Updated: Feb 12
Can you believe the last oral health report was published over 2 decades ago by the U.S. Surgeon General?
3 years ago, I was just a D1 sitting in a public health lecture learning the findings of that report. I figured many of the same disparities still applied to our present-day populations, but still wondered what may have changed over the years.
Well, today is the day! The NIH blessed us with a report compiled by over 400 researchers that took a staggering 2 years to complete!
An incredible feat, considering the attention span of the average person on social media is about 15 seconds. 😅
Since I know 790 pages might discourage some of us from checking it out. I decided to help us out by reading, well most of it!
Now as a dental professional, you should probably browse the report when you do get a chance because I can't possibly nail all the key points and there's definitely more to the story, like planned initiatives. But for now, I guess you have to trust I interpreted everything correctly 😄.
DISCLAIMER: So I don't have to reference the same document a million times, please remember, all the data and conclusions you will see below, have obviously been obtained from the report, and they are in no way my own findings. Seems silly, but you just never know anymore.
Anywhoooo, without further ado, enjoy your super-condensed not as formal, but still worth reading, Oral Health Report! 🥳
1 PAGE QUICK GUIDE TO THE NEW NIH ORAL HEALTH REPORT by Josie Dental
First off, The Federal Healthy People 2020 initiative added new groups that require additional attention when examining disparities of oral health. These include high-risk mothers, chronically ill and disabled people, people with HIV/AIDS, mentally ill people, individuals with substance use disorders, homeless individuals, and immigrants & refugees. Better late than never!
Now let's discuss the biggest shock for me in this whole document! Remember when we learned that Black men had higher incidences of oropharyngeal cancer (OPC) than any other ethnicity? Well, this is no longer valid! White men when considering age, now have the highest incidence of OPC. It seems like black men are decreasing risky behavior that contributed to their high rate in the first place. Unfortunately, the survival rate when non-Hispanic Black men do present with OPC, still remains lower than that of any other ethnicity, a low 47% survival when compared to non-Hispanic white men who have a survival rate of 68.7%.
Oropharyngeal cancer as a result of HPV infection is on the rise, with an aggressive jump from 35% to 75%. Better lifestyle changes have decreased other causes of OPC, so now, we are left with HPV as the more common culprit. Luckily the report notes that... "less than 5% of oral squamous cell cancers are caused by HPV. "
Let's jump into behavioral patterns and disease progressions. Oral health IS improving. Woo! Honestly, children are the ones that have seen the most improvement throughout the past several years, due to greater insurance availability to cover their dental visits. We are seeing less rampant caries in children as well as much smaller disparities between all of their ethnic and socioeconomic groups.
For example, low-income individuals below the poverty level between the ages of 2 to 18, have had significant increases in accessing dental care when compared to any other income group. Unfortunately, poverty in this group has actually increased and so they still have higher oral health issues.
Similarly, in Latinx children, increased access to routine dental care has weirdly not improved the oral health of these children, particularly when observing Mexican American adolescents. A whopping 70% of Mexican-American children are still being affected by caries. This was not the case for the last report.
On the bright side, we are seeing improvements in reducing the prevalence of untreated decay in this group. Non-hispanic-Whites on the other hand, have actually gone from 15% to an 18% increase in untreated caries, contributing to the narrowing of health disparity gaps in this group.
Previously we weren't really able to break down Hispanic ethnic groups. As a Cuban-American woman, I can tell you that all Latinos are very diverse in every sense of the word. The good news is, new statistical advancements allow for subgrouping of the Hispanic population, providing more exact data for said subgroups.
Interestingly, despite the overall poverty many Hispanics find themselves living in, the study noted that there is a difference in health outcomes within the group itself. Health outcomes between Hispanic immigrants and Hispanics born in the U.S. differ. Immigrants have better health outcomes. When comparing first-generation Latinos, they have a self-rated oral health quality that is much higher than those Latinos born in the U.S. and that of Whites as well. Mind you, this finding is still being explored since not all studies have found significant agreement.
African-American adolescents seem to be following their adult counterparts and are now seen to binge drink less than other ethnic groups. This advantage diminishes around the time they reach high school. After about 10th grade we see Whites and Hispanics significantly reduce risky behavior that can impact their oral health, while African-American teens begin to lag behind.
So I don't think this new generation has ever had to sit through a D.A.R.E. presentation, and yet somehow, these adolescents have shown to have decreased the use of illicit drugs when compared to previous generations. However, before we hand out stickers, they are weirdly overdosing a lot more as a result of opioids. We're taking 1000% increase in E.R. visits for 19 years olds and younger!! This sadly does mean that there has been an increase in deaths as well.
