# Presentation: 448457

## Focus Area 21: Oral HealthProgress Review

**Focus Area 21****: Oral Health****Progress Review**

**Richard J. Klein****National Center for Health Statistics**
**February 7, 2008**

## According to the 2000 Surgeon General’s Report on Oral Health, oral health is essential to the general health and well-being of all Americans.
Dental caries is the most common chronic disease in children.
Despite increases in coverage, nearly 3 times as many children lacked dental insurance compared to those lacking medical insurance in both 1995 and 2003-04.
Americans without dental insurance are more likely to have unmet dental needs compared to those with insurance.

**Oral Health**

**According to the ****2000 ****Surgeon General’s Report on Oral Health, oral health is essential to the general health and well-being of all Americans.**
**Dental caries is the most common chronic disease in children****.**
**Despite increases in coverage, nearly 3 times as many children lacked dental insurance compared to those lacking medical insurance in both 1995 and 2003-04.**
**Americans without dental insurance are more likely to have unmet dental needs compared to those with insurance.**

## Highlighted Objectives

**21****-****4****	****Complete Tooth Loss**** **
**21****-****5****b****	****Destructive Periodontal Disease**** **
**21****-****8****a****	****Dental Sealants****, Children 8 years **
**21-9****	****Community Water Fluoridation **
**21****-****10****	****Annual ****Dental Visits**** **
**21****-****12****	****Preventive Dental Services**** Among L****ow-****I****ncome**** youth **
**21****-****14****	****Community ****Health Centers with ****O****ral ****H****ealth ****Service C****omponent**** **
**21****-****17****a,b****	****Dental Public Health Infrastructure**

**Improving**

**Getting worse**

**Little or no ****progress*******

**Target met**

- *Percent of targeted change achieved is between -10% and 10%, or change not statistically significant.

**Highlighted Objectives**

## Ever Had Caries in Permanent Teeth

**100**
**75**
**50**
**25**
**0**

**Percent**

**     ****Decrease desired**

**Total****                White         Black       Mexican            Female        Male    **
**                                                           ****American**

**1988-94**

**1999-2004**

**2010 Target: 51**

**Ever**** ****Had Caries in ****Permanent**** Teeth**
**Adolescents 15**** Years**

- Note: I= 95% confidence interval. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**Obj. 21-1****c**

## Ever Had Caries*

**100**
**75**
**50**
**25**
**0**

**Percent**

**     ****Decrease desired**

**Total****                White         Black       Mexican            Female        Male    **
**                                                           ****American**

**1988-94**

**1999-2004**

**2010 Target: 42**

**Ever**** ****Had Caries*******
**Children 6-8**** Years**

**Obj. 21-1****b**

- *In primary or permanent teeth.
- Note: I= 95% confidence interval. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

## Ever Had Caries in Primary Teeth

**Total****                White         Black       Mexican            Female        Male    **
**                                                           ****American**

**100**
**75**
**50**
**25**
**0**

**Percent**

**     ****Decrease desired**

**1988-94**

**1999-2004**

**2010 Target: 11**

**Ever**** ****Had Caries in ****Primary**** Teeth**
**Children 2-4**** Years**

**Obj. 21-1****a**

- Note: I= 95% confidence interval. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

## Residents Served with 

**   ****Increase desired**

**Percent**
**0-24**
**25-49**
**50-74**
**75-100**

**1992: 62%**

**2006: 69%**

**Residents Served with **
**Community Water Fluoridation**

- Note: Proportion of persons receiving optimally fluoridated water from public systems among resident population served by public water systems.
- Source: CDC Fluoridation Census, NCCDPHP, CDC

**Obj. 21-9**

## Use of Dental Sealants

**Total****               White         Black       Mexican           Female        Male    **
**                                                          ****American**

**Use of D****ental**** S****ealants**
**Children 8 Years**

**Obj. 21-****8a**

- Note: I= 95% confidence interval. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**75**
**50**
**25**
**0**

**Percent**

**     ****Increase desired**

**2010 Target: 50**

**1988-94**

**1999-2004**

## Annual Preventive Dental Services

**75**
**50**
**25**
**0**

**Percent**

**     ****Increase desired**

**2010 Target: 66**

**1996**

**2004**

**T****otal****            White      Black   Hispanic  American  Asian          Female     Male **
**                                                                     ****Indian                                                                   **

**Obj. 21-****12**

- Note: I= 95% confidence interval. *Data statistically unreliable. Low income is less than 200% of Federal poverty level.  Preventive services include examination, dental sealant application, fluoride treatment, cleaning, or X-ray examination in the past year. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select only one race prior to 2003. For 2003 and later years, respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group.  American Indian includes Alaska Native, and Asian includes Pacific Islander.
- Source: Medical Expenditure Panel Survey, AHRQ.

**Annual Preventive Dental Services**
**Low Income Youth Under 19 Years**

*****

## Annual Dental Visits

**T****otal****          White     Black  Hispanic American Asian       < 12 yr    12 yr    12+ yr**
**                                                               ****Indian**

**Annual Dental Visits**
**2 Years and Older**

**Obj. 21-****10**

- Note: I= 95% confidence interval. Data are age adjusted to the 2000 standard population. Education estimates are based on persons aged 25 years and over. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select only one race prior to 2003. For 2003 and later years, respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. American Indian includes Alaska Native, and Asian includes Pacific Islander.
- Source: Medical Expenditure Panel Survey, AHRQ.

