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ORAL HEALTH
Preventing Cavities, Gum Disease,
and Tooth Loss

At A Glance 2009

The Burden of Oral Disease

Oral health is often taken for granted, but is an essential part of our everyday lives. Good oral health enhances our ability to speak, smile, and kiss; smell, taste, touch, chew, and swallow; and convey a world of feelings and emotions through facial expressions. However, mouth and throat diseases, which range from cavities to oral cancer, cause pain and disability for millions of Americans each year.

• Tooth decay (cavities) is a common problem for people of all ages. For children, untreated cavities can cause pain, dysfunction, absence from school, difficulty concentrating on learning, and poor appearance—problems that greatly affect quality of life and ability to succeed. Children from lower income families often do not receive timely treatment for tooth decay and are more likely to suffer from these problems. Tooth decay also is a problem for many U.S. adults. Adults of some racial and ethnic groups experience more untreated decay.
   
• Periodontal (gum) disease is an infection caused by bacteria under the gum tissue that begin to destroy the gums and bone. Teeth become loose, chewing becomes difficult, and teeth may have to be extracted. Gum disease may also be related to damage elsewhere in the body; recent studies point to associations between such oral infections and diabetes, heart disease, stroke, and preterm, low-weight births. Research is underway to further examine these connections.

Most Oral Diseases are Preventable

Many children and adults still go without simple measures that have been proven effective in preventing oral diseases and reducing dental care costs. For example, fluoride prevents tooth decay, and the most cost-effective way to deliver the benefits of fluoride to all residents of a community is through water fluoridation—that is, adjusting the fluoride in the public water supply to the appropriate level for decay prevention. However, only 25 states have met the Healthy People 2010 objective of having 75% of their citizens on public water systems with water fluoridation. Fluoridation also is cost effective. A CDC study found that in communities with more than 20,000 residents, every $1 invested in community water fluoridation yields about $38 in savings each year from fewer cavities treated.

Dental sealants—plastic coatings applied to the chewing surfaces of the back teeth where most decay occurs—are a safe, effective way to prevent cavities. Yet, only about one-third of children aged 6–19 years have sealants. And, although children from lower income families are almost twice as likely to have decay as those from higher income families, they are only half as likely to have sealants.

Oral Health Problems are Costly

• Each year, Americans make about 500 million visits to dentists.
   
• In 2008, an estimated $102 billion was spent on dental services.

CDC’s Response

CDC is the lead federal agency responsible for promoting oral health through public health interventions. CDC does the following:

• Helps states strengthen their oral health programs, reach people most affected by oral diseases, and expand the use of measures proven effective in preventing oral diseases.
   
• Promotes oral health in communities, schools, and health care settings nationwide.
   
• Supports research to strengthen prevention efforts at the community level.
   
• Evaluates the cost-effectiveness of prevention strategies.

Support for State-based Programs

CDC provides 16 states with funds, technical assistance, and training to build strong oral health programs. With CDC support, states can better promote oral health, monitor oral health behaviors and problems, and conduct and evaluate prevention programs. This funding also allows states to enhance coordination and management of community water fluoridation programs and school-based dental sealant programs. CDC works with the Association of State and Territorial Dental Directors to guide states on oral health issues, improve state oral health program standards, and help states develop the expertise to assess oral health needs and conduct effective prevention programs.

Monitoring Oral Health in America

Routine surveys provide a wealth of information about the oral health of Americans—for instance, what are the most serious oral health problems, how many people are receiving preventive services, which oral diseases are on the rise, and which groups of people are most at risk. This information can guide public health practice.

CDC supports Web-based systems that bring together oral health data from many sources and makes this information widely available to public health professionals and consumers. For example, the National Oral Health Surveillance System (http://www.cdc.gov/nohss) links oral health data from various state-based systems, including state oral health surveys and the Behavioral Risk Factor Surveillance System.

In addition, the annual State Dental Program Synopses (http://apps.nccd.cdc.gov/synopses/index.asp) present state population demographics and information about the activities and funding levels of state dental programs.

CDC also manages the Data Resource Center (http://drc.hhs.gov), a joint project with the National Institute of Dental and Craniofacial Research, which assembles oral health data and other information needed to support research, policy development, and program evaluation.

