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Preventing Cavities, Gum Disease, and Oral Cancers

Oral Health Problems: Painful, Costly, and Preventable

Oral HealthMouth and throat diseases—ranging from cavities to cancer—cause pain and disability for millions of Americans. This fact is disturbing because almost all oral diseases can be prevented.

For children, cavities are a common problem that begins at an early age. Tooth decay affects nearly a fifth of 2–4-year-olds, more than half of 8-year-olds, and more than three-fourths of 17-year-olds. Hardest hit are low-income children. About half of all cavities among low-income children go untreated. Untreated cavities may cause pain, dysfunction, absence from school, underweight, and poor appearance—problems that can greatly reduce a child’s capacity to succeed in life.

Tooth decay is also a problem for adults, especially for the increasing number of older adults who have retained most of their teeth. Despite this increase in tooth retention, tooth loss remains a problem among older adults. Almost 3 of every 10 adults over age 65 have lost all of their teeth, primarily because of tooth decay and gum disease, which affects about 25% of U.S. adults. Tooth loss has more than cosmetic effects—it may contribute to nutrition problems by limiting the types of food that a person can eat.

Oral cancers also pose a threat to the health of American adults. Each year, about 30,000 Americans learn they have mouth and throat cancers, and nearly 8,000 Americans die of these diseases.

U.S. Children Ages 5–17 Years Who Have Had Cavities

This bar chart of 1988-1994 data shows how tooth decay affects U.S. children at very young ages and becomes more common as children grow older. About 10 percent of 5-year-olds had at least one cavity in a permanent tooth, compared with about 30% of 10-year-olds and more than 75% of 17-year-olds. Baby teeth are also affected by tooth decay. More than 40 percent of 5-year-olds had at least one cavity in a baby tooth, compared with nearly 60 percent of 9-year-olds. Source:  National Center for Health Statistics, CDC.  Third National Health and Nutrition Examination Survey, 1988-1994

Source: National Center for Health Statistics, CDC. Third National Health and Nutrition Examination Survey, 1988–1994.

In 2003, Americans made about 500 million visits to dentists, and an estimated $74 billion was spent on dental services. Yet many children and adults still go without measures that have been proven effective in preventing oral diseases and reducing costs. For example, more than 100 million Americans still do not have access to water that contains enough fluoride to protect their teeth, even though the per capita cost of water fluoridation over a person’s lifetime is less than the cost of one dental filling.

CDC’s National Leadership to Improve Oral Health

CDC is the lead federal agency responsible for promoting oral health through public health interventions. With fiscal year 2004 funds of about $12 million, CDC

  • Helps states strengthen their oral health programs, reach people hardest hit 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 in communities.
  • Evaluates the cost-effectiveness of prevention strategies.

Building Capacity in States

CDC provides 12 states and the Republic of Palau with funds, technical assistance, and training to build strong oral health programs. With CDC support, states can better promote oral health, monitor the population’s oral health behaviors and problems, and conduct and evaluate prevention programs. Four of these states also receive funds to develop and coordinate community water fluoridation programs or school-based dental sealant programs.

CDC also works with the Association of State and Territorial Dental Directors to give states guidance on oral health issues, raise state oral health program standards, and help states develop the expertise to assess oral health needs and conduct effective prevention programs.

Encouraging Effective Use of Fluoride

CDC provides national leadership in assessing the appropriate use of various forms of fluoride. CDC also works with partners to improve the quality of water fluoridation and implement water fluoridation in new communities.

Over the past 50 years, the damage caused by dental decay has been drastically reduced, primarily through the use of fluoride. The most cost-effective way to deliver the benefits of fluoride to all residents of a community is water fluoridation—adjusting the fluoride in the public water supply to the right level for decay prevention.

A CDC study found that, in communities with more than 20,000 residents, every $1 invested in community water fluoridation yields $38 in savings each year from fewer cavities treated. The Task Force on Community Preventive Services, which strongly recommends community water fluoridation, concluded that tooth decay in American children has decreased by 30%–50% because of fluoridation. CDC activities for promoting fluoride include

  • Providing fluoridation training to state drinking water system engineers, dental directors, and other public health staff.
  • Managing a Web-based system to help states monitor the quality of fluoridated water systems.
  • Educating people about the appropriate use of fluoride products.

Promoting Use of Dental Sealants

Dental sealants—a plastic coating applied to the chewing surfaces of the back teeth—are a safe, effective way to prevent cavities among schoolchildren. In some cases, sealants can even stop tooth decay that has already started. Sealants significantly reduce a child’s risk for having untreated cavities.

Healthy People 2010 calls for half of all U.S. children to have dental sealants by 2010, but currently less than 25% of schoolchildren do. Children in some racial and ethnic groups are less likely than others to have sealants. For example, only 10% of Mexican American 8-year-olds have sealants on their teeth.

CDC researchers evaluated several strategies and found that delivering sealants to all children attending low-income schools was the most cost-effective strategy for reducing disparities in sealant use. By offering school-based or school-associated sealant programs, some communities have already reached the Healthy People 2010 objective for dental sealants. In addition, the Task Force on Community Preventive Services strongly recommends school-based or school-linked sealant programs as an effective way to prevent and control cavities.

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