The release this year of “Oral Health in America: A Report of the Surgeon General”—the first such report on this topic in U.S. history—gives national visibility to the scope and breadth of oral health and disease in America. The report emphasizes oral health's inextricable link to general health and well-being. Although the country has seen major improvements in oral health, some population groups have yet to benefit from these improvements. To address health disparities and improve quality of life for all Americans, the surgeon general's report calls for the development of a National Oral Health Plan.
Conclusions
“Oral Health in America” identifies opportunities for the dental profession on behalf of the nation's overall health. The profession is uniquely positioned to ensure that all components of the National Oral Health Plan are addressed: changing perceptions to ensure that oral health is seen as integral to general health; removing barriers to care; enhancing health infrastructure; accelerating the transfer of science into practice; and continuing to participate in private/public partnerships.
Clinical Implications
The report's findings highlight the importance of assessing patients' known risks of experiencing oral diseases and of educating patients about health-promoting behaviors. The integral role of oral health in general health, as described in the report, makes it imperative for health professionals to ensure appropriate referrals to practitioners in all areas of health care.
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MESSAGES AND ACTIONS
For those in the dental profession, many of the messages of “Oral Health in America” are not new. Nevertheless, for the public and for the health care provider community at large, this report presents bold messages about the importance of oral health and what can be done to further improve it—and, thereby, improve general health—in this country. The report's major message is that “oral health is essential to the general health and well-being of all Americans and that improved oral health
FIVE KEY QUESTIONS: WHAT THE REPORT ADDRESSES
The current and future challenges to the public, providers of oral health services, educators, researchers, administrators and policy-makers are found in the responses to the five questions that serve as the framework of the surgeon general's report:
What is oral health?
What is the status of oral health in America?
What is the relationship between oral health and general health and well-being?
How is oral health promoted and maintained and how are oral diseases prevented?
What are the needs
A FRAMEWORK FOR ACTION
Surgeon General Satcher states that “everyone has a role in improving and promoting oral health. Together we can work to broaden public understanding of the importance of oral health and its relevance to general health and well-being, and to ensure that existing and future preventive, diagnostic and treatment measures for oral diseases and disorders are made available to all Americans.”1 He puts forth a framework for action, calling on everyone—individual people, health care providers,
THE REPORT AS A SPRINGBOARD
The report stays true to its charge, highlighting the critical and extensive relationships between oral health and general health and between oral health and lifelong well-being. The media flurry at the time of the report's release shows the breadth of the national, state and local interest. At that time, both Surgeon General Satcher and Secretary Shalala emphasized the importance of oral health and warned the American people that ignoring oral health problems can be devastating. Many
CONCLUSION
There is no question that dentistry is uniquely positioned to lead the nation in further improvements of oral health and to build on the many findings highlighted in the surgeon general's report on America's oral health. The report has proved to be a visible and far-reaching document. The full report contains much highly detailed information and provides a platform for future initiatives regarding oral health in America. We need to use it as part of the armamentarium to further
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2024, American Journal of Orthodontics and Dentofacial Orthopedics
Near-infrared imaging (NIRI) has been proposed as an alternative to radiographs and uses nonionizing radiation in the near-infrared spectrum to differentially scatter light off tooth surfaces and generate images allowing interproximal caries detection. The new iTero 5D Element Scanner (Align Technology, Santa Clara, Calif) has integrated NIRI capture and viewing technology but has not been specifically studied in a pediatric population. Therefore, this study aimed to assess clinicians’ abilities to detect and characterize caries in pediatric patients using this instrument.
Bitewing (BW) radiographs and an intraoral scan were captured on 17 pediatric patients (344 surfaces were analyzed). Data were randomized and graded by 5 calibrated clinicians individually with 2 different rounds of grading.
The reliability of lesion characterization (ie, grade) among examiners was poor to fair in both systems, whereas the reliability of caries detection was moderate. Both systems had a high specificity and low sensitivity. The reliability of the characterization of the combined dataset was moderate to substantial, whereas, for detection, it was substantial.
When using either BW or NIRI analysis, reliability is relatively poor, and clinicians are more likely to correctly identify a healthy tooth surface when compared with a carious surface. There is a small difference in error rate between BW and NIRI systems that is not likely to be clinically significant. When NIRI and BW data are combined, clinician agreement for both lesion characterization and detection increases significantly.