CDC works to improve surveillance methods. Current measures of periodontal infections are extremely resource-intensive because they require a clinical examination. CDC is conducting research to develop self-report questions to measure periodontal disease status that can be readily included in state and local surveillance systems.

In addition, CDC helps state health departments collect, interpret, and share oral health data specific to their areas. States and communities use the data to monitor their progress in meeting Healthy People 2010 goals for oral health, target limited resources to people with the greatest needs, and compare their oral health problems with those of other states and the nation.

Providing Education and Sharing Expertise

CDC aims to assure that the public has the information it needs to achieve optimal oral health throughout the lifespan, either directly or by informing the public health professionals who serve them.

CDC provides national leadership in assessing the appropriate use of various forms of fluoride. CDC works with state and national partners to improve the quality of water fluoridation and to implement water fluoridation in more communities. CDC provides fluoridation training to state drinking water system engineers, dental directors, and other public health staff members. CDC manages a Web-based system that helps states monitor the quality of fluoridated water systems. Through the Web site and partners, CDC educates people throughout the country on the appropriate use of fluoride products.

CDC is also working with experts to publish updated guidelines for school-based dental sealant programs. CDC convened an expert work group to review the state of the science supporting specific practices in school-based and -linked dental sealant programs. CDC conducted and published several studies that answered important questions for school programs. CDC is working with public and private partners to ensure that they understand the safety and cost-effectiveness of these programs. Those new guidelines will be published in 2009.

Supporting Prevention Science and New Approaches

CDC supports research to enhance the effectiveness of interventions to prevent oral diseases. Besides the recent research activities on the effectiveness of dental sealants, CDC also has looked at fluoride use to see which interventions have been successful, and how to deliver them most efficiently and evaluate their ability to prevent and control tooth decay. In addition, CDC conducts studies to assess the cost-effectiveness of water fluoridation and school-based dental sealant programs. CDC has developed computer software, Sealant Efficiency Assessment for Locals and States (SEALS), that allows state and local programs to assess the impact of providing sealants, including estimating associated reductions in the cost of treating dental decay.

CDC supports demonstrations of new community approaches to promote adult oral health. These approaches include monitoring oral health status, expanding partnerships, supporting prevention research, and increasing public and professional awareness of common oral conditions, risk factors, and healthy behaviors. CDC has provided several grants to help states identify unmet oral health needs among older adults at high risk for oral diseases, as well as to devise community strategies to address these needs. Lessons learned from grant-funded projects are being shared with stakeholders involved in aging, public health, and dental public health activities.

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Guiding Infection Control in Dentistry

Infection control practice in dental offices is essential to ensuring the public’s safety and retaining its confidence. To help minimize the risk of transmitting infectious diseases in dental environments, CDC published an updated Guidelines for Infection Control in Dental Health-Care Settings available at http://www.cdc.gov/mmwr. CDC recommendations guide infection control practices in dental offices nationally and globally and provide direction for the public, policy makers, and dental practitioners. These recommendations also affect technology development in the dental industry. In addition, CDC investigates disease transmission in dental offices and identifies emerging problems.

Oral Cancer

Each year more than 30,000 new cases of cancer of the oral cavity and pharynx are diagnosed, and over 7,000 deaths occur. The 5-year survival rate for these cancers is only about 50%. Detection of cancer lesions at early stages affects treatment plans and increases the survival rate for these cancers. CDC is exploring ways to improve data collection on oral cancers and examining methods for identifying lesions or individuals with oral cancer at an earlier stage.

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Success Stories

Colorado Works to Improve Oral Health Among Schoolchildren

Colorado schoolchildren with oral pain and acute infection lose about 7.8 million hours of class time each year according to the state’s oral health surveillance system. African American and Hispanic children have about three times more untreated decay and missing teeth because of tooth decay, but are about one-third as likely to receive dental sealants. Studies show that children who receive dental sealants as part of a school-based or school-linked program have 60% fewer newly decayed teeth compared with children who are not in school programs.

