Mouth 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
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 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
- 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
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
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.