A Healthier Future for West Virginia - Healthy People 2010

21 - Oral Health

Objectives | References

Background

Oral diseases are among the most common health problems in the United States. Millions of Americans suffer diseases and conditions of the oral cavity that result in needless pain and suffering; difficulty speaking, chewing, and/or swallowing; increased cost of care; loss of self-esteem; decreased economic productivity through lost work and school days, and, in extreme cases, death. Oral diseases and conditions, including dental caries (also known as cavities), periodontal diseases (a broad term encompassing several diseases of the gums, jaw bone, and tissues supporting the teeth), and tooth loss, afflict more persons than any single disease in the United States. Further, oropharyngeal cancer, which primarily affects adults older that 55, results in significant morbidity and disfigurement associated with treatment, substantial cost, and more than 8,000 deaths annually.

In 1998-1999, a national survey found that 94% of dentate adults had experienced coronal dental caries and 25% had experienced root caries. Gingivitis and periodontal disease are diseases of the gums that support the teeth and affect nearly half of all employed Americans between 18 and 64 years of age. Periodontal disease in its most severe form results in tooth loss.

Dental caries is the most common infectious disease of United States children. Sixty-one percent (61%) of children aged 15 have been affected by dental caries; in West Virginia the rate is 66%. By the time these children graduate from high school, the proportion has increased to 84%. Nationally 20% of 15-year-olds have untreated decay; this percentage rises to 33% in West Virginia. Unless stopped by early dental treatment or reversed, the carious infection will continue to destroy the tooth, resulting in pain and acute infection of surrounding tissues.

As these statistics show, although the past two decades have witnessed significant improvement, poor oral health remains a neglected West Virginia epidemic, especially among certain segments of our population. In fact, 80% of dental caries in children in our state is concentrated in just 25% of the child population.

Prevention, education, and regular care are essential elements in oral health. Among preventive measures, community water fluoridation is the single most effective and efficient means of preventing dental caries in children and adults, regardless of race or income level. In West Virginia, 82% of all community water systems are fluoridated, but improvements are needed. Regular care is a factor in maintaining oral health; however, only approximately one-half of all West Virginians obtain regular dental care. Among persons having a low income, the proportion not receiving care is even higher.

In the minds of many West Virginians, eventual loss of all permanent teeth is inevitable. In fact, according to 1995-97 data published by the CDC in 1999, West Virginia ranked first among all the states in the percentage of people aged 65 and older who had lost all their natural teeth at 47.9%. This indicates that education is greatly needed. Strategies need to be devised to educate not only individuals but also health care workers in methods of prevention and control of oral diseases.

Simply stated, at a time when there is less decay, thus making control of oral problems within reach, less resources are being allocated. Access to treatment remains a problem in many locations in the state among both children and adults. For those persons who are unable to afford dental care, who have limited or no dental insurance, and who are often at highest risk of oral diseases, there needs to be improved access to preventive and treatment services and removal of barriers to the dental care system.

The Objectives

FLAGSHIP OBJECTIVE
OBJECTIVE 21.1. Reduce dental caries (cavities) in primary and permanent teeth (mixed dentition) so that the proportion of children who have had one or more cavities (filled or unfilled) is no more than 60% among children aged 8 and 60% among adolescents aged 15. (Baseline: age 8, 65.6%; age 15, 66% in 1998)

Data Source: West Virginia Bureau for Public Health (WVBPH), Office of Maternal, Child & Family Health (OMCFH), Research Epidemiological Snapshot, Volume 3, Number 1, April 1999

OBJECTIVE 21.2. Reduce untreated cavities in the primary and permanent teeth (mixed dentition) so that the proportion of children with decayed teeth not filled is no more than 30% among children aged 6-8 and 25% among adolescents aged 15. (Baseline: ages 6-8, 35.5%; age 15, 32.9% in 1998)

Data Source: WVBPH, OMCFH, Research Epidemiological Snapshot, Volume 3, Number 1, April 1999

OBJECTIVE 21.3. Reduce to not more than 40% the proportion of people aged 65 and older who have lost all their natural teeth. (Baseline: 47.9% in 1995-97)

Data Source: CDC/Morbidity and Mortality Weekly Report (MMWR), Volume 48, Number 10, March 1999.

