Oral Diseases Are Rampant, Report Says
A “silent epidemic” of oral diseases plagues the United States, where about a third of the population has no fluoridated water on tap, more than a third lack dental insurance and nearly a third of the elderly have lost all their natural teeth, according to an unprecedented report released Thursday by the U.S. surgeon general.
Despite enormous advances in dental care and fluoridation in the past half-century, “there are profound and consequential disparities in the oral health of our citizens,” wrote Surgeon General David Satcher. He noted that impoverished children and elderly people, ethnic minorities and the disabled suffer the worst oral health in the nation.
In California, where 70% of the population lacks access to fluoridated community water, children have twice as much tooth decay as their counterparts nationwide, according to a related report on the state’s oral health, also released Thursday.
“Many other childhood diseases--for example, measles, mumps and whooping cough--are well managed or have been nearly eliminated by aggressive prevention programs,” said Dr. Jared Fine, chairman of the committee that prepared the California report for the Dental Health Foundation. “But oral diseases remain unchecked.”
Oral diseases--infections or illnesses in and around the mouth--can include everything from cavities to cancer. Experts say they traditionally have been considered separate from other medical conditions, as though the mouth were not part of the body. Many applauded the surgeon general’s attempt to bridge this great divide.
“People [need to] realize the mouth is attached to the body,” said Dr. Tim Collins, dental director at the Los Angeles County Department of Health Services. “It’s not floating around in the cosmos. Oral health is part of good overall health.”
Commissioned by U.S. Department of Health and Human Services Secretary Donna Shalala, the report notes that marked improvements in clinical care and prevention mean most middle-aged and younger Americans can expect to retain their teeth over their lifetime and won’t experience serious illness.
Yet “many among us still experience needless pain and suffering, complications that devastate overall health and well-being, and financial and social costs that diminish the quality of life and burden American society,” the report states.
Among the findings:
* About 100 million people have no access to community water fluoridation and more than 108 million children and adults lack dental insurance--2 1/2 times the number who lack medical insurance.
* Tooth decay is the single most common chronic childhood disease--five times more common than asthma and seven times more common than hay fever. Poor children suffer twice as much decay as their more affluent peers and are more likely to go untreated. Untreated disease leads to problems eating, speaking and learning, resulting in 51 million lost hours in school each year.
According to the California Dental Foundation’s report, this state’s children suffer disproportionately. Because of cost and some small but vocal political opposition, fluoridation of community water is limited and only recently has received state legislative support.
The city of Los Angeles only recently began adding fluoride to its water and San Diego just approved doing so. Beverly Hills and Long Beach are the only other cities in Los Angeles County to have added fluoride.
“California ranks 47th of the 50 states in the percentage of its population that has access to fluoridated water,” said Dr. Kent Farnsworth, president of the California Dental Assn. Yet “fluoridation is the most effective and least expensive way to vaccinate against tooth decay.”
The California Dental Foundation report says that just 10% of 8-year-olds in California get sealants for their first permanent molars and a third of parents give their preschoolers nighttime juice or milk bottles, a practice known to promote tooth decay. That practice is thought to be more of a problem in this state because of the high number of immigrants from countries where it is common.
* Medicaid (Medi-Cal in California) is not filling the gap in care to poor youngsters. Fewer than one in five children enrolled in the government’s health care program for the poor visited the dentist during a yearlong study period.
* Most adults show signs of disease around their teeth and gums and nearly a fourth of the elderly have severe disease. Nearly a third of the elderly have lost their natural teeth. Many take prescription drugs that dry their mouths and lead to tooth decay. In addition, Medicare does not pay for routine dental care and many elderly Americans lose their dental insurance when they retire.
* About 30,000 Americans annually are diagnosed with oral and pharyngeal cancers; 8,000 die of these diseases each year.
Satcher’s report underscores the importance of attending to oral health in part because the mouth and face are “a mirror of health and disease” and can serve as “an early [disease] warning system.” A physical examination of the mouth can reveal signs of conditions such as HIV and diabetes, drug use, domestic abuse and addictions like smoking.
In addition, X-rays and other imaging techniques can detect early signs of skeletal changes that are characteristic of conditions like osteoporosis and may expose salivary, congenital and developmental disorders. Saliva can be tested for evidence of disease more easily than blood and urine, the report states.
The mouth, as well, can act as a “portal of infection” for disease pathogens. One widely recognized example is the potential for mouth bacteria to cause heart inflammation.
Both the federal and state reports urged quick action to improve oral health.
Satcher’s report called for a change in Americans’ perception of oral health as somehow secondary to other health concerns.
He recommended enhanced behavioral and clinical research; an integration of oral health into other public health programs; use of partnerships between public and private entities to reduce health disparities; and improved access to care by improving dental insurance coverage.
The Dental Health Foundation report on California’s children included a call for improved access to water fluoridation, expansion of school- and community-based treatment programs and involvement of dental professionals in preventing children’s tobacco use.
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Poor Dental Health Among Low-Income
Poor children in each ethnic group have a higher percentage of untreated decayed primary teeth:
Complete tooth loss varies by ethnicity and income. A higher percentage of poor and non-poor white adults (18 and older) have no teeth compared with blacks and Latinos.
* Level of poverty was measured by the federal poverty level, which was $12,092 for a family of four in 1988 and $15,141 for a family of four in 1994.
Source: Third National Health and Nutrition Examination Survey, 1988-94
