Revisiting Oral Health in America: A Report of the Surgeon General

Oral Health in America: A Report of the Surgeon General,¹ released in 2000 during my tenure as surgeon general of the United States, was the first ever Surgeon General’s Report on Oral Health. Its purpose was to inform the American people about the importance of oral health and how crucial oral health is to overall health.

Although the Surgeon General’s Report on Oral Health acknowledged that progress had been made over the past 50 years, it also reported that significant oral health disparities exist between different racial/ethnic groups. For example, it had been predicted that by the year 2000, annually a little more than 30 000 Americans would be diagnosed with oral or oropharyngeal cancer (the seventh most common cancer among all American males and the fourth most common among Black males) and that approximately 8000 people would die of these diseases.² Also, poor children were found to suffer twice as many dental caries as their more affluent peers, and the disease was more likely to be untreated. The disparities were related to determinants of health, such as income, age, gender, race/ethnicity, access to care, and medical status.

According to the 2004 report Factors Affecting the Health of Men of Color in the United States³ released by the Health Policy Institute of the Joint Center for Political and Economic Studies, Black men (51%) are more likely to have untreated dental problems than are White men (28%). In addition to serious periodontal disease, Black men, with 50% having untreated cavities, are 1.5 times more likely than are White men to have missing teeth. General health risk factors, such as tobacco use and poor dietary practices, also affect oral and craniofacial health.

The Surgeon General’s Oral Health Report concluded that although common dental diseases are preventable, many people face barriers, sometimes insurmountable, that prevent their access to oral health care. The report outlined a collaborative National Oral Health Plan that is all inclusive and wide ranging in its approach to reducing oral health disparities. Furthermore, it emphasized the importance of focusing on people at the highest risk for specific oral diseases and improving access to existing care. One approach involved making dental insurance available to all Americans.

THE STATUS OF ORAL HEALTH IN AMERICA TODAY

So where are we today in terms of promoting oral health and preventing disease 16 years after the release of the first ever Surgeon General’s Oral Health Report? The 2011–2012 National Health and Nutrition Examination Survey⁴ found that, among children aged two to eight years, the prevalence of untreated tooth decay in primary teeth was higher for Hispanic and non-Hispanic Black children than for non-Hispanic White children. Other data showed that among Hispanic children aged six to 11 years, 27% had dental caries in permanent teeth, 1.5 times more than non-Hispanic White and Asian children had, at 18% each. Also, in those aged six to 11 years, non-Hispanic White children (at 44%) were more likely to have dental sealants than were non-Hispanic Black and Asian children (at 31% each). The study, thus, concluded, “Disparities in caries continue to persist for some race and ethnic groups in the United States.”^4(p1) It has been reported that almost half of Americans aged 30 years and older have periodontal disease, which is more prevalent among Blacks, the economically disadvantaged, the uneducated, and smokers.⁵

The American Cancer Society estimated that in 2016 close to 50 000 people would contract oral or oropharyngeal cancer and that close to 10 000 people would likely die of these diseases—a significant increase over the 30 000 and 8000, respectively, predicted for the year 2000. Their prevalence is greater among men than women, and the incidence is about the same for Blacks as Whites.⁶ Death rates from all cancers combined are higher among Blacks than Whites.⁷

In terms of promoting oral health and preventing disease, the good news is that our understanding of common oral diseases continues to grow. We know that people living in communities with water fluoridation have 25% fewer cavities than do those living in communities without fluoridation. Children’s access to dental care has improved because dental benefits are now required under the Affordable Care Act, which says that dental care for children is an “essential health benefit.” Oral health has benefitted from our efforts to reduce obesity. For example, more emphasis is now placed on good nutrition and healthy lifestyles by programs, such as Fuel Up to Play 60, that encourage children to eat more fruits and vegetables, thus helping to prevent tooth decay and build strong bodies.

The bad news is that too many Americans continue to experience needless pain and suffering from diseases of the mouth because of oral health disparities. Some prevention services, such as fluoridated water, are not available to everyone; the potential danger of fluoridation is a growing debate.

CONCLUSIONS

The major challenge, expressed in the conclusion of Oral Health in America: A Report of the Surgeon General, “that not all Americans have achieved the same level of oral health and well-being”^1(p287) is as relevant today as it was when the report was released in 2000. We must accelerate efforts toward achieving this goal. Continuing to play a major role in the effort to eliminate oral health disparities and improve oral health for all, the Centers for Disease Control and Prevention, Division of Oral Health has made oral health an integral part of public health programs in the United States.

We must address the compelling need for a more diverse oral health workforce. Continued investment in research, such as that undertaken by the National Institute of Dental and Craniofacial Research Centers for Research to Reduce Disparities in Oral Health, is critical. Lastly, we must continue to expand initiatives to prevent tobacco use and promote better dietary choices.

Looking to the future, we are hopeful that at least the children’s benefit, prioritized under the Affordable Care Act, will not be dismantled. Also, Medicare needs to cover routine and preventive dental care for our seniors. Despite the current social and political climate, we hope that progress will continue to be made toward eliminating oral health disparities and improving the oral health and overall health of all Americans.