Oral Health In America: A Report of the Surgeon General

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Oral Health In AmericaA Report of theSurgeon
General
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The Charge

• Define, describe, and evaluate the interaction
  between oral health and general health and well
  being through the life span in the context of
  changes in society.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Report Organization

• What is oral health?
• What is the status of oral health in America?
• What is the relationship between oral health and
  general health and well-being?
• How is oral health promoted and maintained and
  how are oral diseases prevented?
• What are the needs and opportunities to enhance
  oral health?

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Themes

• Oral health includes healthy teeth but means much
  more.
• You cannot be healthy without good oral health.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Themes

• There are safe and effective disease prevention
  measures that everyone can adopt to improve oral
  health and prevent disease.
• Risk factors common to many diseases and
  conditions, such as tobacco and alcohol use and
  poor dietary practices, also affect craniofacial
  health.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Major Message

• Oral health is essential to the general health
  and well-being of all Americans and can be
  achieved.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Major Message

• However, not all Americans are able to take
  that message to heart.
• In spite of safe and effective means for
  preventing oral diseases, many people
  experience needless pain and suffering,
  devastating complications, and costs that
  significantly diminish the quality of life.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Major Message

• Actions at all levels of society, from
  individuals and neighborhoods to the nation as
  a whole, are required
• to maintain the health and well-being of
  Americans already enjoying good oral health
• to address the gaps in oral health status of
  others

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Major Message

• A coordinated effort can overcome the
  educational, environmental, social, health
  systems, and financial barriers that have
  created vulnerable populations whose
  oral health is at risk.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Major Findings

• Oral diseases and disorders affect health and
  well-being throughout life.
• Range from birth defects to chronic disabiling
  conditions and cancer
• Interfere with vital functions
• Cause other health problems
• Undermine social interaction, self-esteem
• Incur fiscal and social costs

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Dental Decay is One of the Most Common Diseases
Among 5- to 17-year-olds
Source NCHS, 1996
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Untreated Tooth Decay is Widespread
Source Unpublished data from NHANES III 1988-1994
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Major Findings

• There are safe and effective measures to prevent
  dental decay and periodontal (gum) diseases.
• Community water fluoridation
• Personal oral hygiene and use of a fluoride
  toothpaste
• Other fluoride measures and dental sealants
• Cessation/prevention of tobacco use

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Major Findings

• Lifestyle behaviors that affect general health,
  such as tobacco use, excessive alcohol use, and
  poor dietary choices, also affect oral and
  craniofacial health.
• Birth defects, cancer, periodontal disease,
  dental decay, yeast infections (candidiasis),
  etc.
• Health professionals can provide counseling

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Major Findings

• There are profound and consequential oral health
  disparities within the American population.
• Disparities relate to income, age, gender,
  race/ethnicity
• Disparities are due to lack of information or
  access to preventive measures

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Percent of Children Aged 2 - 4 Years Who Have
Ever Had Tooth Decay
Family Income
Source NHANES III, 1988-94
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Untreated Tooth Decay in 6 to 8-year-old Children
Race/Ethnicity
Source NHANES III, 1988-94
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Percent of Children Aged 15 Years with Untreated
Tooth Decay
Level of Education (Head of Household)
Source NHANES III, 1988-94
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Percent of Children with at Least One Dental
Sealant
Family Income
Level of Education
Age 8
Age 14
Source NHANES III, 1988-94
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Percent of Sealant Use in 8-year-old Children by
Race/Ethnicity
Race/Ethnicity
Source NHANES III, 1988-94
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Percent of Children with a Preventive Visit in
Past Year
includes prophylaxis, fluorides, or sealants
Source Medical Expenditure Panel Survey, 1996
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Percent of Children, Aged 0 - 18 Years with a
Preventive Visit in the Past Year
includes prophylaxis, fluorides, or sealants
Source Medical Expenditure Panel Survey, 1996
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Prevention Strategies in Children

• Opportunities for cost-effective preventive
  strategies for children include
• Early screening by primary care providers
• Counseling parents and other caregivers on
  healthy feeding practices
• Promoting appropriate use of fluoride products
  including daily supervised brushing with a
  pea-sized amount of fluoridated toothpaste
  (children lt age 6)
• School-based and -linked sealant programs

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Percent of Adults Aged 35 - 44 Years with
Untreated Tooth Decay
Race/Ethnicity
Source NHANES III, 1988-94
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Percent of Adults Aged 65Years with Complete
Tooth Loss
Level of Education
Source NHIS, 1997
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Total Tooth Loss, Adults Aged 65 Years, 1995 -
1998
HP 2000 Objective ?20
Data unavailable
Source BRFSS 1995-1998
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Percent of Adults Aged 35 - 44 Years with
Destructive Periodontal Disease
Family Income
Source NHANES III, 1988-94
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Oral Cancer Mortality Rates for Adults Aged 45 -
74 Years
per 100,000
Source Vital Statistics, 1997
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Percent of Adults Aged 35 Years Reporting a
Dental Visit in the Past Year
Level of Education
Source NHIS 1997
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Dental Visits in Past Year, Adults Aged 35
Years, 1995 - 1998
?70
65-69.9
HP 2000 Objective ?70
lt65
Data unavailable
Source BRFSS 1995-1998
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Prevention Strategiesfor Adults