OBJECTIVE 21.4. Increase to at least 40% the proportion of oropharyngeal cancer lesions detected at stage 1. (Baseline: 37% in 1993-96)

Data Source: WVBPH, Office of Epidemiology and Health Promotion (OEHP), West Virginia Cancer Registry

OBJECTIVE 21.5. Increase to at least 40% the proportion of children aged 8 and 14 who have received protective sealants on permanent molar teeth. (Baseline: age 8, 36.7%; age 14, 34.6% in 1998)

Data Source: WVBPH, OMCFH, Research Epidemiological Snapshot, Volume 3, Number 1, April 1999

OBJECTIVE 21.6. Increase to at least 85% the proportion of the population served by community water systems with optimally fluoridated water. (Baseline: 82% in 1992)

Data Source: Centers for Disease Control and Prevention, 1992 Fluoridation Census

OBJECTIVE 21.7. (Developmental) Increase the use of topical fluorides by people not receiving optimally fluoridated public water. (Baseline data available in 2000)

Data Source: WVBPH, OEHP, Behavioral Risk Factor Surveillance System (BRFSS)

OBJECTIVE 21.8. Increase to 50% the proportion of school-based health centers (pre-kindergarten through grade 12) with an oral health component. (Baseline: 40% in 1998)

Data Source: WVBPH, Office of Community and Rural Health, Division of Primary Care, West Virginia School-Based Health Center Directory, October 1998

Meeting the Objectives

Health Promotion Channels for Achieving Objectives Worksites

• Schools
• Public Health Programs
• Networks
• Health Care System
• Higher Education

The Public Health Dentistry Project is addressing the objectives through the health promotion channels to the community listed above, using various strategies:

• community and school fluoridation programs
• fluoride tablet and drop supplements
• school fluoride rinses
• oral hygiene programs (e.g., the Brush-in)
• pit and fissure dental sealants
• clinic and private office care

Work Group Members

Greg Black, DDS, Work Group Leader, Children's Dental Consultant, OMCFH
Kay Medley, Dental Coordinator, Children's Dentistry Services, OMCFH
David Walker, DDS, Director, WVU School of Dentistry, Charleston Area Medical Center - Dental Center
David Miranda, DDS, Cabell-Huntington Health Department
Jerry Dice, DDS, Wayne County Health Department
Pam Dice, RN, Family Nurse Practitioner
Amy Black, RN, Thomas Memorial Hospital
Richard Meckstroth, DDS, Chairman, Dental Practice and Rural Health, School of Dentistry, WVU

References/Resources

American Cancer Society. Cancer Facts and Figures 1998. Atlanta, GA: 1998.

CDC. CDC Fluoridation Census 1992. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, 1992.

CDC. "Total tooth loss among persons aged greater than or equal to 65 years – selected states, 1995-1997." MMWR 48, no. 10, (March 1999).

Gift HC, Reisine ST, Larach DC. "The social impact of dental problems and visits." American Journal of Public Health 82, (December 1992): 1663-1668.

Kaste LM et al. "Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States: 1988-1991." Journal of Dental Research 75 (1996): 631-641.

National Institute of Dental Research. Oral Health of United States Children: The National Survey of Dental Caries in U.S. School Children, 1986-1987. NIH Publication no. 89-2247. Bethesda, M.D.: National Institutes of Health, 1989.

West Virginia Bureau for Public Health, Office of Maternal, Child & Family Health. Research Epidemiological Snapshot. Vol. 3, no. 1, April 1999.

West Virginia Bureau for Public Health. Unpublished data from the 1994 Behavioral Risk Factor Surveillance System. Charleston, WV: West Virginia Department of Health and Human Resources.

For More Information

Oral Health Consultant
Office of Maternal, Child & Family Health
350 Capitol Street
Charleston, WV 25301-3714
Phone: (304) 558-5388; Fax: (304) 558-2866

This page was last updated April 5, 2001.
For additional information about HP2010, contact Chuck Thayer at (304) 558-0644 or Chuck.E.Thayer@wv.gov