Oral Health Update: Problems and Issues National Health Policy Forum The George Washington University it Washington, D.C. January 21, 2011 Caswell A. Evans, DDS, MPH Associate Dean for Prevention and Public Health Sciences UIC College of Dentistry
What are some of the oral health problems and issues among our population?
Dental caries (tooth decay) is the single most common chronic childhood disease-- 5 times more common than asthma and 7 times more common than hay fever Poor children suffer twice as much dental caries as their more affluent peers, and their disease is more likely to be untreated Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
Dental caries is one of the most common diseases among 5- to 17- year-olds Caries 58.6 Asthma 11.1 Hay fever 8.0 Chronic bronchitis 4.2 0 10 20 30 40 50 60 70 Percentage of children and adolescents ages 5 to 17 Note: Data include decayed or filled primary and/or decayed, filled, or missing permanent teeth. Asthma, chronic bronchitis, and hay fever based on report of household respondent about the sampled 5- to 17- year olds. Source: NCHS 1996 Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
Poor children 2 to 9 in each racial/ethnic group have a higher percentage of untreated Primary teeth than nonpoor children primary ed per decayed e untreate hild Non- Mexican Non- Hispanic American Hispanic Black White entage of th that are c Perce teet 80 70 60 50 40 30 20 10 0 67.4 70.5 56.1 56.9 57.2 37.3 Source: NCHS, 1996 Poor Children Nonpoor Children Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
Children For each child without medical insurance, there are at least 2.6 children without dental insurance Uninsured children are 2.5 times less likely than insured children to receive dental care Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
Cleft Lip/Palate Cleft lip/palate, l one of the most common birth defects, is estimated to affect 1 out of 600 live births for whites and 1 out of 1,850 live births for African Americans Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
Adults & Older Adults For every adult 19 years or older without medical insurance, there are three without dental insurance Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
Severe periodontal disease (measured as 6 millimeters of periodontal attachment loss) affects about 14 percent of adults aged 45 to 54 Twenty-three three percent of 65- to 74-year-olds have severe periodontal disease About 30 percent of adults 65 years and older are edentulous, compared to 46 percent 20 years ago Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
Oral and Pharyngeal Cancer Oral and pharyngeal cancers are diagnosed in about 30,000 Americans annually; 8,000 die from these diseases each year Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
Males have higher incidence rates of oral and pharyngeal cancers than females Black 6.0 20.8 White 6.0 14.9 Asian & Pacific Islander American Indian & Alaskan native 35 3.5 4.8 10.2 11.6 Female Male Hispanic* 8.8 0 10 20 30 Rate per 100,000 Note: Age adjusted to the 1970 U.S. standard *Data unavailable for Hispanic females Source: Adapted from Wingo et al., 1999; SEER Program, 1990-96, Ries et al 1999 Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
Cancers of the oral cavity and pharynx are the seventh most common cancers in white males and the fourth most common in black males (incidence per 100,000) Prostate Gland Lung & Bronchus Colon/Rectum Urinary Bladder Lymphomas Melanoma of Skin Oral Cavity & Pharynx Leukemia Kidney/Renal White Males 147.34 73.06 53.21 31.17 20.21 17 14.88 13.95 12.58 9.83 Prostate Gland Lung & Bronchus Colon/Rectum Oral Cavity & Pharynx Stomach Urinary Bladder Lymphomas Pancreas Kidney/Renal Pancreas Esophagus 13.5 Black Males 112.33 58.14 20.79 17.07 15.5656 15.44 14.91 14.47 222.88 0 50 100 150 200 250 0 50 100 150 200 250 Note: Age adjusted to the 1970 U.S. standard Sources: Adapted from Wingo et al. 1999; SEER Program, 1990-96, Ries et al. 1999
Surgical Repair VS. Issues: - Prevention of disease - Early intervention - Management of disease - Payment systems support surgical approach
Distribution and supply of oral health workforce Rural Low income Populations of color Elderly Emerging workforce models
Access to Care Oral Health Disparities
Lack of Health Information Technology - common nomenclature - common record systems - quality of care and outcome measures
Summary Surgical repair focus Distribution of supply workforce Access to care Oral Health Disparities Information Technology
You are not healthy without oral health. C. Everett Koop, (former) US Surgeon General