'Epidemic of Oral Disease' Is Found in Poor
Since this study was made public in 2000, Deamonte Driver, a 12-year-old Prince George's County, boy died of an abscessed tooth, and his 10-year-old brother was found to have ten abscessed teeth. Who can concentrate in school if he has a toothache? Richard Rothstein has observed that fixing children's teeth is a cheap way to raise test scores. But our corporate politicos find it easier to blame teachers for problems of poverty, to call for national standards and tougher tests, rather than fixing this one fixable problem of poverty.
The study found that more than a third of all poor youngsters ages 2 to 9 had untreated cavities. "These are kids that are sitting in class with toothaches. This is a problem, and it's neglected."
In 2000, the Surgeon General released a study Oral Health in America, delineating the scope of the problem. It's been 9 1/2 years. Imposing skill drill on Pre-schoolers won't fix their aching teeth.
Also see: The Future of Oral Health in America.
By Sheryl Gay Stolberg
Oral diseases, from tooth decay to mouth cancer, threaten the health of poor people, members of minorities, children and the elderly, despite vast improvements in dental care over the past 50 years, according to a study made public today by the surgeon general.
The report, the first comprehensive review of the scientific literature on oral health, found that most Americans who are middle-age or younger can expect to keep their teeth for life, largely because fluoride in the drinking water is helping to prevent cavities.
But the study also documented profound and little-noticed disparities in care that, it said, amount to "a silent epidemic of oral diseases" among the nation's most vulnerable citizens.
Socioeconomics, inadequate education, poor overall health and lack of access to dental care all play a part, the study found. While an estimated 44 million Americans lack health insurance, more than 108 million lack dental insurance. Many children in poor neighborhoods never see a dentist, the study found, and elderly people often lose dental insurance when they retire.
"We have had a tendency to separate oral health from the rest of the body," said Dr. David Satcher, the surgeon general, in an interview after releasing the study.
"Despite all of the progress that we have made in this country in the last 50 years," Dr. Satcher added, "there are a lot of people in this country who still suffer oral health problems."
Black men, the study found, have the highest rate of pharyngeal cancers -- cancer of the pharynx, which connects the oral and nasal cavities to the esophagus and larynx -- in the United States, and are less likely to survive than whites.
The percentage of people who had untreated dental cavities was substantially higher among blacks than whites -- about twice as many, according to the report. Blacks are more likely than whites to have missing teeth, and also more likely to have gum disease, the study found.
The disparities were particularly great among children. The study found that more than a third of all poor youngsters ages 2 to 9 had untreated cavities, compared with 17 percent of children who are not poor.
<br>And even children with health insurance often lack proper care; a recent study, cited in the surgeon general's report, found that among children covered by Medicaid, the government insurance program for the poor, fewer than 1 in 5 had a preventive dental visit during the previous year.
To dentists who care for the poor, the findings were hardly a surprise. With a grant from the Kellogg Foundation, a nonprofit group, Dr. Allan Formicola, dean of the school of dentistry and oral surgery at Columbia University, has arranged for dental services at six middle schools in the Harlem, Washington Heights and Inwood sections of Manhattan.
"We're seeing about double the rate of dental emergencies, teeth that either need to be extracted or have root canal," as the national average, Dr. Formicola said. "These are kids that are sitting in class with toothaches. This is a problem, and it's neglected."
At the same time, the study highlighted surprising links between oral health and general well-being. Scientists, the report said, are beginning to document associations between chronic oral infection and diabetes, heart disease, stroke, and even low-birthweight babies.
"The mouth can serve as an early warning system," the report said, signaling trouble elsewhere in the body. Thrush, a yeast infection in the mouth, is often a sign of infection by H.I.V., the virus that causes AIDS. Joint disorders in the jaw might be a sign of osteoporosis.
"The mouth," Dr. Satcher said, "is a mirror for many diseases that affect the body."
That point has often been lost on the public, including medical professionals, experts say.
"The surgeon general's report is very important, because it not only looks at things like decay, and what groups are still suffering disproportionately, but it also connects up the problems between oral health and general health," Dr. Formicola said. "It is critical that the public becomes aware of the fact that without good oral health, you can't have good general health."
Others said the study was long overdue. "We're the stepchild of health care in the United States," said Robert Klaus, president of Oral Health America, a nonprofit organization founded by dentists' professional groups. "We think this report will help change that."
Fluoridated drinking water, which helps prevent cavities, is one of the great public health achievements of the 20th century, Dr. Satcher's report said. Yet the study found that fluoridated water reaches only 62 percent of Americans served by public water supplies. Seven of the nation's 50 largest cities, including San Diego, San Antonio and Portland, Ore., do not have fluoridated water.
The surgeon general took a broader view of oral health than simply healthy teeth. The report looked at diseases of the gums and their supporting tissues, the palate, tongue, lips, salivary glands and throat; it found, among other things, that more than a fifth of Americans have destructive gum disease.
The 309-page report took three years to prepare, and Dr. Satcher introduced it today before a group of 24 first-graders at the Shepherd Elementary School here. The children are learning about oral health, under the auspices of a government-sponsored pilot program.
Afterward, Dr. Satcher remarked that the session was an eye-opener for him; as the child of uneducated farmers in rural Alabama, he did not see a dentist until just before he left home to attend college. "There are still too many families like that in this country," he said.
Sheryl Gay Stolberg
New York Times
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