Support the Framework for Action on Oral Health in America: A Report of the Surgeon General

  • Date: Jan 01 2001
  • Policy Number: 200117

Key Words: Oral Health, Water

The American Public Health Association,

Recognizing that Surgeon General Reports are issued to highlight health issues for which the magnitude and gravity of the issue is poorly understood by the public and the health community, where preventive opportunities are under appreciated and underutilized, and new information is available requiring distribution; and

Recognizing that the Surgeon General has recently released a report, Oral Health in America, which highlights the profound and consequential disparities of oral health status within the U.S. population, for example that poor children suffer twice as much dental caries as their more affluent peers1; and their disease is more likely to be untreated1; and 

Recognizing that dental caries is the single most common chronic disease-five times more common than asthma and seven times more common than hay fever1; twenty-three percent of 65 to 75-year olds have severe periodontal disease1; fewer than two-thirds of adults report having visited a dentist in the past 12 months1; those with incomes at or above the poverty level are twice as likely to report a dental visit in the part 12 months as those who are below the poverty level1; and 

Recognizing there is emerging evidence that oral diseases and conditions are associated with other health problems such as diabetes,2-5 heart disease,6-8 and adverse pregnancy outcomes,9,10 and

Recognizing that dental insurance is a strong predictor of access to dental care, shown by the fact that uninsured children are 2.5 times less likely than insured children to receive dental care11-13; for each child without medical insurance, there are at least 2.6 children without dental insurance14; for every adult 19 years or older without medical insurance, there are three without dental insurance15,16; and

Recognizing that water fluoridation is identified by the CDC as one of the top ten public health achievements of the century in the prevention of dental caries, yet over one third of the U.S. population (100 million people), has no access to community water fluoridation;17 and

Recognizing that APHA has seven policies and resolutions relating to the benefits and support for community water fluoridation;18-24 and

Recognizing that oral and pharyngeal cancers have one of the lowest five-year survival rates when compared to other major cancers;25,26

Therefore, APHA supports the overall framework for action called for in the Surgeon General’s Report, specifically to:

  1. Change perceptions regarding oral health and disease, so that oral health becomes an accepted component of general health.
  2. Accelerate the building of the science and evidence base and apply science effectively to improve oral health.
  3. Build an effective health infrastructures that meet the oral health needs of all Americans and integrates oral health effectively into overall health.
  4. Remove known barriers between people and oral health services.
  5. Use public/private partnerships to improve oral health of those who still suffer disproportionately from oral diseases. Furthermore, APHA encourages
    1. Development and implementation of a national health education communication campaign to promote oral health; 
    2. Increased congressional support for the allocation of funds to expand current health care services for children and adults, and
    3. Expansion of dental insurance coverage for all uninsured segments of the population.

References

  1. National Center for Health Statistics (NCHS). Third National Health and Nutrition Examination Survey (NHANES III) reference manuals and reports. Hyattsville MD): NCHS, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1996.
  2. Firatle E. The relationship between clinical periodontal status and insulin-dependent diabetes mellitus. Results after 5 years. J Periodontol 1997 Feb; 68(2):136-40.
  3. Cohen DW, Friedman LA, Shapiro J, Kyle GC, Franklin S. Diabetes mellitus and periodontal disease: two year longitudinal observations. I. J Periodontol 1970 Dec;41(12):709-12.
  4. Grossi SG, Skrepcinski FB, DECaro T, Rovertson DC,Ho AW, Dunford RG, Genco RJ. Treatment of periodontal disease in diabetes reduces glycated hemoglobin. J Periodontol 1997 Aug;68 (8):713-9.
  5. Taylor GW, Burt BA, Bicker MP, Genco RJ, Shlossman M, Knowler WC, Pettitt DJ. Severe periodontitis and risk for poor glycemic control in patients with non insulin-dependent diabetes mellitus. J Periodontol 1996 Oct;67(10 Suppl):1085-93.
  6. Beck J, Garcia R, Heiss G, Bokonal PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol 1996 Oct(10 Suppl):1123-37.
  7. Joshipura KJ, Ascherio A, Rimm E, Douglass CW, Willett WC. The relation between tooth loss and incidence of ischemic stroke. Circulation 1999;99:1121.
  8. Mattila KJ, Valtonen VV, Nieminen M, Huttunen JK. Dental infection and the risk of new coronary events: {prospective study of patients with documented coronary artery disease. Clin Infect Dis 1995 Mar;20(3): 588-92.
  9. Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, McKaig R, Beck J. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996 Oct;67(10 Suppl): 1103-13.
  10. Offenbacher S, Jared HL, O’Reilly PG, Wells SR, Salvi GE, Lawrence HP, Socransky SS, Beck JD. Potential pathogenic mechanisms of periodontitis associated pregnancy complications. Ann Periodontol 1998 Jul;3(1):233-50.
  11. Bloom B, Gift HC, Jack SS. Dental service and oral health, United States, 1998. Vital Health Statistics 1992;10:1-95.
  12. Monheit AC. Cunningham PJ. Children without health insurance. Future Child 1992;2:154-70.
  13. Newacheck PW, Stoddard JJ, Hughes DC, Pearl M. Children’s access to health care: the role of social and economic factors. In: Steir RE, ed. Health Care for children: what’s right, what’s wrong, what’s next. New York: United Hospital Fund; 1997. 
  14. Newacheck P, Hughes DC, Hung YY, Wong S, Stoddard JJ. The unmet health needs of America’s Children. Pediatrics 2000 Apr;105(4pt 2):989-97.
  15. National Center for health Statistics (NCHS). National Health Interview Survey (NHIS)1995. Data tabulated by the Office of Analysis, Epidemiology, and Health Promotion. NCHS, Centers for Disease Control and Prevention; 2000.
  16. Waldman HB. More children are unable to get dental care than any other single health service. J Dent Child 1998 may-June;65(3):204-8.
  17. U.S. Department of Health and Human Services. Magnitude of the Problem. In: Evans CA, executive ed. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.
  18. American Public Health Association, Resolution No. 5005: Fluoridation of Public Water Supplies. APHA Public Policy Statements, 1948-Present, Washington, DC: American Public Health Association, Current Volume. 
  19. American Public Health Association, Resolution No. 5508: Fluoridation of Public Water Supplies. APHA Public Policy Statements, 1948-Present, Washington, DC: American Public Health Association, Current Volume.
  20. American Public Health Association, Resolution No. 5904: Adjustment of Fluorides in Water Supplies. APHA Public Policy Statements, 1948-Present, Washington, DC: American Public Health Association, Current Volume. 
  21. American Public Health Association, Resolution No. 6604: A National Dental Health Program for Children. APHA Public Policy Statements, 1948-Present, Washington, DC: American Public Health Association, Current Volume. 
  22. American Public Health Association, Resolution No. 6912: National Fluoridation Act. APHA Public Policy Statements, 1948-Present, Washington, DC: American Public Health Association, Current Volume.
  23. American Public Health Association, Resolution No. 7402: Fluoridation. APHA Public Policy Statements, 1948-Present, Washington, DC: American Public Health Association, Current Volume.
  24. American Public Health Association, Resolution No. 7911: Fluoridated Communities for the Meeting Sites of National Health Organizations. APHA Public Policy Statements, 1948-Present, Washington, DC: American Public Health Association, Current Volume.
  25. Silverman S. American Cancer Society. Oral cancer. 4th ed. St. Louis: Mosby-Year Book; 1998.
  26. Murphy GP, Lawrence w. Lenhard RE, editors. American Cancer Society textbook of clinical oncology. 2nd ed. Atlanta: American Cancer Society; 1995.

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