Oral Health Health Article

ORAL HEALTH

In twenty-first century America, a healthy smile is considered necessary for social mobility and acceptance, interpersonal relations, employability, and a good self-image.

Poor oral health may lead to pain and infection, absence from school or work, poor nutrition, poor general health, an inability to speak or eat properly, and even early death. Studies done in the late 1990s showed that poor oral health may also lead to low birth-weight babies, heart disease, and stroke. It is clear that oral diseases play a significant role in compromising health potential. Up until the late 1990s, when the new HIV medications became available, over 90 percent of persons with AIDS had HIV-related oral diseases.

MAJOR ORAL DISEASES

There are many different types of oral diseases, but they are generally differentiated as being of hard tissue or soft tissue origin. Hard-tissue oral diseases are those of the teeth, supporting bone, and jaw; whereas soft tissue diseases affect the tissues in and around the mouth, including the tongue, lips, cheek, gums, salivary glands, and roof and floor of the mouth. Some oral diseases may result in both hard and soft tissue disorders or conditions such as cleft palate or oral-facial injuries. The major oral diseases and conditions are:

• Dental caries (tooth decay, cavities)
• Periodontal disease (gum disease)
• Malocclusion (crooked teeth)
• Edentulism (complete tooth loss)
• Oral cancer
• Craniofacial birth defects such as cleft lip and cleft palate
• Soft tissue lesions
• Oral-facial injuries
• Temporomandibular dysfunction (TMD)

The prevalence of oral diseases varies due to differences in the host, agent, and environment. Some diseases have higher rates in certain population groups due to personal habits such as a sugarheavy diet or poor oral hygiene. Others may occur more frequently in individuals who put themselves at risk for injury by not wearing seatbelts or by playing contact sports without using proper mouth and head protection. Environmental and cultural factors may also affect the rates of oral diseases. For example, persons who live in a community in which the water supply is fluoridated would have much less tooth decay than those who live in a nonfluoridated community. Certain cultures, especially in developing countries, have diets almost completely devoid of refined foods that have high sugar content, and therefore have much less tooth decay compared to the average American. A 1997 report by the U.S. Department of Agriculture found that Americans consume an average of about 154 pounds of sugars a year (or 53 teaspoons a day) most of it in processed foods, drinks, and sweets. This was a 28 percent increase in added sugar or sweeteners since 1982. Tooth decay may be viewed as a disease of civilization.

A NEGLECTED EPIDEMIC

Oral diseases have been called a "neglected epidemic" because, while they affect almost the total population, oral health is not integrated into most health policies or programs. This is especially true in the United States, where, in the year 2000, there were 125 million Americans without dental insurance. In addition, many people who have dental insurance are underinsured. Under such conditions, people who are knowledgeable about oral health and have the resources to pay for it are much more likely to receive regular dental care than are the poorer members of society. This situation has resulted in major disparities in oral health status in the United States. Low-income children between ages two and five have almost five times more untreated dental disease than high-income children, and people without health insurance have four times the unmet dental needs of those with private insurance.

Vulnerable or high-risk population groups like children, the poor, the developmentally disabled, the homeless, homebound and elderly persons, persons with HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), and ethnic and cultural minorities are at greater risk for oral diseases, primarily because they do not have access to preventive services or treatment. In 2000, the first ever Surgeon General's report on oral health stressed the importance of oral health as part of total health as well as the need to reduce oral health disparities in the United States.

Although there has been much progress in the improvement of oral health, both nationally and internationally, oral diseases are still epidemic in the United States and many other countries. The nation's dental bill in the year 2000 was about $60.2 billion, or 4.6 percent of total health expenditures in the United States. In 1970, dental care accounted for 6.4 percent of total health expenditures. This 28 percent decrease is primarily due to the higher costs of hospitals and medical care.