The authors aimed to measure population-based preventable emergency department (ED) visits related to infectious oral conditions (IOCs) in Massachusetts and to examine the associated sociodemographic factors to support prevention efforts.
A statewide retrospective analysis of ED visits related to IOCs in Massachusetts from 2014 through 2018 was conducted using a Center for Health Information and Analysis database. The authors described patients' characteristics, dental diagnoses frequencies, emergency severity, lengths of stay, associated treatment, and costs. Multilevel logistic regression was used to assess factors associated with IOC visits.
IOC visits in 2014 through 2018 were 1.2% (149,777) of the total ED visits, with an estimated cost of $159.7 million. There was an annual decline in the prevalence of IOC visits from 2014 through 2018. After adjusting for sociodemographic factors, odds of IOC were higher among males (adjusted odd ratio [AOR], 1.26; 95% CI, 1.24 to 1.27), non-Hispanic Blacks compared with non-Hispanic Whites (AOR, 1.03; 95% CI, 1.02 to 1.06), people residing in dental health care professional shortage areas (AOR, 1.06; 95% CI, 1.04 to 1.07), public insurance beneficiaries (AOR, 1.90; 95% CI, 1.87 to 1.93), or uninsured (AOR, 2.60; 95% CI, 2.54 to 2.66) compared with privately insured.
There was an annual decline in the prevalence of IOC visits from 2014 through 2018. Higher odds of IOC visits were associated with young adults, Black patients, uninsured people, public insurance beneficiaries, and people who reside in dental health care professional shortage areas.
The authors provided statewide data to support proposed policies to improve oral health care in Massachusetts. IOCs are mostly preventable, but well-coordinated care between medicine and dentistry is integral for prevention.
The Hispanic and Latino population is projected to increase from 16.7 percent to 30.0 percent by 2050. Previous U.S. national surveys had minimal representation of Hispanic and Latino participants other than Mexicans, despite evidence suggesting that Hispanic or Latino country of origin and degree of acculturation influence health outcomes in this population. In this article, the authors describe the prevalence and mean number of cavitated, decayed and filled surfaces, missing teeth and edentulism among Hispanics and Latinos of different national origins.
Investigators in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)—a multicenter epidemiologic study funded by the National Heart, Lung, and Blood Institute with funds transferred from six other institutes, including the National Institute of Dental and Craniofacial Research—conducted in-person examinations and interviews with more than 16,000 participants aged 18 to 74 years in four U.S. cities between March 2008 and June 2011. The investigators identified missing, filled and decayed teeth according to a modified version of methods used in the National Health and Nutrition Examination Survey. The authors computed prevalence estimates (weighted percentages), weighted means and standard errors for measures.
The prevalence of decayed surfaces ranged from 20.2 percent to 35.5 percent, depending on Hispanic or Latino background, whereas the prevalence of decayed and filled surfaces ranged from 82.7 percent to 87.0 percent, indicating substantial amounts of dental treatment. The prevalence of missing teeth ranged from 49.8 percent to 63.8 percent and differed according to Hispanic or Latino background. Significant differences in the mean number of decayed surfaces, decayed or filled surfaces and missing teeth according to Hispanic and Latino background existed within each of the age groups and between women and men.
Oral health status differs according to Hispanic or Latino background, even with adjustment for age, sex and other characteristics.
These data indicate that Hispanics and Latinos in the United States receive restorative dental treatment and that practitioners should consider the association between Hispanic or Latino origin and oral health status. This could mean that dental practices in areas dominated by patients from a single Hispanic or Latino background can anticipate a practice based on a specific pattern of treatment needs.
Dr. Evans is executive editor and project director, “Oral Health in America: A Report of the Surgeon General.” He also is assistant director, Los Angeles County Department of Health Services, Los Angeles, Calif.
Dr. Kleinman is co-executive editor, “Oral Health in America: A Report of the Surgeon General.” She also is assistant surgeon general, U.S. Public Health Service, Bethesda, Md., and deputy director, National Institute of Dental and Craniofacial Research, Building 31, Room 2C39, Bethesda, Md. 20892-2290.
