Nearly 20 years ago, the Department of Health and Human Services, Office of the Surgeon General released its ‘Oral Health in America’ report to educate the American public on the importance of oral health. The report’s overarching theme is that oral health is more than a healthy set of teeth, but vital to a person’s overall health and well-being. [1] The report highlights oral health developments made at the turn of the century, but stresses the existing inequities and disparities preventing individuals from reaching their optimal oral health. In 2018, 18 years after the first initial report, an update was published. Once again, the findings presented that despite further developments and improvements, oral health was improving for many Americans—but not for all. [2]
In the U.S., children and adults from low-income households, racial and ethnic minorities, those with disabilities or other diseases, and low education levels are more likely to have poor oral health outcomes. These factors are linked to other social determinants of health affecting an individual’s ability to access dental care: residing in communities that are medically underserved, living in areas with food deserts that increase levels of food insecurity, and the risk for chronic diseases. [3] In addition to having limited access to dental care because of cost or geographical location, many Americans remain uneducated about the role oral health plays in their general health and well-being. [4]
For children, the Centers for Disease Control and Prevention (CDC) found that children ages 5 to 19 from low-income families are twice as likely to have cavities than children from higher-income families. Cavities, if left untreated, can cause pain, infections, and discomfort that can affect a child’s eating, speaking, playing, and learning. [5] Health disparities affecting children’s oral health are evident as dental sealants, used to prevent more than 80 percent of tooth decay, are utilized by only 1 out of every 3 children. Poor oral health in children can also lead to lower grades and an increase in the number of days missed from school. [6]
As people age, they are often at risk of experiencing other oral health issues. In adults, more than 25 percent have untreated tooth decay and nearly half of adults ages 30 and over show signs of gum disease. For older adults, ages 65 and over, 68 percent have gum disease and have higher rates of oral cancer – especially for those who smoke and drink heavily. [7] Furthermore, adults who suffer from a chronic disease are at a greater risk of having missing teeth and poor oral health. [8] For adults, poor health can also affect other facets of life. Studies found that one-third of adults who lived in poverty levels low enough to be eligible for Medicaid reported the appearance of their teeth and mouth affected their ability to interview for a job. [9] About one in five adults reported being embarrassed in social interactions because of the appearance of their mouth. [10] Moreover, between 7 and 15 percent of adults also refrained from laughing, smiling, and engaging in conversation with others because of their oral health issues. [11]
Texas has also made several notable improvements in oral health: 81 percent of children ages 1 to 17 made a dental visit in the last year (2018) and nearly 69 percent of children in Texas’ Medicaid and CHIP programs make annual visits – the highest of any state in the country. While these are big victories for the state, other challenges remain. Texas’ border and rural regions are plagued by the burden of disease, high proportions of low-income households and food insecure populations, and extremely high rates of uninsured with numbers reaching 42 percent in some areas. [12] For Texans living in border and rural regions, the lack of dental and other medical services compounded with the other systemic barriers make them more likely to suffer from poor oral health and other chronic diseases. The Texas Health Institute reported that overall 7.5 percent of children have fair or poor dental health and 11.6 percent of adults have poor dental health. Despite a significant population of children who make annual dentist visits, Texas ranks 39th out of 41 reported states for children with dental caries (tooth decay), and 35th for untreated dental caries. [13]
A 2018 report by the Texas Health Institute provides detailed statistics comparing Texas to the rest of the U.S. More information on oral health and well-being in Texas can be found from the American Dental Association’s fact sheet.
Other public health concerns in Texas are contributing to the burden of oral disease. Sugary beverages, which destroys tooth enamel, are consumed once a week by 18 percent of adolescents in Texas. [14] Behaviors such as tobacco, alcohol, and drug use are concerning to health officials in the state as they can increase the risk of oral health issues and diseases. Moreover, from 2014 to 2017, the number of Texans receiving fluoridated water decreased from 79 percent to 69 percent. Fluoridated water (water with added fluoride) was named one of the CDC’s 10 great public health achievements of the 20th century. [15] It can reduce cavities by 25 percent, supports strong enamel, and decreases the need for fillings and removing teeth. [16]
Policy makers and communities in Texas and throughout the country should take measures to continue improving oral health. A key focus should be bridging the gaps in health disparities so all populations regardless of income, race, and location, can have adequate health and dental care. Texas lawmakers and communities should strive to increase the number of Texans who receive fluoridated water and increase access to dental care for those living in border and rural areas. Regions of the state have begun rolling out mobile medical services that can help increase medical access, and similar measures could be taken for oral health or dental hygiene procedures.
The Texas Department of State Health Services has provided resources to help you find low-cost dental services near you.
[1] “Oral Health in America: A Report of the Surgeon General” (National Institute of Dental and Craniofacial Research, National Institutes of Health: Department of Health and Human Services, 2000), https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf.
[2] “Notice to Announce Commission of a Surgeon General’s Report on Oral Health,” Federal Register, Department of Health and Human Services, July 27, 2018, https://www.govinfo.gov/content/pkg/FR-2018-07-27/pdf/2018-16096.pdf.
[3] Dena J. Fischer, Morgan O’Hayre, John W. Kusiak, Marth J. Somerman, Carl V. Hill, “Oral Health Disparities: A Perspective From the National Institute of Dental and Craniofacial Research.” Am J Public Health. 2017;107(S1):S36–S38. doi:10.2105/AJPH.2016.303622, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497869/
[4] “Oral Health,” Office of Disease Prevention and Health Promotion, Healthy People, n.d., https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health/national-snapshot.
[5] “Oral Health: Children’s Oral Health,” Centers for Disease Control and Prevention, n.d., https://www.cdc.gov/oralhealth/basics/childrens-oral-health/index.html.
[6] “Oral Health: Children’s Oral Health.”
[7] “Oral Health: Adult Oral Health,” Centers for Disease Control and Prevention, n.d., https://www.cdc.gov/oralhealth/basics/adult-oral-health/index.html
[8] “Oral Health: Adult Oral Health.”
[9] Austin Frakt, “How Dental Inequality Hurts Americans,” The New York Times, February 19, 2018, https://www.nytimes.com/2018/02/19/upshot/how-dental-inequality-hurts-americans.html.
[10] “Oral Health in Texas: Bridging Gaps and Filling Needs” (Texas Health Institute, 2018), https://www.texashealthinstitute.org/uploads/3/9/5/2/39521365/thi_report_final.pdf.
[11] “Oral Health in Texas: Bridging Gaps and Filling Needs”
[12] “Oral Health in Texas: Bridging Gaps and Filling Needs”
[13] “Oral Health in Texas: Bridging Gaps and Filling Needs”
[14] “Oral Health in Texas: Bridging Gaps and Filling Needs”
[15] “Community Water Fluoridation,” Centers for Disease Control and Prevention, n.d., https://www.cdc.gov/fluoridation/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ffluoridation%2Findex.htm.
[16] “Community Water Fluoridation: Water Fluoridation Basics,” Centers for Disease Control and Prevention, n.d., https://www.cdc.gov/fluoridation/basics/index.htm