Shifting gears, we of course have to talk about adults. Dental insurance for adults in the U.S. is just laughable, so adults have some catching up to do with our kids. In fact, there has been no change noted since the last report, in regards to decay prevalence as adults age in our country. NO CHANGE IN 2 DECADES. Just call us overachievers, why don't you!
All drama aside, we do see decay being less of an issue than before, especially for those less than 45 years of age. This only applies, however, if they are not part of a household that is 200% below the Federal poverty level.
When there is decay present, we are still bumping into the same wall! In 2 decades, researchers still note the same prevalence of dental caries that go untreated in nearly 25% of the population older than 6 years old, with working adults being the main culprits.
Alright, to clear some of the doom and gloom, we can celebrate losing fewer teeth overall! Somehow we have done something right and have reduced individuals losing teeth as a result of dental disease, by HALF of what it was before. That means the older population finally won one for the team and tooth loss is down to 11 teeth instead of 16 on average.
How did they do it you ask? Greater access to insurance, a 6% increase to be exact! It's worth mentioning that retirees still struggle to afford dental care due to a lack of sufficient Medicare coverage, but we won't get into that discussion today!
As children and those over 65 get more access to insurance, the 19-64 age group who contribute to the workforce, have actually seen a decrease in insurance coverage by about 2%. As we are literally performing magic with new procedures and placing implants left and right, most of the older population without insurance will not be able to benefit from these advancements.
As far as adult lifestyle go, drug overdoses in adults are still highest in non-Hispanic White men, but now women and African American teens are starting to catch up with anywhere from a 3-4 fold increase noted in deaths attributed to overdoses, again fueled in part by opioids and mostly non-prescribed opioids.
As dentists, we're prescribing opioids way less to manage pain. From 15.5% in the 90s as of 2015 we were at 6.4% and just a 3 day supply if needed. Amazing!
However, we need to do better when choosing opioids as pain management options for teens after wisdom teeth extractions. We're actually prescribing more in that group. The risk of these teens getting hooked to narcotics, is high at this age, especially since it's an age attributed to experimentation. For those 25 years and younger, opioid prescriptions are a huge gateway.
Regarding periodontal disease, Mexican-Americans are considered the largest and most periodontally involved ethnic and Hispanic subgroup. However, according to a Survey by HCHS/SOL, more than 1/3 of Cubans and Latinos from Central America, despite not having as high of a prevalence as Mexican-Americans, have higher instances of moderate periodontitis when they are affected. Should we maybe stop making Cuban cigars? I'm only kidding, that would never happen, so hopefully, we get it together!
Non-Hispanic Blacks are close behind Mexican-Americans when it comes to periodontal disease. Periodontal disease for non-Hispanic blacks actually presents as a more severe form, with twice as high of a prevalence, when compared to Whites.
There is still a very HIGH mistrust of dentists in the African-American community due to prior historical instances. Some RCTs have shown unconscious racial bias has influenced the treatment plans dentists presents to this population. Somehow, extractions have been encouraged more in the past for this ethnic group, than say a root canal.
When we talk about untreated decay, Mexican-American adults over 65 have the highest prevalence of any other ethnic group in the same age range.
But when all is said and done, American Indian and Alaska Native Populations, sadly have the highest prevalence of dental disease, when compared to any other ethnic group.
Other notable tidbits:
- 13.6 children in the U.S. have special healthcare needs and 61 million adults have a disability
- The U.S. incarcerates the highest number of people in the WHOLE WORLD: 2.3 million a year!
- Although incarceration entitles people to free dental care, they still have greater rates of untreated dental disease than the normal population, especially after 3 years of incarceration
- Veterans qualify for tons of benefits, but of course definitely not tons of dental ones, that would be too logical! Only certain veterans qualify, and by certain, they mean less than 5%. So SAD.
- Teledentistry seems to have been accelerated by the pandemic. Some studies show diagnosing and treatment planning via Telehealth methods is just as accurate as diagnosing and treatment planning during in-person visits.
- Productivity loss due to untreated oral disease = 45.9 billion in 2015. I'm honeslty scared to ask where we're at now.
-Mandibular advancement devices are just as effective as CPAP machines, but they have to be worn twice as long and as often as CPAP machines for the same effect.
- LAST BUT NOT LEAST say buh bye to the solo practice, this model keeps declining as more group practices are formed and more salaried corp and non-profit jobs are taken by new grads
Well, those are the highlights! I encourage you to check out the entire report below: https://www.nidcr.nih.gov/oralhealthinamerica