Surgeon General's Report On Oral Health: Implications For Children
The recent, first-ever, Surgeon General's Report on Oral Health is a milestone for oral health in America. The report explains the meaning of oral health, and why it is so important for overall health and well-being. The report stresses that oral health and general health are inseparable. It concludes by presenting a framework for action - which emphasizes building partnerships to enhance education, oral health care, research, and the elimination of barriers to care.
The National Institute of Dental and Craniofacial Research (NIDCR), directed by Harold C. Slavkin DDS, took the lead in the development of this report. The NIDCR, a component of the National Institutes of Health since 1948, is on the cutting-edge of oral, dental, and craniofacial research. The goal of the NIDCR is the resolution of all craniofacial diseases - from dental caries to oral cancer.
The Surgeon General's Report is based on a review of all of the scientific literature published in the English-language. The twelve chapters in the report were based on scientific papers submitted by subject-matter experts in various areas of craniofacial health and disease. Independent peer review was conducted for all sections of the report. The report focused on five important questions, which were used to organize it into five parts.
Part One: What Is Oral Health?
Good oral health does not just mean healthy teeth, but also a healthy mouth - which in turn affects overall well-being throughout life. Oral health and general health cannot be separated from one-another. Oral health means being free of oral-facial pain, oral cancer, oral disease, and craniofacial birth defects. The report noted that the genes which control the development of the head, neck, face, and mouth (the craniofacial complex) have counterparts in simpler organisms - like yeast, fruit flies, zebra fish, and mice. It is the evolutionary conservation of these genes which have facilitated research in craniofacial development and disease. The reports also noted that several components of saliva protect the oral tissue through antimicrobial agents, chemical buffering compounds, and minerals which remineralize enamel and keep it healthy.
Part Two: What is the Status of Oral Health In America
The report stated that microbial infections are the primary cause of most oral diseases. Examples include dental caries (bacterial infection), periodontal disease (bacterial infection), herpes labialis (viral infection), and candidiasis (fungal infection). Furthermore, the causes and development of disease affecting the mouth, head, and neck (the craniofacial structures) are complex - involving genetic, environmental, and behavioral factors. Despite improvements in the oral health status of most of the nation, the differences in oral health between some population groups is alarming. Those who suffer the most include poor children. Children who are medically compromised, or who have disabilities are also at greater risk for oral disease than the rest of the population. Tooth decay (dental caries) is the most common chronic childhood disease - five times more common than asthma. Poor children have twice as much dental caries as other children, and the disease is more likely to go untreated. Twenty-five percent of poor children have not been evaluated by a dentist before starting kindergarten. About 26 million American children lack dental insurance. Uninsured children are 2.5 times less likely to receive dental care than insured children. Fewer than twenty percent of Medicaid-covered children receive a dental visit in any given year. Finally, more than 51 million school hours are lost each year due to dental problems.
Part Three: What is the Relationship Between Oral health and General Health and Well-being?
Many systemic diseases have oral manifestations. The report gives examples of how the mouth may signal the presence of disease, and how cells from the mouth or samples of saliva, may be used as diagnostic tools for fighting disease.
Part Four: How Is Oral Health Promoted and Maintained, and How are Oral Diseases Prevented?
In spite of the importance of water fluoridation for oral health, over 100 million people in the U.S. have no community water fluoridation. The report also states that achieving and maintaining oral health requires appropriate self-care, complemented by professional care and community-based health activities. Children need appropriate diet, nutrition, oral hygiene, and health-promoting behaviors. Expenditures for dental services alone make up 4.7 percent, $53.8 billion, of the nation's health expenditures.
Part Five: What Are the Needs and Opportunities to Enhance Oral health?
The report found that anticipatory guidance provided during early dental visits, as well as risk assessment and management, are beneficial for children. The report proposed a framework for action, which included:
Changing health-care providers' perceptions of oral health.
Modifying the medical school curriculum to include more information on oral health and disease.
Improving the effective transfer of research findings to the public and to health professionals.
Improving epidemiological databases for oral health and disease in subgroups of the U.S. population.
Increasing the availability of dental insurance for poor children.
The citation for the Executive Summary is: U.S. Department of Health and Human Services. Oral health in America: A Report of the Surgeon General - Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000 and may be viewed at http://www.nidcr.nih.gov/sgr/execsumm.htm |
