By Susan Richards
The current doctrine that oral health is connected to overall physical health is a given; however, when Oral Health in America: A Report of the Surgeon General was released in 2000 it was considered a milestone for the dental industry. Additionally, then-Surgeon General David Satcher brought to light the inequities in access to affordable oral health care in the U.S.
Two decades later, the National Institutes of Health (NIH) has issued an update to that report titled Oral Health in America: Advances and Challenges, and it offers both good and bad news on the current state of oral health in America.
The comprehensive, 790-page report was prepared under the direction of the current U.S. Surgeon General, Vice Admiral Vivek H. Murthy, MD, MBA, NIH Director Francis S. Collins, MD, PhD, and Rena D’Souza, DDS, MS, PhD, Director of the National Institute of Dental and Craniofacial Research (NIDCR). It was also compiled and reviewed by more than 400 multi-disciplinary contributors. To make it easier to access and understand all the data, the NIDCR has broken it down into sections and snapshots here with the following categories:
- Effect of Oral Health on the Community, Overall Well-Being and the Economy
- Oral Health Across the Lifespan: Children
- Oral Health Across the Lifespan: Adolescents
- Oral Health Across the Lifespan: Working-Age Adults
- Oral Health Across the Lifespan: Older Adults
- Oral Health Workforce, Education, Practice, and Integration
- Pain, Mental Illness, Substance Abuse, and Oral Health
- Emerging Science and Promising Technologies to Transform Oral Health
Continuing Disparities in Care
In Section 1 of the NIH report, the connections between oral health and economic health were examined. It was estimated that $45.9 billion in productivity losses in 2015 could be attributed to untreated oral disease. A 30% increase in dental costs over the past two decades, combined with approximately 66 million Americans without dental insurance coverage, has further widened the gap of oral health care for low-income families and marginalized communities.
As previously written in the Incisor, inequality has created roadblocks to dental care due to social determinants of health, referring to the conditions of where Americans are born, live, and work.
Robert J. Weyant, MS, DMD, DrPH, the senior editor of the first section in the report stresses the point that poor oral health is not a failure at the individual level and shouldn’t be treated as such. “We are where we are today because of deliberate policy choices made years ago,” said Dr. Weyant, specifically referring to the legislative push for essential dental care for children, but little regard for adult and senior care and coverage.
Oral Healthcare by Lifespans
While dental caries are the most prevalent of the oral health concerns for children, there has been an encouraging decrease of caries in permanent teeth from 25% to 18%. However, almost half of the children in the country don’t benefit from regular dental care as a result of socioeconomic status and race. Another worrisome find in the recent report showed that there has been little progress in dental care for children with special needs since the 2000 study.
Although adolescence is a pivotal time in life, it’s often overlooked in major studies. The new NIH report looked at some of the factors that impact the oral health of 12- to 17-year-olds. These included malocclusion of permanent teeth, dental erosion, and dental injuries: approximately 20% of teens have exhibited incisor fractures. Also of concern is the increase of e-cigarette usage among this age group.
High-risk behaviors continue to be a problem with adults as well, including the use of tobacco, opioids, and alcohol that can lead to tooth loss, gum disease, and oral cancers. Additionally, the human papillomavirus (HPV)-related cancers have doubled since the original 2000 report. While dental technology and education has made advances, the U.S. population still struggles with oral healthcare, as more than a quarter of working-age adults lack dental insurance coverage.
Our country is graying rapidly with 1 in 5 Americans expected to be older than 65 by 2030. Older adults have benefited from improved oral health over the years, and more are keeping their natural teeth than ever before. But again, inequities persist for seniors who lose insurance upon retirement or lack access to care due to location, transportation, and other socioeconomic factors.
Researchers on the project see the oral health care of senior citizens as being one of the biggest issues that needs addressing, especially considering that the majority live with some type of chronic disease which can affect their overall health as well.
More Than a Report – A Call to Action
The comprehensive landmark report also reviewed the exciting advances in dental technology, pointing out that today’s students are gaining skills and tools that authors of the 2000 review couldn’t have imagined. Digital records, impressions, and 3D fabrication all contribute to an easier patient experience too.
Although COVID-19 caused major disruptions to dental practices, it helped to incentivize dentists to up their infection control protocols. The pandemic also galvanized the industry to recognize dental health as essential care and reinforce the understanding that it’s intertwined with overall well-being.
As the title indicates, the authors acknowledge the challenges as well as the advances, expressing concern about the ongoing systemic inequities, as well as the rising costs of both dental care and dental education.
But they also include recommendations for the future of the country’s oral health, including the goal for all health professionals to work together, integrating medical and dental care where needed; that a more diverse workforce can improve access; and that insurance coverage and affordability can be expanded.
Let’s hope we don’t have to wait 20 years to see actionable change and opportunities for patients in light of this groundbreaking report.
Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan’s career includes award-winning feature writing, as well as creating content with context for a wide variety of industries.