Study Shows Oral Health Improvements, but Disparities Remain
Recent articles from the New York Times1 and HealthDay News2 have reported encouraging improvements in the oral health of many Americans, but some are making more progress than others, according to a new study from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH).3
The CDC/NIH study examined data from two reporting periods of the National Health and Nutrition Examination Survey (NHANES), covering 1988-1994 and 1999-2002, to monitor national trends in oral health conditions and practices in representative population subgroups (aged greater or equal to two years old). The study assessed cumulative data from both reporting periods to provide current estimates of select dental conditions, including dental caries, edentulism, enamel fluorosis, and the use of dental sealants.
The study revealed considerable oral health improvements over the past decade, including an increase in sealant prevalence among children and adolescents (from 19.6% to 32.2%), a decrease in caries prevalence and severity for adults, and a decline in tooth loss for older Americans. Based on the NHANES data, adults aged greater than or equal to 20 years now retain a mean of 24 out of 28 possible natural teeth, and less than 8% of the general population is edentulous.
The study also highlighted four primary trends in individual oral health:
- Among children aged 2-11 years, caries prevalence in primary teeth held steady.
- For children and adolescents aged 6-19 years, caries prevalence in permanent teeth decreased up to 10 percentage points, and for dentate adults (greater than or equal to 20 years old) the reduction was up to 6 percentage points.
- The proportion of children and adolescents aged 6-19 years who had received dental sealants increased nearly 13 percent.
- Total edentulism among persons 60 years and older dropped by six percentage points.
The CDC/NIH study also identified notable disparities in oral health care across all age groups, racial and ethnic groups, and persons with lower education and income. Children from families with lower incomes had more dental caries, and minority children had more untreated decay. Non-Hispanic black adults were found to retain fewer teeth than non-Hispanic white and Mexican-American adults. In addition, lower-income American adults were found to have twice the untreated tooth decay than experienced by their more affluent peers.
Over the past half-century, preventive oral-health strategies and interventions have generated dramatic improvements in the nation’s oral health, resulting in significant reductions in caries prevalence. In 1999, the CDC identified community water fluoridation as one of ten great public health achievements of the 20th century4,5 Furthermore, as noted by ADA president Dr. Richard Haught, the CDC/NIH study “tells us that preventive measures such as dental sealants, water fluoridation, regular dental visits and programs to promote good oral hygiene practices are having a positive impact on the nation's overall oral health.”6
Appropriate public health interventions and prevention measures, such as oral hygiene instruction, community water fluoridation, and dental sealants (when appropriate), are recommended for patients of all age groups and sociodemographic categories. The Association will continue to promote public awareness of oral disease disparities and of dentally underserved populations, and work with key stakeholders to encourage public-private collaborations designed to improve access to care in critical areas.
1 Bakalar N. Dental health getting worse for some, report says. NY Times. September 13, 2005.
3 Beltran-Aguilar ED, Barker LK, Canto MT, Dye BA, Gooch BF, Griffin SO, Hyman J, Jaramillo F, Kingman A, Nowjack-Raymer R, Selwitz RH, Wu T; Centers for Disease Control and Prevention (CDC). Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism, and Enamel Fluorosis—United States , 1988–1994 and 1999-2002. MMWR Surveill Summ. 2005 Aug 26;54(3):1-43.
4 Centers for Disease Control and Prevention. Fluoridation of drinking water to prevent dental caries. Morbidity and Mortality Weekly Report 1999; 48(41):933-940.
5 Centers for Disease Control and Prevention. Ten great public health achievements—United States, 1900-1999. Morbidity and Mortality Weekly Report 1999; 48(12):933-940.
Oral Health Topics: Access to Oral Health Care
For additional resources, including ADA News and JADA Articles, see the Oral Health Topic: Access to Oral Health Care.