Oral health is “a state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.” – World Health Organization (WHO)
Oral health is essential for overall health and wellness of humans. It affects our ability to speak, smile, eat and make facial expressions to show emotions. Both children and adults are affected by oral health that impacts their self-esteem, as well as their performance & attendance at school and work.
Importance of Oral Health
Many Americans suffer pain and disability due to oral diseases like tooth decay, gum disease or oral cancer. Each year it costs billions of dollars to the taxpayers. Cavities are the most common oral diseases in the US, and over 80% of the population gets at least one cavity by the age of 34. As per the Centers for Disease Control and Prevention, over 40% adults had some form of pain in their mouth in 2015.
Oral health is linked to chronic diseases such as diabetes and heart disease. Risk behaviors like tobacco use, eating & drinking habits, and high-sugar beverages are also linked to oral health. People who are mindful about their eating & drinking habits have better oral health conditions compared to others.
Oral Health Condition
The teeth and its surrounding craniofacial (skull & face) structures is vital to our overall health and wellness. Common oral health conditions include:
- Tooth decay
- Periodontal (gum) diseases
- Oral cancer
- Cleft lip and palate
- Oral and facial pain
- Xerostomia (dry mouth)
Common Oral Health Issues
Cavity or tooth decay is a permanent damage on a tooth, featuring a tiny hole. It is caused when the enamel in tooth is damaged by acids produced by bacteria located in teeth plaque along the gum line and in crevices of the chewing tooth. Carbohydrate-rich food & drinks causes the bacteria to produce acids, resulting in the breakdown of the tooth enamel (coating outer surface of tooth). Tooth decay is generally preventable, but it continues to be the most common childhood disease that affects almost two-thirds of the adolescents. Even adults are affected by tooth decay; in the age group of 20-64 years, over 90% had at least one cavity, and almost 27% had untreated tooth decay. Untreated tooth decay can lead to severe infection under the gums and also spread to other parts of the body, which in rare cases can even be fatal.
Tooth decay can be prevented through programs like community water fluoridation and school-based dental sealants programs. Both the programs have been widely implemented in the US and have proved to be cost-saving and effective in preventing tooth decay.
Periodontal or Gum Disease
Gum disease is an oral health concern, caused by infections and inflammation of gums and bones surrounding and supporting the teeth. People suffering from certain health conditions, such as diabetes, weak immune system, poor oral hygiene, and hereditary factors – are prone to periodontal disease. Gingivitis, the early form of periodontal disease, if left untreated may affect the bones that supports the teeth, and also infect the gums. With little or no bone support, teeth can become loose and may have to be extracted eventually.
Oral and Pharyngeal (mouth and throat) Cancer
Oral cancer is a cancer of the oral cavity (lips & mouth) and oropharynx. Oral cancer is prevalent more among men, older people, and it varies by the socio-economic condition of people. In US, the mortality from oral cancer for some minorities (especially Blacks) is almost twice as high than for Whites. Early detection of oral cancer is vital for increasing the survival rate of the affected people.
Prevention of oral cancer is dependent on programs that sanitize people about the risks associated with behaviors like smoking cigarette, cigar or pipe; using smokeless tobacco; and consuming excessive alcohol.
Studies on causes of cancer has revealed that Oral Human Papilloma Virus (HPV) can cause “oropharyngeal cancer”, which is a cancer in the back of the throat. But medical scientists have not yet reached a conclusion whether HPV itself is the cause of oropharyngeal cancer, or there are other factors (like smoking or chewing tobacco) that interact with HPV causing this cancer. In North America, HPV infections have been found to be a primary cause of oropharyngeal cancer among young adults.
Children’s Oral Health
Cavities (tooth decay) is a common oral disease of children in the US. Children with untreated cavities experience pain & infections, leading to problems like eating, learning, speaking and playing. Such children miss school more often and also get lower grades than those who don’t have poor oral health.
- Almost 20% children in the age group of 5 to 11 years have at least one untreated cavity.
- Nearly 13% adolescents in the age group of 12 to 19 years have at least one untreated cavity.
- Children in the age group of 5 to 19 years from low-income families are more likely (25%) to have cavities, compared to children from higher-income families (11%).
Cavities can be prevented. Fluoride varnish have been effective in preventing almost 33% of cavities in baby teeth. Children residing in communities that have fluoride in tap water have fewer cavities than children from communities without it. Likewise, children who brush with fluoride toothpaste daily have fewer cavities than those who use toothpaste without fluoride.
Dental sealants have also been used to prevent cavities in children’s tooth, for many years now. It has been effective in preventing up to 80% of cavities in children.
Adult Oral Health
Most adults face oral health issues like loss of tooth, a threat that continue throughout life. With increasing age, most adults are likely to suffer tooth loss and gum decay due to decreased production of saliva; receding gums that expose the roots to bacterial decay; difficulties in brushing & flossing due to poor vision, cognitive issues, chronic diseases and physical disabilities.
Oral health problems in adults include:
- Untreated tooth decay
- Gum disease
- Tooth loss
- Oral cancer
- Painful mouth ulcers, impaired taste and dry mouth
Promoting Good Oral Care
Oral health care is determined by the social-economic status of the affected people. Generally, it has been observed that people from low education and income background, and people from certain ethnic groups, have higher incidence of oral diseases. Also, it has been established that people with poor oral health are mostly suffering from disabilities and other health complications, like diabetes.
Persons with poor oral health have been found to indulge in behaviors like:
- Using tobacco
- Excessive use of alcohol
- Poor diet
Oral care habits, like using fluoride toothpaste for brushing, flossing daily, and getting professional treatment for dental diseases, is essential for maintaining good oral health.
Barriers to dental treatments or to the use of preventive interventions include:
- Some people have limited access to dental services
- Some people lack awareness about the need for oral care
- High cost of oral health care
- Some people fear dental procedures
Interventions to prevent tooth decay includes 2 evidence-based programs – Community water fluoridation and school-based dental sealant program.
Community water fluoridation has been recommended by most public health organizations, including the American Dental Association, US Public Health Service, American Academy of Pediatrics, as well as the World Health Organization. In the US, the process of adding fluoride to community water began in 1945. It has since been adopted across the country by communities.
Community water fluoridation is an efficient and cost-effective way of delivering fluoride to everyone in a community, irrespective of the age, income or education level. Studies suggest that fluoridation of community water prevents tooth decay by 18 to 40%.
School-based dental sealant program started in the early 1970s and picked up momentum in the 80s. Today almost all states of the US have adopted the dental sealant program.
School-based dental sealant programs are targeted towards school children from low-income families and aim to seal the chewing surfaces of children’s permanent molar teeth. Studies have revealed that teeth treated with dental sealants can prevent up to 80% of tooth decay.
In the US, these public health programs have successful proved to be effective in preventing cavities in children & adults, and have also established to be cost-saving health programs.