**Age-adjusted**
**Percent**

**75**
**50**
**25**
**0**

**1996**

**2004**

**     ****Increase desired**

**2010 Target: 56**

**Education**

## Complete Tooth Loss

**Total****             White      Black     Mexican        < 12 yr      12 yr     **** ****12+ yr         **
**                                                   ****American**

**    ****Decrease desired**

**1988-94**

**1999-2004**

**2010 Target: 22**

**Complete Tooth Loss**
**Older Adults 65-74 Years**

**Obj. 21-****4**

**Percent**

**50**
**25**
**0**

**Education**

- Note: I= 95% confidence interval. Education estimates are based on persons aged 25 years and over. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

## Destructive Periodontal Disease Adults 35-44 Years

**    ****Decrease desired**

**Total****               White         Black      Mexican            Female       Male    **
**                                                         ****American**

**1988-94**

**1999-2004**

**2010 Target: 14**

**Destructive Periodontal Disease**** ****Adults 35-44 Years**

**Obj. 21-****5b**

- Note: I= 95% confidence interval. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.
- Source: National Health and Nutrition Examination Survey, NCHS, CDC.

**Percent**

**50**
**25**
**0**

## Community Health Centers with Onsite Dental Services 

**Percent**
**100**
**80**
**60**
**40**
**20**
**0**

**2010 Target: 75**

**Number**
**1,000**
**800**
**600**
**400**
**200**
**0**

**     ****Increase desired**

**Community**** Health Centers with Onsite Dental Services **

**Obj. 21-14**

- Source: Bureau of Primary Health Care, HRSA.

**1997  **** ****1998   1999   2000   2001   2002   2003  **** **** 2004  **** ****2005   2006**

**Dental Services at Center**

**Health Centers**

## Dental Programs Directed by Public Health Dental Professionals

**200**
**150**
**100**
**50**
**0**

**State and local dental programs serving 250,000+ **
**Program directed by a dental professional with public health training**

**     ****Increase desired**

**2010 Target: 41**

**Number**

**123**

**152**

**39**

**51**

- Source: Association of State and Territorial Dental Directors.

**Obj. 21-17a**

**Dental Programs Directed by Public Health Dental Professionals**

## Dental Programs Directed by Public Health Dental Professionals

**50**
**25**
**0**

**Number**

**32**

**34**

**9**

**10**

**Indian Health Service and Tribal dental programs serving 30,000+ **
**Program directed by a dental professional with public health training**

**     ****Increase desired**

**2010 Target: 9**

- Source: Division of Oral Health, IHS.

**Obj. 21-17b**

**Dental Programs Directed by Public Health Dental Professionals**

## Progress Toward 2010 Targets

**21-3****	****No permanent tooth loss, **
**	****35-44 yrs**
**21****-****5****b****	****Destructive ****p****eriodontal **
**	****d****isease****, 35-44 yrs**
**21-9****	****Community water fluoridation**
**21****-****12****	****Preventive ****d****ental ****s****ervices**** among l****ow-****i****ncome**** youth under 19 yrs**** **
**21****-****14****	****Community health c****enters with ****o****ral ****h****ealth ****service c****omponent **
**21-15****	****Cleft lip or palate referral**

_**Target Met**_
**21****-****17****a****	****State and local dental programs**
**21****-****17****b****	****Indian Health Service and Tribal dental programs**

_**Moved Away from Target**_
**21****-****1****a****	****Dental ****c****aries****, 2-4 yrs**** **

**Progress Toward 2010 Targets**

_**Little or No Progress**_
**21****-****1****b****	****Dental ****c****aries****, 6–8 yrs**
**21****-****1****c****	****Dental ****c****aries****, 15 yrs**** **
**21-2****a-d****	****Untreated dental decay,****2-4, 6-8, 15 and 35-44 yrs**
**21****-****4****	****Complete ****t****ooth ****l****oss****, ****65-74 yrs**** **
**21-6****	****Early detection of oral and pharyngeal cancers**
**21****-****8****a****	****Dental ****s****ealants****, 8 yrs**** **
**21****-8****b****	****Dental ****s****ealants****, 14 yrs**
**21-10****	****Dental visits, 2+ yrs**

_**Baseline Only**_
**21-5a****	****Gingivitis, 35-44 yrs**
**21-7****	****Annual exam for oral and pharyngeal cancers, 40+ yrs**
**21-11****	****Use of oral health care by long-term care residents**
**21-13****a,b**** School-based health centers with oral health component**
**21-16****	****Oral and craniofacial state-based surveillance**

## Summary

**D****ental caries in ****preschool ****children moved away from the 2010 target.**
**U****se of dental sealants among children ****increased. **
**Oral health continues to improve in the adult population.**
**Disparities by ****race/ethnicity and**** ****education ****persist for many objectives.**

**Summary**

## Acknowledgements

**Jay Anderson, HRSA**
**Laurie Barker, CDC**
**Patrick Blahut, IHS**
**Bruce Dye, CDC**** **
**Tim Iafolla, NIDCR**
**Gina Thornton****-****Evans, CDC**
**Office of Disease Prevention and Health Promotion**
**Christopher Barrett**

**Acknowledgements**

## Progress review data and slides

**Progress review data and slides**
**can be found on the web at:**

**http://www.cdc.gov/nchs/hphome.htm**