Oral Health as a Reflection of Overall Health

In the spring of 2000, the first-ever Surgeon General's Report on Oral Health was released. This report highlighted the importance of good overall health, related oral health to overall health, and examined disparities in oral health care across the nation. After examining the current state of this county's oral health, and as part of the Healthy People 2010 campaign, the Surgeon General set several goals to increase oral health standards throughout the population. These goals include decreasing the number of cavities in children, increasing the percentage of children who have dental sealants, and making fluoridated water available to a greater percentage of the public.

In his report, the Surgeon General found that oral health is often an indication of a patient's overall health. In adults, dental and periodontal diseases often correlate with more serious problems, such as diabetes. In children, dental caries are one of the most common infectious diseases. Left untreated the patient could develop more serious and painful oral diseases and suffer from poor self-esteem in regard to perceived poor appearance due to dental disease.

The dangers of poor oral health is not only cosmetic, though. Oral diseases also can provide dangerous bacteria with easy access to a patient's blood stream. In otherwise healthy patients, the immune system is usually able to respond to these threats, but immune-compromised patients are at a much greater risk of developing serious complications this way.

Despite the fact that oral health is sometimes overlooked by physicians, it is an important part of primary care and a good indicator of overall health. If caught in its early stages, most oral diseases are easily treatable. One of the most important aspects of oral health though, is that it is an excellent example of how a little preventative care goes a long way.

This project-in-a-box will give you some ideas for activities that you can do to help improve oral health by increasing awareness of the importance of oral health and preventative care in the public and community activities, such as fluoridation programs. It will also provide you with the necessary background information on current oral health statistics and programs.

Activity Ideas

Speakers - You can ask a local dentist to come and talk to medical students about proper oral hygiene (for example, how often to brush and floss) as well as how to give a cursory dental exam as part of an overall physical and what to look for. This could be done as a brown bag lunch or even as part of a larger lecture series on preventative medicine.

Community project - You could become involved in a community program to advocate better oral health, such as water fluoridation efforts or a tobacco cessation campaign, or contact one of the resources at the bottom of this page to see what you can do in your area.

Visit schools - Good oral hygiene is much a matter of habit. The earlier children learn how to take care of their teeth and gums, the more likely they are to carry those habits with them into adulthood. You could visit elementary schools to talk to children about the importance of oral health, not just brushing and flossing, but wearing mouth guards while participating in sports. You could even widen the scope a bit and talk about other forms of preventative care, such as wearing bike helmets and buckling up in the car.

Children and Oral Health

Tooth decay
Dental caries are a common disease in children in the US. In children age 2-4, 17% have are affected by tooth decay. That figure rises to 52% of 8 year olds, and 78% of 17 year olds.

Unfortunately, many of these caries are left untreated. One in four children have untreated tooth decay. However, this example of poor oral health is not evenly distributed evenly throughout the population. Minorities and poor children have much higher rates of untreated tooth decay. In children age 2-5 in families with an income below $10,000, 1 in 3 has at least one untreated cavity. This number drops to 1 in 10 in families with an income of at least $35,000.

The number of untreated caries per patient is also unevenly distributed. Eighty percent of untreated caries in patients are found in just 25% of the affected children. These children are mostly from low-income and minority families. In low-income children, 50% of tooth decay is left untreated.

Dental decay, when left untreated, can lead to more serious problems. Untreated decay becomes painful for the patient. This can restrict the child's activities, leading, for example, to missed school days. Poor children suffer from 12 times more of these restricted activity days than do other children. Tooth decay can also instigate a change in eating habits that can cause the child to become underweight. The change in appearance as tooth decay progresses is also discouraging to children. All of these factors can put the child at a disadvantage for attaining success.

Sealants
The best way to fight this disease is through preventative measures. Besides regular brushing and flossing, dental sealants are an excellent way to protect teeth from the harmful bacteria that cause decay. In fact, when used properly, sealants are almost 100% effective. Some states are developing school sealant programs to increase the number of children who receive sealants. Ohio implemented such a pilot program in 1998. The results of this study showed that children in schools where sealant programs are in place are significantly more likely to have sealants applied. In schools without the program, 28% of children had sealants; whereas in schools with the program, 57% of children had sealants. This number is beyond the Surgeon General's goal of 50 percent. Moreover, the programs raised the number of children with sealants in all ethnic and socioeconomic groups, and show potential for eliminating the gaps in the distribution of dental sealants. Nationally, the number of 8 year olds with dental sealants is 23%, but only 11% of African American, 10% of Mexican American, and 3% of low-income children have sealants.

States that are currently developing and implementing programs to increase education of, prevent, and treat oral health disease in school children are: Maine, Rhode Island, South Carolina, and Wisconsin. These educational programs are important because the barriers to good oral health are more than financial. These deep disparities exist despite the fact that dental care is covered under Medicaid and SCHIP (State Children's Health Insurance Plan).

