The neglected epidemic and the surgeon general's report: a call to action for better oral health

The first US surgeon general’s report on oral health will be released soon. Oral diseases have been called a “neglected epidemic,”1–4 because, although they affect virtually the entire population, they have not been made a priority in our country. The surgeon general’s report can help educate and sensitize policy-makers and health leaders about the importance of oral health and the need to make oral health an integral component of all health programs. In the words of former Surgeon General C. Everett Koop, “You’re not healthy without good oral health.” We must seize this unprecedented opportunity to ensure that the mouth becomes reconnected to the rest of the body in health policies and programs. It makes no sense that children, diabetic persons, or senior citizens with an abscess on their leg can receive care through their health insurance or a health program, but if the abscess is in their mouth, they may not be covered. For vulnerable populations and the “have-nots,” the barriers to dental care are even greater. Although we have made much progress in improving oral health since the 1970s as a result of fluoridation, fluorides, new technology, changing attitudes, and increased use of services, oral diseases are still a neglected epidemic. The facts speak for themselves. Seventy-eight percent of 17-year-olds have had tooth decay, with an average of 7 affected tooth surfaces (C. M. Vargas, unpublished estimates, Third National Health and Nutrition Examination Survey, 2000), and 98% of 40- to 44-year-olds have had tooth decay, with an average of 45 affected tooth surfaces (C. M. Vargas, unpublished estimates, Third National Health and Nutrition Examination Survey, 2000). Thirty percent of Americans older than 65 years have no teeth at all.5 Twenty-two percent of 35- to 44-year-olds have destructive periodontal disease.5 Finally, more Americans die from oral and pharyngeal cancer than cervical cancer or melanoma each year.6 Although tooth decay in children has decreased considerably,7 it still affects most children and adults, especially as people live longer and retain more of their teeth. Populations at higher socioeconomic levels are able to pay for dental care; however, dental care is often a luxury for vulnerable and high-risk populations. Jonathan Kozol writes, “Bleeding gums, impacted teeth and rotting teeth are routine matters for the children I have interviewed in the South Bronx. Children get used to feeling constant pain. They go to sleep with it. They go to school with it. … Children live for months with pain that grown-ups would find unendurable.”8(p20,21)