DHED 316: Factors Affecting Oral Health Status in the US

T/F: According to the surgeon general, oral health is essential to general health, but CANNOT be achieved by all Americans.

FALSE

• the surgeon general states that it can be achieved by all Americans

• however, NOT ALL Americans are achieving the same degree of oral health due to substantial oral health disparities

What are health disparities?

"population-specific differences in the presence of disease, health outcomes, or access to healthcare" - HRSA

What are oral health indicators?

measurable characteristics that describe the health of a population

What are the specific oral health indicators? (3)

• Diseases: dental caries, gingivitis, tooth loss, oral cancer

• Determinants of Health: oral health behaviors, oral health risk factors, physical environments, and socioeconomic environments

• Access to Care: # of dental visits or types of procedures, insurance, structural barriers, etc.

Coronal Caries

The incidence of cumulative caries has ____ and the proportion of population that is caries free has ____.

decreased; increased

What kind of decay have we seen the MOST decline in?

smooth surface decay (right on facial or lingual)

Where is the MOST decay seen?

most decay in children's permanent teeth

• buccal pits on Mandibular molars and pits/fissures on occlusals

Which teeth are the MOST affected by caries?

first and second molars

What is the overall trend that we are seeing regarding caries? (3)

• less severe caries

• fewer carious lesions in anterior teeth

• fewer teeth lost due to caries

Which racial and ethnic groups in children have higher rates of caries?

Mexican American and non-Hispanic Black children (3-9 y.o.)

There is a ___ of untreated decay in 2-5 year olds.

DECREASE

• increased % of caries-free children

T/F: Caries are the most prevalent unmet health need in US children.

True

What is the most common chronic childhood disease?

caries

• results in MANY school hours lost per year

In KY, about ____ of kids have untreated decay and about ____ have had caries experience (both treated & untreated decay).

1/3; 2/3

What is the prevalence of sealants in KY?

about 29% of 3rd graders

Kentucky has the highest ___ rates and the lowest ___ rates.

caries; sealant

What is the newer definition of ECC

Having any type of caries less than 6 years old

What is the statistic for pattern of caries?

**KNOW for exam

75% of caries occur in 25% of population

• disparities/inequities based on lower income class, race/ethnicity, and educational attainment

What is the total untreated decay rate?

26.6% of population

___% of 2-5 year old children have ECC.

28%

How does race/ethnicity affect coronal caries rates? (2)

• minority racial and ethnic groups have a higher amount of untreated decay

• Non-Hispanic whites have lower decay rates and least amount of untreated decay

Which racial group has the highest cumulative caries experience and why?

Whites

• having more restorations (filled) bumps them way up

At what age do NA have caries and how many %?

By the age of 15, 90% of NA will have caries

How does income affect coronal caries rates?

• low income has more decay

• decay is more likely to be untreated

• a lot more restricted activity days for lower SES (calling in, missing hours, etc.)

How does age affect coronal caries rates?

For 5-19, it is the lowest rate

For 20-44 - 45-64 the untreated decay prevalence rate is similar and the highest.

For 65+, is is only slightly lower than the rate for early adults to middle aged

In other words, the caries experience = 35+ year olds is higher compared to younger adults

What are other factors influencing coronal caries rates? (6)

• Gender → females have higher DMFS scores than males. F have higher filled scores compared to males.

• Education → less education, more caries

• Dietary factors → carbs, sugars

• Radiation → xerostomia

• Health behaviors

• Tobacco usage

What is the MOST POWERFUL predictor of caries in young children?

their socioeconomic status

Root Caries

__% of Americans over 18 have root caries.

25%

• prevalence increases with age

• 49.7% over 75

Root caries are more prevalent in which gender?

males

Which race/ethnicity shows a slightly higher prevalence in root caries?

African Americans but minorities in general have more untreated disease

What are other factors affecting root caries? (8)

• SES → prevalence decreases w/ increase in SES

• Gingival recession

• Past coronal caries activity

• Diet

• Oral hygiene/preventive behaviors

• Medication usage

• Radiation treatment

• Tobacco use

Periodontal Disease

T/F: There is only one definition/index of periodontal disease.

FALSE

• no single one

• makes epidemiological investigations difficult

Which gender is more likely to have attachment loss, recession, and deeper probing depths?

MEN

How does age affect periodontal disease prevalence?

As people get older, the possibility of getting perio increases. The longer we have teeth in our mouth and the longer we have to maintain oral care, the more likely we’ll develop perio. We also have a greater extent of attachment loss, recession, and PDs.

How does race/ethnicity affect the prevalence of periodontal disease? Is tx the same for all?

African Americans > White Americans or Hispanic populations

• Treatment rates also vary in terms of race/ethnicity

What are other contributing factors of periodontal disease? (4)

TOES

• Systemic disease → diabetes, HIV

• Oral hygiene

• Tobacco use → 2.5-6x higher prevalence in smokers

• Education

Edentulism

Edentulism rates are ____ in the US. How many adults +65 are affected?

declining

11.2% of adults

Edentulism rates are expected to (decrease/increase) and by how much.

DECREASE to 3-4%

What is the principal cause of edentulism?

dental caries (except those 80+)

What kinds of demographics affects edentulism? (4)

• Age → rates increase with age

• Societal values → "my gpa, dad, etc. we all just have bad teeth"; external locus of control

• Gender? → ONLY oral category with no specific gender association

• Income/Race & Ethnicity/Education

Which race is more likely to be edentulous? Which is second?

African Americans and non-Hispanic Asians are second

Which education level is more likely to be edentulous?

those w less than HS

Oral Cancer

Oral cancer accounts for __% of all cancers in the US. It is the ___ most common cancer in the developed world.

3%; 6th

Which gender is more likely to develop oral/pharyngeal cancer?

males 3x more likely

What are other factors that affect the prevalence of oral cancer? (4)

• Age → older ppl are more affected due to the accumulation of risk factors throughout life

• Race/ethnicity → African Americans have highest rates

• Tobacco use → 75% of oral cancers = HUGE risk factor

• Alcohol use

(more/less) ppl are dying of oral cancer. What population is most likely to not survive

More; AA males

What is the ONLY risk factor for fluorosis? During what stage?

ingestion of excessive fluoride during tooth development during the mineralization stage

About ___% of school children exhibit fluorosis.

22% or 1/5 but they are mainly very mild or mild classifications

The prevalence of very mild to mild fluorosis has ___. Why?

INCREASED due to lots of different fluoride products

Oral Health in KY

___% of poor adults report oral health as poor compared to 15% of wealthiest group.

45% abt 1/3

___% of poor adults have active dental caries versus 10% of wealthiest group.

32%

___% of poor adults have had all teeth extracted vs. 0% of wealthiest group.

20%

___% report having oral pain within 3 months. (40% of Medicaid recipients)

25%

In summary, those with the poorest oral health overall: (4)

• Educational attainment → Lower; some college + increases oral health status

• Socioeconomic status → Lower income

• Race/ethnicity → Non-Hispanic African Americans, Hispanics, American Indiana/Alaskan natives

• Gender → Males, with the exception of edentulism

What is the #1 indicator of correlation for those w poor oral health? What is the #2nd

1. Education

2. SES