Oral diseases are progressive and cumulative and become more complex over time.  They can affect our ability to eat, the foods we choose, how we look, and the way we communicate.  These diseases can affect economic productivity and compromise our ability to work at home, at school, or on the job.  Health disparities exist across population groups at all ages.  Over one third of the U.S. population (100 million people) has no access to community water fluoridation.  Over 108 million children and adults lack dental insurance, which is over 2.5 times the number who lacks medical insurance.  The following are highlights of oral health data for children, adults, and the elderly.  (Refer to the full report for details of these data and their sources).

CHILDREN

  • Cleft lip/palate, one of the most common birth defects, is estimated to affect 1 out of 600 live births for whites, and 1 out of 1,850 live births for African Americans.
  • Other birth defects such as hereditary ectodermal dysplasias, where all or most teeth are missing or misshapen, cause lifetime problems that can be devastating to children and adults.
  • Dental caries (tooth decay) is the single most common chronic childhood disease – 5 times more common than asthma and 7 times more common than hay fever.
  • Over 50 percent of 5- to 9-year-old children have at least one cavity or filling, and that proportion increases to 78 percent among 17-year-olds.   Nevertheless, these figures represent improvements in the oral health of children compared to a generation gap.
  • There are striking disparities in dental disease by income.  Poor children suffer twice as much dental caries as their more affluent peers, and their disease is more likely to be untreated.  These poor-nonpoor differences continue into adolescence.  One out of  four children in America is born into poverty, and children living below the poverty line (annual income of $17,000 for a single family of four) have more severe and untreated decay.
  • Tobacco-related oral lesions are prevalent in adolescents who currently use smokeless (spit) tobacco.
  • Unintentional injuries, many of which include head, mouth, and neck injuries, are common in children.
  • Intentional injuries commonly affect the craniofacial tissues.
  • Professional care is necessary for maintaining oral health, yet 25 percent of poor children have not seen a dentist before entering kindergarten.
  • Medical insurance is a strong predictor of access to dental care.  Uninsured children are 2.5 times less likely than insured children to receive dental care.  Children from families without dental insurance are 3 times more likely to have dental needs than children with either public or private insurance.  For each child without medical insurance, there are at least 2.6 children without dental insurance.
  • Medicaid has not been able to fill the gap in providing dental care to poor children.  Fewer than one in five Medicaid-covered children received a single dental visit in a recent year-long study period.  Although new programs such as the State Children’s Health Insurance Program (SCHIP) may increase the number of insured children, many will still be left without effective dental coverage.
  • The social impact of oral diseases in children is substantial.  More than 51 million school hours are lost each year to dental-related illness.  Poor children suffer nearly 12 times more restricted-activity days than children from higher-income families.  Pain and suffering due to untreated diseases can lead to problems in eating, speaking, and attending to learning.

Adults

  • Most adults show signs of periodontal or gingival diseases.  Severe periodontal disease (measured as 6 millimeters of periodontal attachment loss) affects about 14 percent of adults aged 45-54.
  • Clinical symptoms of viral infections, such as herpes labialis (cold sores), and oral ulcers (canker sores) are common in adulthood affecting about 19 percent of adults 22 to 44 years of age.
  • Chronic disabling diseases such as temporomandibular disorders, Sjögren’s syndrome, diabetes, and osteoporosis affect millions of Americans and compromise oral health and functioning
  • Pain is a common symptom of craniofacial disorders and is accompanied by interference with vital functions such a eating, swallowing, and speech.  Twenty-two percent of adults reported some form of oral-facial pain in the past 6 months.  Pain is a major component of trigeminal neuralgia, facial shingles (post-herptic neuralgia), temporomandibular disorders, fibromyalgia and Bell’s palsy
  • Population growth as well as diagnostics that are enabling earlier detection of cancer means that more patients than ever before are undergoing cancer treatments.  More than 400,000 of these patients will develop oral complications annually.
  • Immunocompromised patients, such as those with HIV infection and those undergoing organ transplantation, are at higher risk for oral problems such as candidiasis.
  • Employed adults lose more than 164 million hours of work each year due to dental disease or dental visits
  • For every adult 19 years or older with medical insurance, there are three without dental insurance.
  • A little less than two thirds of adults report having visited a dentist in the past 12 moths.  Those with income at or above the poverty level are twice as likely to report a dental visit in the past 12 months as those who are below the poverty line.

OLDER ADULTS

  • Twenty-three percent of 65- to 74-year-olds have severe periodontal disease (measured as 6 millimeters of periodontal attachment loss).  (Also, at all ages men are more likely than women to have more severe diseases, and at all ages people at the lowest socioeconomic levels have more severe periodontal disease.)
  • About 30 percent of adults 65 years and older are edentulous, compared to 46 percent 20 years ago.  These figures are higher for those living in poverty.
  • Oral and pharyngeal cancers are diagnosed in about 30,000 Americans annually; 8,000 die from these diseases each year.  These cancers are primarily diagnosed in the elderly.  Prognosis is poor.  The 5-year survival rate for white patients is 56 percent; for blacks, it is only 34 percent.
  • Most older Americans take both prescription and over-the-counter drugs.  In all probability, at least one of the medications used will have an oral side effect – usually dry mouth.  The inhibition of salivary flow increases the risk for oral disease because saliva contains antimicrobial components as well as minerals that can help rebuild tooth enamel after attack by acid-producing, decay-causing bacteria.  Individuals in long-term care facilities are prescribed an average of eight drugs.
  • At any given time, 5 percent of Americans aged 65 and older (currently some 1.65 million people) are living in a long-term care facility where dental care is problematic.
  • Many elderly individuals lose their dental insurance when they retire.  The situation may be worse for older women, who generally have lower incomes and may never have had dental insurance.  Medicaid funds dental care for the low-income and disabled elderly in some states, but reimbursements are low.  Medicare is not designed to reimburse for routine dental care.

Source:  U.S. Department of Health and Human Services. Oral Health in America:  A Report of the Surgeon General.Rockville, MD:  U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000:2-3.