Surgeon General'S Perspectives: Oral Health: The Silent Epidemic

Surgeon General’s Perspectives
Oral Health: The Silent Epidemic
We are taught from an early age that proper oral health

is maintaining healthy teeth. The simple acts of brush-
ing and flossing are instilled in us so that we maintain
our “pearly whites;” yet, oral health is much more than
clean teeth. It involves the gums and their supporting
tissues, the palate, the lining of the mouth and throat,
the tongue, the lips, the salivary glands, the chewing
muscles, the nerves, and the bones of the upper and
lower jaws. Recent research has indicated possible asso-
ciations between chronic oral infections and diabetes,
heart and lung disease, stroke, and low birthweight or
premature births.1 In other words, oral health refers
to the health of our mouth and, ultimately, supports
and reflects the health of the entire body.
Since the 20th century, numerous advances in
research and technology have improved the status of VADM Regina M. Benjamin,
Surgeon General
oral health in America for most populations. With the
development of fluoridated drinking water and dental
sealants, Americans are less likely to experience tooth
loss and gingivitis by middle age, which commonly decay in their permanent teeth.3 Strikingly, one-quarter
plagued Americans prior to the turn of the last cen- of adults aged 65 years and older have lost all of their
tury.1 In addition, the development of dental implants teeth due to untreated oral disease.3,4
and the refinement of dental materials and treatment Despite these statistics, the majority of Americans
techniques have improved our ability to restore func- often take oral health for granted.2 Unknown to many
tion due to tooth loss. are the complications associated with untreated dental
Strides toward achieving the Healthy People 2010 caries and periodontal disease. If left untreated, they
objectives for oral health have highlighted the prog- may cause pain, dysfunction, poor appearance, loss of
ress made in recent decades. Between 1988–1994 and self-esteem, absence from school or work, and difficulty
1999–2002, the proportion of 15-year-olds with dental concentrating on daily tasks.3
caries (tooth decay) declined from 61% to 57%. Simi- The health disparities surrounding access to proper
larly, 15-year-olds with untreated dental caries dropped dental care add another layer of complexity. The silent
from 20% to 18%. Between 1992 and 2002, the pro- epidemic of oral diseases disproportionately affects
portion of the U.S. population served by community disadvantaged communities, especially children, the
water fluoridation increased from 62% to 67%, moving elderly, and racial/ethnic minority groups. Oral health
toward the target of 75%.2 Community water fluorida- disparities are exacerbated by the fact that a cavity
tion continues to be a vital, cost-effective method of continues to enlarge and become more difficult to
preventing dental caries. repair the longer it remains untreated. Only one in five
Although largely preventable, dental caries and school-aged children from low-income families receives
periodontal disease are the two biggest threats to oral dental sealants to prevent dental caries. Furthermore,
health, and are among the most common chronic 40% of Mexican American children aged 6–8 years
diseases in the United States. Dental caries is the most have untreated tooth decay, compared with 25% of
common chronic disease in children: it is about five non-Hispanic white children.3 More astonishing is the
times as common as asthma and seven times as com- 87% of American Indian and Alaska Native children
mon as hay fever. The most common cause of tooth aged 6–14 years and 91% of the 15- to 19-year-olds who
loss among adults is untreated periodontal disease. have a history of tooth decay.5
Fifty-three million people live with untreated tooth In 2000, former Surgeon General David Satcher
158  Public Health Reports / March–April 2010 / Volume 125

Surgeon General’s Perspectives  159
released Oral Health in America: A Report of the Surgeon the point that most Americans take their oral health
General,1 which highlighted the importance of oral for granted. Yet, as most of us benefit from these
health as the gateway to general health and well-being. advances, profound disparities in oral health still exist.
The report revealed how oral disease is a silent prob- To decrease the disparities that exist among differ-
lem, especially in underserved populations. In 2003, ent groups, all stakeholders at the federal, state, and
former Surgeon General Richard H. Carmona released community levels must be engaged in the issues sur-
a National Call to Action to Promote Oral Health,6 which rounding oral health promotion/disease prevention.
built upon Satcher’s report and underscored the many Additionally, raising the country’s understanding of
disparities related to oral health. It charged individuals, the linkage between good oral health and good overall
whether as community leaders, volunteers, health-care health will help to reduce the disparities associated with
professionals, researchers, or policy makers, to collabo- oral health and will lead to a healthier nation.
rate to promote oral health and reduce disparities. The author thanks Michael J. Strong, MS, MPH, an
The interest in oral health and related disparities MD candidate at Tulane University School of Medicine
has contributed to expanding the language in the Chil- and a summer 2009 intern at the Office of the Surgeon
dren’s Health Insurance Program Reauthorization Act General, for his contributions to this article.
of 2009 (CHIPRA). Under CHIPRA, states are allocated
funding to help strengthen existing programs and
provide additional services to low-income uninsured
children. The funding provided by CHIPRA allows
states to expand coverage of dental services necessary Regina M. Benjamin, MD, MBA
to prevent disease, promote oral health, restore health VADM, USPHS
and function, and treat emergency conditions.7 Surgeon General
An important first step in combating the two leading
causes of poor oral health—dental caries and periodon-
reFerenceS
tal disease—is understanding that tooth loss is often
the result of disease or injury, rather than an inevitable 1. Department of Health and Human Services (US). Oral health in
America: a report of the Surgeon General. Rockville (MD): HHS,
consequence of aging. Educational programs emphasiz- Office of the Surgeon General (US); 2000. Also available from:
ing the importance of oral health promotion/disease URL: http://www.surgeongeneral.gov/library/oralhealth [cited
2009 Jun 3].
prevention are also necessary to raise awareness and 2. Department of Health and Human Services (US). Healthy People
discourage the lack of concern regarding oral health. 2010: midcourse review on oral health. Washington: U.S. Govern-
ment Printing Office; December 2006.
Proper oral health is vital to a productive and healthy 3. Centers for Disease Control and Prevention, Division of Oral Health
life. Messages that encourage lowering sucrose intake, (US). Oral health: preventing cavities, gum disease, and tooth loss
reducing acidic beverage consumption, and routinely [cited 2009 Jun 3]. Available from: URL: http://www.cdc.gov/
nccdphp/publications/aag/doh.htm
brushing and flossing teeth should continue to be 4. National Institute of Dental and Craniofacial Research, National
disseminated through all sources of media, including Institutes of Health (US). Data and statistics [cited 2009 Jun 6].
Available from: URL: http://www.nidcr.nih.gov/DataStatistics
dental literature, television, newspapers, magazines, 5. Department of Health and Human Services (US). The 1999 oral
radio, and the Internet, and should be incorporated health survey of American Indian and Alaska Native dental patients:
into the education curriculum targeting children, care- findings, regional differences and national comparisons. Rockville
(MD): HHS, Indian Health Service (US); 1999.
givers, and communities. Together, we will be able to 6. Department of Health and Human Services (US). National call to
promote good oral health and encourage our children action to promote oral health. Rockville (MD): HHS, Public Health
Service, National Institutes of Health, National Institute of Dental
to be vigilant of their oral health status. and Craniofacial Research (US); Spring 2003. NIH Publication No.
Over the years, research, technological advances, 03-5303.
and public involvement have improved oral health to 7. Children’s Health Insurance Program Reauthorization Act of 2009.
Title V, Sec. 501.
Public Health Reports / March–April 2010 / Volume 125

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Surgeon General’s Perspectives

Oral Health: The Silent Epidemic

We are taught from an early age that proper oral health

158  Public Health Reports / March–April 2010 / Volume 125

Public Health Reports / March–April 2010 / Volume 125

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