1. Focus Area 21: Oral Health Progress Review Richard J. Klein National Center for Health Statistics February 7, 2008

2. Oral Health According to the 2000 Surgeon General’s Report on Oral Health, oral health is essential to the general health and well-being of all Americans. Dental caries is the most common chronic disease in children. Despite increases in coverage, nearly 3 times as many children lacked dental insurance compared to those lacking medical insurance in both 1995 and 2003-04. Americans without dental insurance are more likely to have unmet dental needs compared to those with insurance.

3. 21-1a-cDental Caries Experience 21-4Complete Tooth Loss 21-5bDestructive Periodontal Disease 21-8aDental Sealants, Children 8 years 21-9Community Water Fluoridation 21-10Annual Dental Visits 21-12Preventive Dental Services Among Low-Income youth 21-14Community Health Centers with Oral Health Service Component 21-17a,bDental Public Health Infrastructure ImprovingGetting worseLittle or no progress*Target met *Percent of targeted change achieved is between -10% and 10%, or change not statistically significant. Highlighted Objectives

4. 100 75 50 25 0 Percent Decrease desired Total White Black Mexican Female Male American 1988-94 1999-20042010 Target: 51 Ever Had Caries in Permanent Teeth Adolescents 15 Years Note: I= 95% confidence interval. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 21-1c

5. 100 75 50 25 0 Percent Decrease desired Total White Black Mexican Female Male American 1988-94 1999-20042010 Target: 42 Ever Had Caries* Children 6-8 Years Obj. 21-1b *In primary or permanent teeth. Note: I= 95% confidence interval. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC.

6. Total White Black Mexican Female Male American 100 75 50 25 0 Percent Decrease desired 1988-94 1999-20042010 Target: 11 Ever Had Caries in Primary Teeth Children 2-4 Years Obj. 21-1a Note: I= 95% confidence interval. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC.

7. 2010 Target: 75 Increase desired Percent 0-24 25-49 50-74 75-100 1992: 62% 2006: 69% Residents Served with Community Water Fluoridation Note: Proportion of persons receiving optimally fluoridated water from public systems among resident population served by public water systems. Source: CDC Fluoridation Census, NCCDPHP, CDC Obj. 21-9

8. Total White Black Mexican Female Male American Use of Dental Sealants Children 8 Years Obj. 21-8a Note: I= 95% confidence interval. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. 75 50 25 0 Percent Increase desired 2010 Target: 50 1988-941999-2004

9. 75 50 25 0 Percent Increase desired 2010 Target: 66 19962004 Total White Black Hispanic American Asian Female Male Indian Obj. 21-12 Note: I= 95% confidence interval. *Data statistically unreliable. Low income is less than 200% of Federal poverty level. Preventive services include examination, dental sealant application, fluoride treatment, cleaning, or X-ray examination in the past year. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select only one race prior to 2003. For 2003 and later years, respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. American Indian includes Alaska Native, and Asian includes Pacific Islander. Source: Medical Expenditure Panel Survey, AHRQ. Annual Preventive Dental Services Low Income Youth Under 19 Years *

10. Total White Black Hispanic American Asian < 12 yr 12 yr 12+ yr Indian Annual Dental Visits 2 Years and Older Obj. 21-10 Note: I= 95% confidence interval. Data are age adjusted to the 2000 standard population. Education estimates are based on persons aged 25 years and over. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select only one race prior to 2003. For 2003 and later years, respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. American Indian includes Alaska Native, and Asian includes Pacific Islander. Source: Medical Expenditure Panel Survey, AHRQ. Age-adjusted Percent 75 50 25 0 19962004 Increase desired 2010 Target: 56 Education

11. Total White Black Mexican < 12 yr 12 yr 12+ yr American Decrease desired 1988-94 1999-20042010 Target: 22 Complete Tooth Loss Older Adults 65-74 Years Obj. 21-4 Percent 50 25 0 Education Note: I= 95% confidence interval. Education estimates are based on persons aged 25 years and over. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC.

12. Decrease desired Total White Black Mexican Female Male American 1988-94 1999-20042010 Target: 14 Destructive Periodontal Disease Adults 35-44 Years Obj. 21-5b Note: I= 95% confidence interval. Respondents were asked to select only one race prior to 1999. For 1999 and later years, respondents were asked to select one or more races. For all years, the categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Percent 50 25 0

13. Percent 100 80 60 40 20 0 2010 Target: 75 Number 1,000 800 600 400 200 0 Increase desired Community Health Centers with Onsite Dental Services Obj. 21-14 Source: Bureau of Primary Health Care, HRSA. 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Dental Services at Center Health Centers

14. 2003 2006 200 150 100 50 0 State and local dental programs serving 250,000+ Program directed by a dental professional with public health training Increase desired 2010 Target: 41 Number 123 152 39 51 Source: Association of State and Territorial Dental Directors. Obj. 21-17a Dental Programs Directed by Public Health Dental Professionals

15. 2003 2006 50 25 0 Number 32 34 9 10 Indian Health Service and Tribal dental programs serving 30,000+ Program directed by a dental professional with public health training Increase desired 2010 Target: 9 Source: Division of Oral Health, IHS. Obj. 21-17b Dental Programs Directed by Public Health Dental Professionals

16. Moved Toward Target 21-3No permanent tooth loss, 35-44 yrs 21-5 b Destructive periodontal disease, 35-44 yrs 21-9Community water fluoridation 21-12Preventive dental services among low-income youth under 19 yrs 21-14Community health centers with oral health service component 21-15Cleft lip or palate referral Target Met 21-17 a State and local dental programs 21-17 b Indian Health Service and Tribal dental programs Moved Away from Target 21-1 a Dental caries, 2-4 yrs Progress Toward 2010 Targets Little or No Progress 21-1 b Dental caries, 6–8 yrs 21-1 c Dental caries, 15 yrs 21-2 a-d Untreated dental decay, 2-4, 6-8, 15 and 35-44 yrs 21-4Complete tooth loss, 65-74 yrs 21-6Early detection of oral and pharyngeal cancers 21-8 a Dental sealants, 8 yrs 21-8 b Dental sealants, 14 yrs 21-10Dental visits, 2+ yrs Baseline Only 21-5aGingivitis, 35-44 yrs 21-7Annual exam for oral and pharyngeal cancers, 40+ yrs 21-11Use of oral health care by long-term care residents 21-13 a,b School-based health centers with oral health component 21-16Oral and craniofacial state- based surveillance

17. Most oral health objectives moved toward their 2010 targets, although some of the improvements were not statistically significant. Dental caries in preschool children moved away from the 2010 target. Use of dental sealants among children increased. Oral health continues to improve in the adult population. Disparities by race/ethnicity and education persist for many objectives. Summary

18. FA21 Interagency Workgroup Jay Anderson, HRSA Laurie Barker, CDC Patrick Blahut, IHS Bruce Dye, CDC Tim Iafolla, NIDCR Gina Thornton-Evans, CDC Office of Disease Prevention and Health Promotion Christopher Barrett Acknowledgements

19. Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm