It is difficult to believe that preventive dentistry has only been in practice for less than 60 years in the United States. Prior to the 1960s, dentistry did not include routinely scheduled patient care. Although preventive dentistry is common practice in the U.S., we have seen an increase in dental caries in children age 2-11 years old. The most recent report by the National Institute of Dental and Craniofacial Research (NIDCR) indicates overall, dental caries in deciduous teeth in children age 2-11 declined from the early 1970s until the mid-1990s. From the mid-1990s until the latest NIH nutrition examination survey (1999-2004), this trend has reversed, and what is more troubling is that this trend is more severe in younger children. Currently 42% of children 2-11 years old have been diagnosed with dental caries in their primary dentition. Black and Latino children, and those living in families with lower incomes have more dental caries. With adolescent children ranging from 12-19 years old, dental caries did not decrease in Latino-Americans, and those living in families with lower incomes between 100% and 199% of the Federal Poverty Level (FPL). Current statistics indicate 59% of adolescents 12-19 years old have had dental caries in their permanent teeth and almost 5% of adults 20-64 years of age are edentulous. In this same adult age group, 92% have had dental caries in their permanent teeth. There also continues to be an unmet need where Black and Latino adults, younger adults, and those with lower incomes and less education have more untreated dental caries. In this same age category, we are also seeing White adults living in families with higher incomes and more education have been diagnosed with more dental caries than in past reports.
The U.S. Census reports by 2060 the number of seniors is expected to reach almost 95 million or 24% of the overall U.S. population. For the first time in U.S. History, older adults will outnumber children by 2035. With seniors age 65 years and older, approximately 5% are edentulous and 93% of seniors have had dental caries in their permanent teeth. Again, we also see White seniors and those living in families with higher incomes and more education have had more dental caries. The National Center for Health Statistics (NHANES) of the Center for Disease Control (CDC) indicates the average older adult takes 4-5 prescription drugs. In addition, seniors reported also taking 2-3 over-the-counter drugs. Drugs most commonly prescribed for our patients include statins, antihypertensive agents, analgesics, drugs for endocrine dysfunction, e.g., hypothyroid and diabetes, anticoagulant and antiplatelet agents, and drugs for respiratory and gastrointestinal dysfunction. We know there are hundreds of drugs that contribute to xerostomia. A 2018 systematic review and metaanalysis examined medications that cause the reduction of saliva in the older population. The researchers found seniors who took medications for urinary incontinence had the greatest risk for xerostomia. They also found antidepressants and psycholeptic prescription drugs significantly affected saliva production. To learn more about pharmacological effects, see the additional resources section at the end of the course.
The American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) recommend children be seen by a dentist in their first year of age. We know that evidence-based prevention, early detection and management of oral conditions greatly benefit children. Delayed care can exacerbate oral conditions, leading to the potential for future oral pain and costly dental care. A 2018 national survey conducted on behalf of the AAPD revealed 74% of parents do not take their children to the dentist by their first birthday. Even though 96% of parents surveyed indicated oral health is important, 3 in 10 parents considered toothaches a less serious ailment than earaches, tummy aches, and sore throats.
The National Cancer Institute (NCI) of the National Institutes of Health (NIH) indicates oral cancer kills one American every hour of every day and only 50% of those diagnosed with oral cancer will survive more than 5 years. As dental providers, we know early detection of oral cancer is critical. However, NCI indicates only 1/3 of oral cancer is found in the early stages, with 1/3 of oral cancer occurring in patients younger than 55 years of age. Recent studies by John Hopkins indicates 1 in 7 people diagnosed with oral cancer were younger than 40 years of age, with 25% of these patients not having the traditional risk factors for oral cancer. About 2/3 of oral cancer occurs in the floor of the mouth and tongue and 1/3 of cases are diagnosed as oropharyngeal cancer. We know that tobacco use places our patients at high-risk for cancer. Current statistics indicate people who use tobacco are six times more likely to develop oral cancer, where 8 in 10 patients diagnosed with oral cancer have smoked. This course includes current data for dental clinicians as they determine patient treatment.