Oral Health

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A National Call to Action to Promote Oral Health marks the latest in an ongoing effort to address the country’s oral health needs in the 21st century. In 2000, Dr. David Satcher released Oral Health in America: A Report of the Surgeon General outlining the needs and future directions of oral health and bringing public attention to the oral health of Americans. This report noted that oral health means much more than healthy teeth, and oral health is essential to the general health and well-being of all children and adults.^* Although safe and effective means for preventing oral diseases exist, not all Americans have benefited from them. Many persons experience needless pain and suffering, complications that can devastate overall health, and financial and social costs that lower quality of life and burden society. Left untreated oral diseases become more complicated over time and may impact aspects of physical and mental health. Oral health problems can affect the eating, and speaking as well as restricting lifestyle activities.

Routine visits for dental care are as important as physical checkups for children. Dental caries (tooth decay) is the most common childhood chronic disease and dental care is a common unmet need among US children. Barriers to oral health care include lack of dental insurance, lack of out-of-pocket funds, lack of transportation, and the inability to take time off work. When queried, community groups cited lack of access to dental care as a critical unmet need. The inability to adequately address this need for care supports the importance of developing population-based prevention programs that will reduce the need within our communities. The Task Force on Community Preventive Services recommends community water fluoridation and school-based/school-linked sealant programs as proven measures to reduce the burden of disease in the population.

Oral Health of Adults

Regular dental visits are important to maintain healthy teeth. The Surgeon General's Report on oral health in 2000 noted links between chronic oral (periodontal/gum) infections and diabetes, heart disease, stroke, lung disease, and even premature births.1 The Healthy People goal is to increase the number of people who use the oral health care system each year to 56 percent. There has been a small decline in the number of people reporting routine dental visits in all areas of Texas since 2002.

Fifty-nine percent of Bexar County residents reported visiting a dentist within the past year, which is a 7 percent decrease from the 66 percent reported in 2002. The northern sectors of the county reported higher rates of dentist visits, with the highest being reported in the Northwest sector, at 70 percent and the Northeast and North Central sectors both at 63 percent. The Behavioral Risk Factory Surveillance System (BRFSS) sample was too small to report reliable rates for the all sectors in the south of the county.^β Overall, only 47 percent of residents in the southern sectors reported having seen a dentist in the past year. In the south sector, only 36 percent of residents reported having routine dental visits. The majority of dentists are located in north Bexar County, which limits access to dental care for residents living in the south. Harris County had a slightly higher rate at 62 percent.

Fewer Hispanics (57 percent) and African-Americans (63 percent) than whites (72 percent) had an annual dental visit in 2005. Those families with an annual income above $50,000 were more likely to have an annual dental visit (81 percent) than those with an income lower than $50,000 (46 percent). The greatest disparity in dental care was observed in education level. Only 44 percent of persons with an elementary education (Grades 1-8) had an annual dental visit compared to 70 percent of those individuals with a college or post-graduate education. Frequency of dental visits was related to education level.

The extent and severity of periodontal/gum disease has been linked to diabetes. Therefore, regular dental prophylaxis (cleaning) is suggested in the routine management of the diabetic patient. In Bexar County, 48 percent of patients with diabetes received routine dental cleaning while 62.1 percent of nondiabetic or nondiagnosed diabetics received an annual prophylaxis (cleaning). Residents with a higher body mass index (BMI) were also less likely to have had a dental visit in the past year (62 percent with higher BMI, 71 percent with lower BMI). Since these persons are at greater risk for type 2 diabetes and the oral conditions that are associated with diabetes, health care providers should refer their patients for regular dental examinations.

Tobacco use is a known risk factor for increased incidence of oral disease, both periodontal disease and oral cancer. Therefore, it is imperative that individuals with increased exposure to those known risk factors receive more frequent dental examinations and cleanings. However, the converse is true in Bexar County. More non-smokers than smokers see the dentist for an annual prophylaxis (65 percent of nonsmokers compared to 49 percent of smokers). Almost half (40 percent) of smokers in Bexar County are irregular dental attendees, defined as not having had a dental cleaning in 5 years or more. A similar pattern of dental attendance is observed with smokeless tobacco and chronic alcohol users. Smokeless tobacco users are more likely to have not had a dental visit in the past year than nonusers. This observation identifies a population at-risk for more severe oral disease that is not being targeted for more frequent dental visits.

When compared to the findings from the 2002 Bexar County Community Health Assessment, indicators of oral health have not improved or have worsened. With the exception of the advent of community water fluoridation, little has been done to improve the oral health of the residents of Bexar County. Failure to remove those barriers that impede access to adequate prevention and oral health care services for all of our residents will result in continued disparities in health.