CDC funded Colorado’s Oral Health Unit to develop a state plan, convene a statewide coalition, and develop community prevention efforts. State officials also are working to provide sealants to all Colorado children at greatest risk for tooth decay. In 2009, the Oral Health Unit will expand its Be Smart & Seal Them! program to include all urban schools with a student population of 50% or more who qualify for the federal free or reduced lunch program and rural school districts that serve families with a median income at or below 235% of the federal poverty level.

Colorado has partnered with community groups such as Denver Health, Eastern Plains, Southwest Smilemakers, and Eagle County to reach children most at risk for tooth decay with screening services, prevention services, and oral health education. During the 2007–2008 school year, more than 1,200 schoolchildren in Denver were screened for dental problems, and 971 received sealants. Children in rural areas received preventive services, such as sealants and fluoride varnish, as well as other dental treatments. Many of these children had never seen a dental provider before.

These partnerships have resulted in increased sealant coverage among schoolchildren in Colorado, which will help the state achieve its goal of reaching those students most in need of sealants.

[A text description of this map is also available.]

South Carolina Brings Groups Together To Address Oral Health Across the Lifespan

Public health programs often face the challenging task of bringing stakeholders with different points of view to the same table. The stakeholders must identify a common goal and remain energized as they work towards that goal.

For the past 5 years, with funding support from CDC, the Division of Oral Health of the South Carolina Department of Health and Environmental Control (DHEC) brought together two groups—the South Carolina Oral Health Advisory Council and the South Carolina Oral Health Coalition—to address oral health issues across the lifespan. These groups include representatives from private clinical practice, public health, academia, and communities, and each stakeholder brings a different perspective.

In early 2006, a series of focus groups conducted by CDC’s Division of Oral Health (DOH) revealed a lack of effective communication and coordination between the two groups. As a result, a unified meeting structure was introduced to help the groups work together toward a common goal. Through improved communication and a shared vision, the groups were able to successfully implement a comprehensive state oral health plan.

DOH kept coalition members engaged and actively involved in several activities, including advocacy training for stakeholders. Work groups formed to address seven key oral health areas—advocacy and policy, surveillance, water fluoridation, social marketing, workforce, chronic disease, and special populations.

Work groups also were created to address different age groups, such as early childhood, school-aged children, and older adults. This successful public-private collaboration has ensured a solid foundation for a long-lasting collaboration and commitment to achieve better oral health outcomes for all South Carolina residents.

New York Stakeholders Work Together To Develop State Oral Health Plan

Policy makers are often overwhelmed by many organizations advocating for many different health and prevention programs. Although all stakeholders are working to improve health, they can sometimes be at cross-purposes. A state oral health plan is a necessary and key component of public oral health infrastructure.

A plan identifies health problems and gaps in policy, prevention, access, and workforce issues. It also identifies surveillance needs and provides a common agenda for action. Before 2001, New York did not have a comprehensive plan.

With CDC funding, the New York State Department of Health’s Bureau of Dental Health brought together dental and nondental stakeholders to develop a state oral health plan. Five work groups were formed to address the key issues of policy, population-based prevention, access to care, workforce needs, surveillance, and research. The variety of stakeholders who served on the work groups ensured that many different local and state perspectives were represented, which can be difficult in a large, diverse state such as New York.

Using surveillance data, the work groups identified needs, highlighted the critical dental public health issues in the state, and defined goals and strategies for each issue. They set targets for each objective and identified best and promising practices. The plan was adopted statewide in 2005. Since that time,

• The plan has provided a blueprint for action for improving the oral health of all New York residents. It helps stakeholders partner with other groups to promote a common agenda.
   

• A statewide oral health coalition has been formed.
   

• Oral health indicators were included in the state health department’s Prevention Agenda for the Healthiest State.
   

• The New York Dental Association formed a task force to address key issues outlined in the plan.
   

• Several organizations, such as Perinatal Networks, Area Health Education Centers, and Rural Health Networks, adopted some of the recommendations in the plan and have advocated for policy changes to promote oral health.

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Related Materials

• Oral Health—At A Glance 2009 (PDF–3.3Mb)
• Oral Health—Success Stories (PDF–934K)
• CDCs Oral Health Web Site
• Preventing Dental Caries
• State and Program Examples (78K–PDF)

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Page last reviewed: March 3, 2009
Page last modified: March 3, 2009
Content source: National Center for Chronic Disease Prevention and Health Promotion