What is oral health and how common are oral health problems?

According to the CDC, oral health affects our ability to speak, smile, eat, and show emotions. It also affects self-esteem, school performance, and attendance at work and school.  Oral health problems include untreated tooth decay, gum disease, tooth loss, and oral cancer.  By age 34, more than 80% of people have had at least one cavity.  On average, the nation spends more than $113 billion a year on costs related to dental care.^[1]

Tooth decay, also known as cavities (the scientific term is dental caries), is a common condition afflicting children and adults in the United States.^[2]

• About 1 of 5 (20%) children aged 5 to 11 years have at least one untreated decayed tooth.
• 1 of 7 (13%) adolescents aged 12 to 19 years have at least one untreated decayed tooth.
• The percentage of children and adolescents aged 5 to 19 years with untreated tooth decay is twice as high for those from low-income families (25%) compared with children from higher-income households (11%).
• Tooth decay, affects up to two-thirds of adolescents ^[3] 

The Causes of Oral Health Problems

Tooth decay, or cavities, are caused by an erosion of the tooth’s enamel by the acids produced by bacteria that forms a film called plaque that collects on the surface of teeth, especially along the gum line and in the crevices on the chewing surfaces of the teeth. Eating and drinking foods high in sugar and other simple carbohydrates make it easier for bacteria to produce the acids that can demineralize the enamel, or when exposed, cause the root surface to break down. Untreated tooth decay can lead to abscess in the jaw under the tooth.  Like all infections, it can spread to other parts of the body and have serious, and in rare cases fatal, results. 
Gum disease, or periodontal disease, is mainly the result of bacterial infections and inflammation (i.e. gingivitis) of the gums.  Plaque can lead to hard deposits of calculus that contribute to the periodontal disease process that in turn can weaken and destroy the bone that surrounds and supports the teeth.  Teeth with little bone support can become loose and may eventually have to be extracted.  Chronic conditions that increase the risk for periodontal disease include diabetes, a weakened immune system, poor oral hygiene, and heredity.

The lifetime risk of oral cancers can be minimized by avoiding high risk behaviors starting as a teen, including cigarette, cigar or pipe smoking, use of smokeless tobacco, and excessive use of alcohol.  And early detection can increase the survival rate for oral cancers. Oral human papilloma virus (HPV), the most common sexually transmitted disease, can also cause cancers of the throat, called oropharyngeal cancers.

Preventive Advice for Children

Fortunately tooth decay is largely preventable. Community water fluoridation and school-based dental sealants programs are both cost-saving, proven strategies to prevent tooth decay.^[4][5] Fluoride varnish, a high concentration fluoride coating that is painted on teeth, can prevent about one-third (33%) of decay in the primary (baby) teeth. ^[6] Children living in communities with fluoridated tap water have fewer decayed teeth than children who live in areas where their tap water is not fluoridated. ^[7] Similarly, children who brush daily with fluoride toothpaste will have less tooth decay.^[8] Applying dental sealants to the chewing surfaces of the back teeth is another way to prevent tooth decay. Studies in children show that sealants reduce decay in the permanent molars by 81% for 2 years after they are placed on the tooth and continue to be effective for 4 years after placement.^[9]

CDC advises parents and caregivers to ensure good oral health for children with the following steps:

• Protect your child's teeth with fluoride.
• Use fluoride toothpaste.
• If your child is younger than age 6, watch your child brush their teeth. Make sure your child only uses a pea-sized amount of toothpaste and always spits it out rather than swallows it.
• If your child is younger than age 2, do not use fluoride toothpaste unless your doctor or dentist tells you to.
• Learn more about fluoride toothpaste and other sources of fluoride at Brush Up on Healthy Teeth.
• Talk to your pediatrician, family doctor, nurse, or dentist about putting fluoride varnish on your child’s teeth as soon as the first tooth appears in the mouth.
• If your drinking water is not fluoridated, ask your dentist, family doctor, or pediatrician if your child needs oral fluoride supplements like drops, tablets, or lozenges.
• Talk to your child's dentist about dental sealants. Sealants protect teeth from decay.
• Visit a dentist for a first checkup by age 1, as recommended by the American Academy of Pediatrics. 
• If your school does not have sealant program, ask them to start one.

Find a dentist if your child needs one. Use the Insure Kids Now Dentist Locator.^[10] (https://www.insurekidsnow.gov/state/find-a-dentist/index.html)

Oral health problems of teens and adults include the following:

• Untreated tooth decay. More than 1 in 4 (27%) adults in the United States have untreated tooth decay.^[11] Among those aged 20-64 years, more than 90% have had at least one cavity, and 27% had untreated decay.^[12]
• Gum disease. Nearly half (46%) of all adults aged 30 years or older show signs of gum disease; severe gum disease affects about 9% of adults.^[13]
• Tooth loss. Complete tooth loss among adults aged 65-74 years has steadily declined over time, but disparities exist among some population groups. ^[14]If left untreated, tooth decay and periodontal (gum) disease lead to tooth loss.
• Oral cancer. Oral cancers are most common in older adults, particularly in people older than 55 years who smoke and are heavy drinkers.^[15] In 2012, there were nearly 40,000 new cases of cancer of the oral cavity and pharynx diagnosed in the United States and nearly 9,000 deaths. The 5-year survival rate for these cancers is about 59 percent.^[16] (See chapter 6, Preventing Cancer.)
• People who receive cancer chemotherapy may suffer from oral problems such as painful mouth ulcers, impaired taste, and dry mouth.
• Chronic diseases. Obesity and chronic diseases, such as arthritis, heart disease, stroke, diabetes, emphysema, hepatitis C, temporomandibular joint (TMJ) disorder and temporomandibular disorder (TMD), autoimmune conditions such as Sjorgren’s Syndrome, and osteoporosis may compromise oral health and functioning and increase the risk of having missing teeth.^[17]
• Patients with weakened immune systems, such as those infected with HIV and those on drugs that suppress the immune system (e.g., after organ transplants) and on some medications (e.g., steroids) are at higher risk for some oral problems.^[18]

Oral Health Prevention for Teens and Adults^{[19] [20]}

It is only recently that the majority of people will keep most of their natural teeth over their entire lifetime.  Public health experts attribute this progress in oral health largely to the benefits of water fluoridation and use of fluoride toothpaste. However, threats to oral health continue throughout life and may increase with age because of problems with saliva production; receding gums that expose “softer” root surfaces to decay-causing bacteria; or difficulties flossing and brushing because of poor vision, cognitive problems, chronic disease, and physical limitations.

Although some adults may have difficulty accessing dental treatment expert care is essential. For every adult aged 19 years or older without medical insurance, there are three who don’t have dental insurance. ^[21] Continuing dental care includes at least once daily brushing and flossing. The American Dental Association recommends, "brushing for two minutes, twice a day with a fluoride toothpaste, cleaning between teeth once a day with an interdental cleaner and regular dental visits advised by your dentist." The ADA also stated that interdental cleaners, including floss, "are an essential part of taking care of your teeth and gums."^[22] Professional cleaning by a dental hygienist two or three times a year, periodic dental X-rays and evaluation by a dentist at regular intervals and restorative dentistry as needed are also essential to maintain good oral health.  Minimizing consumption of high sugar foods, sugar sweetened beverages and other refined carbohydrates is also advisable for children, teens and adults.

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Endnotes and Links

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