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?

• 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.

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?

• 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 pattern of caries?

**KNOW for exam

75% of caries occur in 25% of population

• disparities/inequities based on SES, race/ethnicity, and educational attainment

How does race/ethnicity affect coronal caries rates?

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?

Whites

• the restored (filled) part bumps them way up

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?

untreated decay prevalence = similar to 20-64 year olds but slightly lower for 65+ (18.5-20%)

• Caries experience = 35+ year olds is higher compared to younger adults

What are other factors influencing coronal caries rates?

• Education → less education, more caries

• Gender → females have higher DMFS scores than males

• Dietary factors -- especially for high risk

• Health behaviors

• Radiation → xerostomia

• Tobacco usage

Why do females have higher DMFS scores than males?

they have more filled caries than males do

What is Early Childhood Caries as defined by the AAPD?

diagnosed by the presence of 1 or more decayed, missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months (6 years) of age or younger

Early childhood caries is more prevalent in which race/ethnicity?

More prevalent among Hispanic and African American populations

Early childhood caries is more prevalent in ___ SES. (socic-economic status)

LOWER

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

their socioeconomic status

of Americans over 18 have root caries.

prevalence increases with age

Root caries are more prevalent in which gender?

males

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

African Americans

• minorities have more untreated disease

What are other factors affecting root caries?

• SES → prevalence decreases w/ increase in SES

• Gingival recession

• Past coronal caries activity

• Diet

• Oral hygiene/preventive behaviors

• Medication usage

• Radiation treatment

• Tobacco use

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?

greater extent of attachment loss with age as well as recession & probing depths

• accumulation of disease, not increased susceptibility

• accumulation of disease is due to not following through on homecare as age increases

How does race/ethnicity affect the prevalence of periodontal disease?

African Americans > White Americans or Hispanic populations

• Treatment rates also vary in terms of race/ethnicity → higher for non-Hispanic whites

What are other contributing factors of periodontal disease?

• Systemic disease → diabetes, HIV

• Oral hygiene

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

• Education

Edentulism rates are ____ in the US.

declining

• currently affects about 13.3% of adults 65+ years old nationwide

Edentulism rates are expected to ___.

DECREASE to 3-4%

What is the principal cause of edentulism?

dental caries

• except those 80+

What kinds of demographics affects edentulism?

• Age → rates increase with age

• Societal values → "my gpa, dad, etc. had no teeth"

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

• Income/Race & Ethnicity/Education

Which race is more likely to be edentulous?

African Americans

• non-Hispanic Asians are second

Which education level is more likely to be edentulous?

less than HS

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

males 2.6x more likely

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

• Age → accumulation of risk factors throughout life

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

• Alcohol use

• Race/ethnicity → African Americans have highest rates

What is the ONLY risk factor for fluorosis?

ingestion of excessive fluoride during tooth development

• occurs in mineralization stage

About ___% of school children exhibit fluorosis.

mainly very mild or mild classifications

The prevalence of very mild to mild fluorosis has ___.

INCREASED

• due to lots of different products with fluoride

In summary, those with the poorest oral health overall:

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

• Socioeconomic status → Lower income

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

• Gender → Males, with the exception of edentulism