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Oral Health in America

Despite all the time and money spent, insurance coverage, and dental visits, one out of five Americans rates his or her oral health as fair to poor. Statistics show that almost a quarter of young people today between the ages of eighteen and thirty-four have gum disease and say their teeth hurt when they drink hot or cold beverages.3 Rarely do any middle-aged or elderly people have white or perfect teeth. Dental problems are not about concern or time. Such problems exist because the majority of people do not know how to protect their teeth and keep them strong, attractive, and healthy. People assume that teeth crumble and wear out with age, and that gum disease is unavoidable.
In May 2000, U.S. Surgeon General David Stacher released a report about the status of oral health in America.4 It was a report similar to the one Luther Terry had issued in 1964 about the relationship between tobacco and health. Both reports were designed to develop science and research on vital public health issues and were supposed to encourage, motivate, and mobilize the public to deal with serious health problems more effectively. Stacher’s report included a call to action to improve an unhealthy dental situation across America. The situation was deemed especially serious for disadvantaged and minority children, who were found to be at the greatest risk for severe medical complications from dental disease.
In April 2003, Surgeon General Richard H. Carmona created a document called the “National Call to Action,” which described the epidemic of dental disease sweeping through urban and rural districts of America.5 Carmona talked of the need to build a science base for three purposes: (1) to examine treatment effectiveness; (2) to encourage dentists to make informed decisions; and (3) to accelerate public awareness. Even today, among educated circles in the dental profession, there remains a serious gap in basic knowledge about evidence-based effective ways to control and prevent dental disease.6 Most disturbing is the lack of public awareness about methods that anyone could use to avoid dental problems.
Statistics from Carmona’s report show that tooth decay is the single most common chronic childhood disease, five times more common than asthma and seven times more common than hay fever. The report further describes the impact that dental disease has on productivity among schoolchildren and employed adults. More than 51 million school hours are lost each year from dental-related illness; more than 164 million work hours are lost annually from dental disease or dental visits. The Department of Health and Human Services’ Centers for Medicare and Medicaid Services estimated that the nation’s total bill for dental services was $70 billion in 2002. With such horrible statistics, the questions must once again be asked: Why is there so much dental disease? Why have all the generally accepted methods of prevention been unable to stop it? What are the best ways for the public to avoid being a part of this problem?
Many city, rural, and suburban children in the United States need extensive fillings or extractions by kindergarten age. Statistics show that tooth decay in baby teeth is not declining, despite all the measures tried over the past forty years. More than half of first-grade children have cavities in their teeth; these are often in new adult molars. More than three-quarters of high school seniors have cavities, damage, or scarring on their teeth, especially around braces.7
 An alarming number of teenagers are diagnosed with gum disease that may cause permanent damage to their teeth before they are twenty. Most of these children have seen dentists during their childhood, have been involved in school dental programs, and have been given regular cleanings, X-rays, and fluoride treatments. Ever-increasing amounts of Medicaid money have been spent, state-of-the-art clinics have been built, school-centered mobile units have been purchased and equipped, even high-tech teledentistry has been used to examine children, yet the problems continue to escalate. How can it be that with so much care, so many children have so much dental damage?
More people than ever seem to be experiencing brittle, weak enamel and sensitive teeth. Are oral care products or the overuse of corrosive, abrasive, or whitening products damaging dental enamel? Or is the decline of dental health related to modern American beverage consumption, medication side effects, stress, allergies, or the use of sugarless products that could promote acid reflux symptoms? Today most medications have mouth-drying side effects, and a dry mouth is a risk factor for dental problems (see chapter 4). The saliva that protects teeth also protects your esophagus. If the coating is absent from your teeth, it may also leave your esophagus vulnerable to bacterial or fungal infections that create symptoms of acid reflux (see chapter 5).8 It is interesting how dry mouth, dental problems, and acid reflux are so closely linked.
A few years ago I visited a graduate dental program and talked with senior residents, some of the best dentists in the world. I asked if they believed dental disease was a preventable condition. The young professionals expressed pessimistic views about their patients’ ability to floss. In the opinion of these senior residents, dental disease was solely the result of inadequate flossing. They seemed resigned to providing fillings, crowns, bridges, and other work to repair the inevitable damage they expected. It was obvious that these dentists viewed their responsibility as one of fixing dental damage to the best of their ability. Even before they entered the work world, the young dentists were blaming patients and had no confidence in any preventive process to stop fillings or other dental problems. They believed that, eventually, everyone needs some kind of treatment.
Despite this pessimistic outlook, not one of these dentists questioned whether flossing was a good preventive method or if there might be a better way to care for teeth that had been overlooked. Any dentist will confirm that for someone to question flossing, fluoride, or any other accepted treatment is professionally challenging, and those who have asked such questions have received hate mail, complaints from their peers, and worse.
Interestingly, there are no randomized clinical trials to show that flossing prevents cavities, yet dentists have collectively repeated the flossing mantra for fifty years. In the world of dentistry it is politically incorrect to question the usefulness of flossing. This would not be a concern if the outcome of this traditional dental advice had guided the population to a lifetime of healthy, white teeth. The problem is that in the USA today, almost 100 percent of adults—even those who floss regularly—eventually will succumb to and suffer from dental disease. Despite expensive treatments, flossing, dental cleanings, and regular dental visits, everyone is expected to end up with tooth loss and the need for artificial replacements.

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