Better access to dental care and better oral health education among racial and ethnic minority groups still are needed.
One of our primary purposes as health care providers is to reduce the morbidity of oral disease. According to a recent surveillance report from the Centers for Disease Control and Prevention (CDC),1 we are achieving this goal with regard to dental caries. Although this report demonstrates a clear trend of improved oral health within the U.S. population as a whole during the past 10 to 15 years, it also highlights existing disease disparities among specific populations. Data from the National Health and Nutrition Examination Survey (NHANES) reporting periods of 1988 through 1994 and 1999 through 2002 were used to identify trends and to examine the present state of dental caries, dental sealants, tooth retention and tooth loss.
Dental caries is widespread and affects both the primary and permanent dentitions. Children between the ages of 2 and 11 years show a caries prevalence of 41 percent in their primary dentition, while 42 percent of children and adolescents between the ages of 6 and 19 years have caries in their permanent dentition. The prevalence of caries increases over time, and more than 90 percent of adults experience caries during their lifetime. The good news is that when the two periods are compared, there is a 7.4 percent absolute decrease in caries in the permanent dentition among children and adolescents, and an absolute increase of 12.6 percent in the use of sealants in permanent teeth. Unfortunately, only a small, absolute decrease in untreated caries of 1.6 percent was noted.
Coronal caries shows an interesting trend in which dentate adults with higher incomes have an increased caries rate (93.2 percent) compared with people with incomes of 100 to 200 percent of the federal poverty guidelines (FPG) (89.1 percent). This latter group, in turn, has a higher caries rate than people below 100 percent of the FPG (86.7 percent).
One explanation for this finding could be that people with low incomes will wait until they need an extraction, or they will choose to have an extraction rather than a more expensive dental procedure. Thus, they have less caries and fewer restored teeth than do patients with higher incomes. This assumption is supported by the much higher rate of untreated caries found among people with lower incomes. Those with family incomes above 200 percent of the FPG had a 15.7 percent rate of untreated carious lesions compared with a 35.3 percent rate among adults at 100 to 200 percent of the FPG, and a 40.9 percent rate among adults with family incomes below 100 percent of the FPG.
The prevalence of root caries among adults is 17.6 percent and is distributed unevenly over the years. While people older than 60 years have a root caries prevalence of more than 31.6 percent, younger adults (aged 20 to 39 years) have a root caries rate of only 9.4 percent, which increases to 17.8 percent among those 40 to 50 years old. An improvement of 5.8 percent less root caries was detected when the two survey periods (1988–1994 and 1999–2002) were compared.
Although 7.7 percent of all adults in the United States have lost all their teeth, the average number of remaining teeth among dentate people is almost 24—out of a full dentition of 28 teeth. Even dentate people older than 60 years have retained an average of more than 19 teeth. However, among the U.S. population, 24.9 percent of all people older than 60 years are edentulous, compared with only 4.9 percent of adults in the age bracket of 40 to 50 years.
Interestingly, Mexican-American adults had the lowest prevalence of edentulism compared with non-Hispanic whites and non-Hispanic blacks. The increase in tooth retention was slight—only one more tooth—when the two survey periods were compared, but the prevalence of edentulism decreased more than three absolute percentage points.
There are clear trends that can be noticed in this report. The prevalence and severity of caries in permanent teeth have dropped between the two survey periods, but not in primary teeth. Non-Hispanic black and Mexican-American children and adults, as well as families with incomes below 200 percent of the FPG, are more affected by caries than are non-Hispanic white people and families with incomes above 200 percent of the FPG. The same holds true for people with lower educational levels and current smokers.
With an aging population that, to a large extent, retains its dentition in later years, there still is work to be done. Although almost one-quarter of all people older than 60 years are edentulous, this proportion will most likely decline as the baby boomers get older. However, better access to dental care and better oral health education among racial and ethnic minority groups still are needed. The need to improve dental care among families wsith lower incomes and lower educational levels also is evident. The higher prevalence of caries among smokers may be a function of the lack of concern for overall and general health within this group, but it also could result from a possible direct causative relationship. Either way, instituting smoking-cessation programs may be beneficial.
This study, showing decreases in oral disease, retention of more teeth and a reduction in the disease disparities among racial and ethnic minorities, is a credit to our profession. We are doing a great job, but there still is work to be done.
