Dental Health Trends

   In the Summer 2005, articles in the New York Times (Sept. 13, 2005) and HealthDay News (Aug. 25, 2005) reported encouraging improvements in the oral health of many Americans, but some are making more progress than others, according to a recent study from the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH).

The CDC/NIH study examined data from two reporting periods of the National Health and Nutrition Examination Survey (NHANES), covering 1988-1994 and 1999-2002. The study used data from both reporting periods to provide current estimates of select dental conditions, including tooth decay, edentulism (missing teeth), enamel fluorosis (a fluoride poisining disease) and the use of dental sealants (thin plastic coatings applied to teeth to prevent decay).

The study revealed improvements in oral health over the past decade, including an increase in sealant prevalance among children and adolescents, a decrease in the prevalance and severity of tooth decay in adults, and a decline in tooth loss for older americans. However, there were notable disparities across all age, ethnic, and socioeconomic groups. Children from lower-income families had more dental caries, and minority children had more untreated decay. Non-Hispanic black adults were found to have more missing teeth than non-Hispanic whites, and lower-income American adults in general had twice the untreated tooth decay than their more affluent peers.

Dental fluorosis, a disease caused by excessive ingestion of fluoride during childhood, has shown increased prevalence over the last 30 years in both fluoridated and non-fluoridated communities. In some cases, the severity of dental fluorosis is also increasing. The most common symptom is a defect in the tooth enamel of children, causing a visible and aesthetically objectionable condition which can be a source of social embarrassment and related psychological problems in the school-aged population. In recent years, dental fluorosis has become a concern among dental health professionals for reasons beyond the cosmetic effects of excessive exposure to fluoride. Other tissues are thought to be damaged as well, and several studies have found correlations between the severity of dental fluorosis and the frequency of bone fractures in children and adults. The disease can be caused by exposure during early childhood to fluoride supplements, fluoridated toothpaste, and/or infant formula use in nonfluoridated communities.

The CDC recommends parental supervision of toothbrushing for children under 6, many of whom have not yet learned to control the swallowing reflex: no more than a pea-sized amount (0.25 g) of fluoridated toothpaste should be placed on the toothbrush, and after brushing the child should be encouraged to spit excess toothpaste into the sink. For children younger than 2 years, a dentist or other health care provider should consider the fluoride level in the community drinking water when weighing the risk and benefits of using fluoride toothpaste.

The American Dental Association (ADA) has, over the past half-century, promoted preventive oral-health strategies and interventions that have generated dramatic improvements in the nation's oral health. These interventions and prevention measures have included community water fluoridation, oral hygeine instruction, and encouraging the use of dental sealants in children and adolescents. However, the Association, in a statement released August 25, 2005 regarding the CDC report, decried these disparities and said:

"We and society should find it unacceptable that in 21st century America that millions of children still cannot sleep or eat properly and cannot pay attention in school because they're suffering from untreated dental disease, and that too many adults cannot find employment because of poor oral appearance."