Change is in the air. The United States' population just passed 300 million people making the U.S. the third largest country in the world. The United States now has more than 110 million Americans without dental insurance and 46 million people without medical insurance. Why do we remain the only industrial nation in the world without universal health coverage—health coverage that includes mental, vision, oral and systemic health?

USC School of Dentistry is one of the top dental schools in the country.  Our academic programs are on a par with the finest in the nation, our faculty continue to earn teaching awards and continue to publish cutting-edge research in the finest journals, and our student body graduate to become leaders and entrepreneurs in the health professions and beyond.  We offer distinctive academic programs for dental hygiene, dentistry, craniofacial molecular biology, biokinesiology, physical therapy, occupational science and occupational therapy. We offer distinctive programs that engage service learning and translate into providing health promotion, risk assessment, disease prevention, diagnosis and various types of therapy to tens of thousands of people every year.

From our position of excellent performance, we must continue to strive to improve across all metrics. We must not lose sight of the big picture. We need to continue to foster innovations in all of our education, research, patient care and service activities.

For example, many of us have very good relationships with a caring and competent physician.  Many of us have learned the significance of regular exercise and heart-healthy dietary choices, but very few of us correlate cardiovascular health with oral health.  Our mouth contains six billion bacteria.  These bacteria live in communities called biofilms.  Under certain environmental condition, specific bacteria can become virulent or pathogenic.  Under specific conditions, oral bacteria can become blood-borne (bacteremia/septicemia) and can relocate to other parts of our bodies. For example, atherosclerotic plaque can form along the lumen of a major cardiac artery.  Within the forming plaque, bacteria can and do release toxins and provoke chronic inflammatory responses associated with our immune systems.

We know that 75 percent of Americans over the age of 35 years present with periodontitis—a chronic infectious disease related to adjacent inflammation and bone loss.  Emerging evidence suggests that chronic oral infections can result in bacteremia and septicemia.  Curiously, the Center for Disease Control and Prevention reported in the journal Stroke that there is a higher risk for heart attack and stroke with increased tooth loss.  Additional research shows a correlation between periodontal disease and a more atherogenic subtype of LDL cholesterol suggesting increased risk.  Another study of more than 1,000 patients reported that higher levels of periodontal bacteria are associated with thicker internal linings of carotid arteries.  Another study indicates that tooth loss is correlated with the onset of Alzheimer's disease.  Critically, we must also state that these types of data sets are "suggestive" of an association and are less than a cause and effect relationship at this time.  However, while clinical studies evolve from observations and epidemiological to the gold standard of randomized multi-center clinical trials, we should do everything possible to manage oral infection in order to reduce and prevent systemic diseases.

This month Scientific American published a special issue "Oral and Whole Body Health" that presents a superb assessment of what is known, what needs to be learned and the scientific challenges ahead.  In this issue we learn that an awareness of oral health has been known since A.D. 250 when Kemetic Egyptians used myrrh and other antiseptic herbs to treat oral infections.  We have come a long way. From my perspective, the fields of medicine and dentistry have been worlds apart for the past 150 years.  Growing evidence now suggests that oral infection is associated with low birth weight, premature infants, cardiovascular disease, cerebrovascular disease, and pulmonary diseases.  Oral infections present viral, bacterial and yeast (Candida albicans) infections with associated chronic inflammation.  These studies, and so much more, argue for curriculum reform, modifications in standards of practice, and innovations in dental and medical education.   The "…times they are a-changin."