• Dental decay and gum diseases can be prevented.
• Community water fluoridation benefits adults as
  well as children.
• Fluoride therapies or antimicrobial rinses are
  effective in adults at high risk of decay.
• Conscientious oral hygiene practices - twice
  daily tooth brushing and use of dental floss -
  can prevent gum disease.
• Smoking cessation counseling, and limiting use of
  alcohol, can reduce the risk of oral cancer.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Community Water Fluoridation

• Community Water Fluoridation is one of the great
  public health achievements of the 20th Century.
• On average, saves 38 for every 1 invested by
  large communities (Griffin et al., 2001).
• About 145 million people, or 62 of the
  population served by public water supplies, drink
  water with optimal fluoride levels.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Community Water Fluoridation1992 Fluoridation
Census
75 and greater
50 to 74
49 and less
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Major Findings

• More information is needed to improve Americas
  oral health and eliminate disparities.
• Data are needed for
• Health conditions, diseases and
  disorders, quality of life, health services,
  and workforce
• All racial/ethnic populations
• National, state, and local estimates

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Major Findings

• The mouth reflects general health and well-being.
• Diagnostic role
• Portal, as well as a barrier, for infections
• Saliva, buccal (cheek) cells, and other oral
  components have additional diagnostic potential

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Major Findings

• Oral diseases and conditions are associated with
  other health problems.
• Diabetes
• Heart disease
• Adverse pregnancy outcomes
• Respiratory infections
• Osteoporosis
• HIV infection

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Linkages Between Oral Health and Other Health
Conditions
Respiratory Infections
Diabetes
Osteopenia Osteoporosis
Pre-Term and Low Birth Weight Deliveries
Coronary Heart Disease
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Oral Health and General Health and Well-Being

• Many diseases and conditions have oral
  manifestations. These manifestations may be the
  initial sign of clinical disease and serve as a
  catalyst to make clinicians aware of the need
  for additional assessments.
• Many medications and other therapies used to
  treat systemic conditions may adversely affect
  the oral cavity and its functions. Discomfort
  that results from these therapies may
  compromise patient compliance with treatment.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Oral Health and General Health and Well-Being

• Individuals with diabetes are at greater risk for
  periodontal disease.
• Animal and population-based studies have
  demonstrated an association between periodontal
  disease and diabetes, stroke, and adverse
  pregnancy outcomes.
• Further research is needed to determine the
  extent to which these associations are causal
  or coincidental.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Major Findings

• Scientific research is key to further reduction
  in the burden of disease and disorders that
  affect the face, mouth, and teeth.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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A Framework For Action

• To eliminate health disparities and improve
  quality of life for all Americans, the report
  calls for the development of a National Oral
  Health Plan that includes collaborations among
  individuals, health care providers, communities,
  and policymakers.

Oral Health in America A Report of the Surgeon
General DHHS 2000
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A Framework For ActionPlan Components

• Change perceptions regarding oral health and
  disease so that oral health becomes an
  accepted/understood component of general health.
• Change the perception of
• The public
• Policymakers
• Health providers

Oral Health in America A Report of the Surgeon
General DHHS 2000
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A Framework For ActionPlan Components

• Accelerate building the science and evidence base
  and apply science effectively to improve oral
  health.
• Support clinical trials, health services
  research, demonstration programs, etc.
• Develop risk assessment and management
  approaches, diagnostic measures, etc.
• Promote adoption of research findings into
  practice

Oral Health in America A Report of the Surgeon
General DHHS 2000
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A Framework For ActionPlan Components

• Build an effective health infrastructure that
  meets the oral health needs of all Americans
  and integrates oral health effectively into
  overall health.
• Focus on public health infrastructure
• Increase diversity of workforce
• Recruit and retain faculty and researchers

Oral Health in America A Report of the Surgeon
General DHHS 2000
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A Framework For ActionPlan Components

• Remove known barriers that stand between people
  and oral health services.
• Increase insurance coverage
• Increase reimbursement for services
• Prepare workforce to address needs of individuals
  with disabilities
• Enhance knowledge, attitudes, and behaviors of
  the public towards oral health
• Assess distribution and supply of providers

Oral Health in America A Report of the Surgeon
General DHHS 2000
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Dentists per 100,000 U.S. Population, 1950-2020
Sources HRSA 1999, ADA 1996
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U.S. Dentist-to-Population Ratios by
Race/Ethnicity of the Dentist, 1996
Source HRSA 1999
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Dental Services as a Percentage of Total U.S.
Health Care Expenditures, 1997
Oral Health in America A Report of the Surgeon
General DHHS 2000
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A Framework For ActionPlan Components

• Use public-private partnerships to improve the
  oral health of those who suffer
  disproportionately.
• Promote multi- and inter-disciplinary efforts
• Build alliances to address common risk factors
• Take advantage of existing initiatives

Oral Health in America A Report of the Surgeon
General DHHS 2000
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General DHHS 2000
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Oral Health In AmericaA Report of theSurgeon
General