The first-ever Surgeon General's report on oral health identifies a "silent epidemic" of dental and oral diseases that burdens some population
groups and calls for a national effort to improve oral health among all Americans. The report, commissioned by Health and Human Services
Secretary Donna E. Shalala, also focuses on the relationship between oral health and overall good health throughout life; the mouth as a "mirror for
general health and well-being and the association between oral heath problems and other health problems."
"During the last 50 years, there have been dramatic improvements in oral health, and most middle-aged and younger Americans expect to retain
their natural teeth over their lifetimes," Surgeon General David Satcher, M.D., Ph.D. said. "However, this report illustrates profound disparities
that affect those without the knowledge or resources to achieve good oral care. Those who suffer the worst oral health include poor Americans,
especially children and the elderly. Members of racial and ethnic groups also experience a disproportionate level of oral health problems. And,
those with disabilities and complex health conditions are at greater risk for oral diseases that, in turn, further complicate their health."
Satcher announced the report's findings at a press conference today in Washington, D.C., highlighting that good oral health and general health are
"The Surgeon General's Report on Oral Health provides important reminders that oral health means more than sound teeth. Oral health is integral
to overall health," Shalala said. "Furthermore, safe and effective disease prevention measures exist that everyone can adopt to improve oral health
and prevent disease."
The report calls for a national partnership to provide opportunities for individuals, communities and the health professions to work together to
maintain and improve the nation's oral health. Satcher also urged broadened awareness and use of common preventive tactics, including personal
daily oral hygiene habits such as brushing with a fluoride toothpaste and flossing daily, community programs such as community water fluoridation
and tobacco cessation programs, and health care provider-based interventions such as the use of dental sealants and examinations for oral and
"To ignore oral health problems can lead to needless pain and suffering, complications that can devastate well-being, and financial and social costs
that significantly diminish quality of life and burden American society," Shalala said. "Together we can affect the changes we need to maintain and
improve oral health for all Americans and remove known barriers that stand between people and oral health services."
Satcher noted that major barriers to oral health include socioeconomic factors, such as lack of dental insurance or the inability to pay out of
pocket, or problems of access that involve transportation and the need to take time off from work for health needs. While 44 million Americans
lack medical insurance, about 108 million lack dental insurance. Only 60 percent of baby boomers receive dental insurance through their
employers, and most older workers lose their dental insurance at retirement.
Meanwhile, uninsured children are 2.5 times less likely to receive dental care than insured children, and children from families without dental
insurance are 3 times as likely to have dental needs as compared to their insured peers.
Living in a community that lacks a fluoridated water supply may also exacerbate oral health problems, and people with disabilities and complex
health problems may face additional stumbling blocks, Satcher said. A major barrier to seeking and obtaining professional help is a general lack
of public understanding and awareness of the importance of oral health.
Oral diseases and craniofacial disorders are linked to total health and well-being throughout life. Oral problems may include dental caries or tooth
decay and periodontal or gum disease, oral infections such as cold sores that occur at any stage of life, as well as birth defects in infancy and the
chronic facial pain conditions and oral cancers seen in later years.
"Serious oral disorders may undermine self-image and self-esteem, discourage normal social interaction, and lead to chronic stress and depression
as well as incurring great financial cost," Satcher said. "They also may interfere with vital functions such as breathing, eating, swallowing and
speaking. The burden of disease restricts activities in school, work, and home, and often significantly diminishes the quality of life."
The report reiterates that general health risk factors, such as tobacco use and poor dietary practices, also affect oral and craniofacial health. The
evidence for an association between tobacco use and oral diseases has been clearly delineated in virtually every Surgeon General's report on
tobacco since 1964, and the oral effects of nutrition and diet are presented in the Surgeon General's report on nutrition. Moreover, recent
research findings have pointed to possible associations between chronic oral infections and diabetes, heart and lung disease, stroke and
low-birth-weight premature births. The report assesses these emerging associations and explores possible mechanisms that may underlie these
oral-systemic disease connections.
"Oral Health in America: A Report of the Surgeon General" charts a broad course of action including: enhancing the public's understanding of the
meaning of oral health and the relationship of the mouth to the rest of the body; raising the awareness of the importance of oral health among
government policy makers to create effective public policy that will improve America's oral health; and educating non-dental health professionals
about oral health and disease topics and their role in assuring that patients receive good oral health care.
Also recommended is an expansion of the science base to determine the people and populations most at risk for serious oral health conditions;
accelerate the application of research findings into targeted and effective health prevention methods, and promotion of their adoption by the public
and health professions.
Expenditures for dental services alone made up 4.7 percent of the nation's health expenditures in 1998 – $53.8 billion out of $1.1 trillion. The
national health expenditure for dental services is expected to exceed $60 billion in 2000. The report says these expenditures underestimate the
true costs to the nation, since data are unavailable to determine the extent of expenditures and services provided for craniofacial health by other
health providers and institutions.