Focus Area 21: Oral HealthProgress Review

Richard J. KleinNational Center for Health Statistics

February 7, 2008

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.

21-1a-c Dental Caries Experience 21-4 Complete Tooth Loss 21-5b Destructive Periodontal Disease 21-8a Dental Sealants, Children 8 years 21-9 Community Water Fluoridation 21-10 Annual Dental Visits 21-12 Preventive Dental Services

Among Low-Income youth 21-14 Community Health Centers with

Oral Health Service Component 21-17a,b Dental Public Health

InfrastructureImproving

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

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. 21-1c

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. 21-1b

*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.

Total White Black Mexican Female Male American

100

75

50

25

0

Percent

Decrease desired1988-

941999-2004

2010 Target: 11

Ever Had Caries in Primary Teeth

Children 2-4 Years

Obj. 21-1a

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.

2010 Target: 75

Increase desired

Percent0-2425-4950-7475-100

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

Total White Black Mexican Female Male American

Use of Dental SealantsChildren 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

75

50

25

0

Percent

Increase desired

2010 Target:

66

1996 2004

Total 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 ServicesLow Income Youth Under 19 Years

*

Total White Black Hispanic American Asian < 12 yr 12 yr 12+ yr Indian

Annual Dental Visits2 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-adjustedPercent

75

50

25

0

1996 2004

Increase desired

2010 Target:

56

Education

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

Decrease desired

1988-94

1999-2004

2010 Target: 22

Complete Tooth LossOlder Adults 65-74 Years

Obj. 21-4

Percent

50

25

0Education

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.

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

52 5359 57

60 6164 66

69 70

Percen

t100

80

60

40

20

0

2010 Target: 75Number

1,000

800

600

400

200

0

Increase desired

Community Health Centers with Onsite Dental

Services

Obj. 21-14Source: Bureau of Primary Health Care, HRSA.

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Dental Services at Center

Health Centers

2003 2006

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: 41Number

123

152

39 51

Source: Association of State and Territorial Dental Directors. Obj. 21-17a

Dental Programs Directed by Public Health Dental Professionals

2003 2006

50

25

0

Number

3234

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

Moved Toward Target21-3 No permanent tooth

loss, 35-44 yrs

21-5b Destructive periodontal disease, 35-44 yrs

21-9 Community water fluoridation

21-12 Preventive dental services among low-income youth under 19 yrs

21-14 Community health centers with oral health service component

21-15 Cleft lip or palate referral

Target Met21-17a State and local dental

programs21-17b Indian Health Service

and Tribal dental programs

Moved Away from Target21-1a Dental caries, 2-4 yrs

Progress Toward 2010 TargetsLittle or No Progress21-1b Dental caries, 6–8 yrs21-1c Dental caries, 15 yrs 21-2a-d Untreated dental decay,

2-4, 6-8, 15 and 35-44 yrs

21-4 Complete tooth loss, 65-74 yrs

21-6 Early detection of oral and pharyngeal cancers

21-8a Dental sealants, 8 yrs 21-8b Dental sealants, 14 yrs21-10 Dental visits, 2+ yrsBaseline Only21-5a Gingivitis, 35-44 yrs21-7 Annual exam for oral and

pharyngeal cancers, 40+ yrs

21-11 Use of oral health care by long-term care residents

21-13a,b School-based health centers with oral health component

21-16 Oral and craniofacial state-based surveillance

• Most oral health objectives moved toward their 2010 targets, although some of the improvements were not statistically significant.

• Dental caries in preschool children moved away from the 2010 target.

• Use 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

FA21 Interagency WorkgroupJay Anderson, HRSALaurie Barker, CDCPatrick Blahut, IHS

Bruce Dye, CDC Tim Iafolla, NIDCR

Gina Thornton-Evans, CDC

Office of Disease Prevention and Health PromotionChristopher Barrett

Acknowledgements

Progress review data and slides

can be found on the web at:

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

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