Adults and Basic Oral Health
Since the end of WWII, advances in the biomedical sciences led to much improved oral health for most Americans. The baby boomers will be the first generation wherein a majority of adults retain their natural teeth over their lifetime. Even so, 1 in 3 adults has untreated tooth decay, almost 1 in 2 has gingivitis, and more than 1 in 5 has a destructive gum disease. There is again an unequal distribution among low-income and minority groups. Of Americans earning an income of less than $10,000, 1 in 2 has at least one untreated cavity, vs. 1 in 6 Americans earning at least $35,000 a year. Certainly, lack of insurance has something to do with these figures. For every adult without medical insurance, there are 3 without dental insurance.

Oral cancer
Bad habits that commonly develop in adulthood, as well as the influence of certain kinds of drugs, can promote oral health disease if preventative measures are not taken. Tobacco is an important contributor to poor oral health. Smokers are seven times more likely to develop periodontal disease, and tobacco is a major risk factor for over 75% of oral and pharyngeal cancers. There are 30,000 new cases of oral cancer each year, and it is the cause over 8,000 deaths annually. The 5-year survival rate for oral cancer is about 50%, and even lower for African American men.

The effects of dry mouth
Another risk factor for oral disease is dry mouth. Saliva contains anti-microbial agents that fight damaging bacteria, as well as minerals that help rebuild tooth enamel. Dry mouth is a common side effect of many medications, so these patients are at a slightly greater risk of developing tooth decay. Chemotherapy patients are also at a greater risk for oral disease. Approximately 400,000 cancer patients suffer from chemotherapy-related oral health problems. Their weakened immune systems make this a more serious threat, as oral disease can diminish the mouth's ability to prevent harmful bacteria from entering the bloodstream.

Relationship to overall health
Oral health can often be used as an indicator for certain other health conditions. Oral conditions are sometimes used to help diagnose HIV infections or to determine the stage of infection. In women, bone loss in the lower jaw may precede bone loss in other parts of the skeleton. Also, saliva can be used as a diagnostic tool for drug use. There may be even more of a relationship between oral health and overall health than we now know. Research is currently being performed to study the correlation between oral health and certain diseases, such as diabetes and stroke.

Fluoridation
Over the past 50 years, oral health has steadily improved and dental decay has drastically decreased. This is mostly due to the increased use of fluoride in toothpaste and mouthwash and the fluoridation of public water supplies. The benefits of fluoride are undisputed, and using water to bring fluoride to a population is the cheapest way to benefit a large number of people. People who drink fluoridated water over a lifetime will develop 70% fewer cavities, and the per capita cost of fluoridated water over a lifetime is less than the cost of one dental filling. Yet today, only 62% of the US population with access to a public water supply system receives fluoridated water. That leaves 100 million Americans without this protective benefit in their drinking water. The Healthy People 2010 goal is to have 75% of Americans with access to a public water supply to have fluoridated water. Fluoridated water benefits the entire community, without regard to age, race, or economic status.

References and Resources

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

NIDCR News. First-ever Surgeon General's Report on Oral Health Finds Profound Disparities in Nation's Population. Rockville, MD: National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

National Health Law Program. GAO Issues Report on Dental Disease. Article found online: http://www.healthlaw.org/pubs/200007GAOdental.html, 2000.

Centers for Disease Control and Prevention. Improving Oral Health: Preventing Unnecessary Disease Among All Americans 2001. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention. Oral Health Resources. Fact sheets. Available online: National Center for Chronic Disease Control and Prevention, Centers for Disease Control and Prevention.

MMWR. Impact of Targeted, School-Based Dental Sealant Programs in Reducing Racial and Economic Disparities in Sealant Prevalence Among Schoolchildren - Ohio, 1998-1999. Atlanta, GA: Centers for Disease Control and Prevention, Aug 31, 2001. 50(34); 736-738.

Health Resources and Services Administration
U.S. Department of Health and Human Services
Oral Health Initiative
http://www.ask.hrsa.gov/OralHealth.cfm

Health Care Financing Administration
U.S. Department of Health and Human Services
State Children's Health Insurance Program

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Oral Health, MS F-20
4770 Buford Hwy, NE
Atlanta, GA 30341
1-888-CDC-2306
http://www.cdc.gov

National Institute of Dental and Craniofacial Research
National Institutes of Health
Building 45, room 4AS-19
45 Center Drive, MSC 6400
Bethesda, MD 20892-6400
http://www.nidcr.nih.gov

National Health Law Program (NHeLP)
http://www.healthlaw.org

National Oral Health Information Clearing House
U.S. Department of Health and Human Services
--offers pamphlets for professionals and patients
http://www.aerie.com/nohicweb

National Oral Health Resource Center
U.S. Department of Health and Human Services
http://www.ncemch.org/oralhealth

American Council on Science and Health
1995 Broadway
Second Floor
New York, NY 10023-5860
Phone: (212) 362-7044
Fax: (212) 362-4919
http://www.acsh.org