
Heaton adds that she’s also looking forward to being able to train and mentor more researchers as part of the project, allowing for a potential positive impact that extends beyond research results and into the next generation of researchers. “To be able to contribute to a pipeline of trainees who are dedicated to population oral health and focused on disparities is especially exciting.”
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