Focus Area 21: Oral HealthProgress ReviewMarch 17, 2004

• Estimated new cases of oral/pharyngeal cancers in U.S. will affect 28,000 + persons in 2004

• Profound disparities exist in disease levels and receipt of care

• 100+ million Americans lack dental insurance

The Burden of Oral Disease

• Reduction in decay among U.S. teens in the 1990s (NHANES 1988-94 to 1999-2000) saved more than 30 million teeth from decay and almost $3 billion in treatment costs

Progress:

Improving Cannot assess (limited data)

Oral Health Objectives

Getting worse

21-16 Oral and craniofacial State-based surveillance system

21-7 Annual exams for oral and pharyngeal cancers

Children 2-4 years Children 6-8 years Adolescents 15 years

21-1 Dental caries experience

Children 2-4 years Children 6-8 years Adolescents 15 years Adults 35-44 years

21-2 Untreated dental decay

21-3 No permanent tooth loss

21-4 Complete loss

21-5 Periodontal diseases

21-6 Early detection of oral and pharyngeal cancers

21-8 Dental sealants

21-9 Community water fluoridation

21-12 Dental services of for low-income children

21-13 School-based health centers with oral health components

21-14 Health centers with oral health service components

Children 8 years Adolescents 14 years

21-10 Use of oral health care system

21-11 Use of oral health system by long- term care facilities residents

21-15 Referral for cleft lip or palate

21-17 Tribal, State & local programs

21-16 Oral and craniofacial State-based surveillance system

21-7 Annual exams for oral and pharyngeal cancers

Improving Cannot assess (limited data)

Oral Health Objectives

Getting worse

Oral Health Objectives Children 2-4 years Children 6-8 years Adolescents 15 years

21-1 Dental caries experience

Children 2-4 years Children 6-8 years Adolescents 15 years Adults 35-44 years

21-2 Untreated dental decay

21-3 No permanent tooth loss

21-4 Complete loss

21-5 Periodontal diseases

21-6 Early detection of oral and pharyngeal cancers

21-8 Dental sealants

21-9 Community water fluoridation

21-12 Dental services of for low-income children

21-13 School-based health centers with oral health components

21-14 Health centers with oral health service components

Children 8 years Adolescents 14 years

21-10 Use of oral health care system

21-11 Use of oral health system by long- term care facilities residents

21-15 Referral for cleft lip or palate

21-17 Tribal, State & local programs

Children 2-4 years Children 6-8 years Adolescents 15 years

21-1 Dental caries experience

Improving Cannot assess (limited data)

Children 2-4 years Children 6-8 years Adolescents 15 years Adults 35-44 years

21-2 Untreated dental decay

21-3 No permanent tooth loss

21-4 Complete loss

21-5 Periodontal diseases

21-6 Early detection of oral and pharyngeal cancers

21-7 Annual exams for oral and pharyngeal cancers

21-8 Dental sealants

21-9 Community water fluoridation

21-12 Dental services of for low-income children

21-13 School-based health centers with oral health components

21-14 Health centers with oral health service components

Children 8 years Adolescents 14 years

21-10 Use of oral health care system

21-11 Use of oral health system by long- term care facilities residents

21-15 Referral for cleft lip or palate

21-16 Oral and craniofacial State-based surveillance system

Oral Health Objectives

Getting worse

21-17 Tribal, State & local programs

21-7 Annual exams for oral and pharyngeal cancers

Improving Getting worse Cannot assess (limited data)

Oral Health Objectives Children 2-4 years Children 6-8 years Adolescents 15 years

21-1 Dental caries experience

Children 2-4 years Children 6-8 years Adolescents 15 years Adults 35-44 years

21-2 Untreated dental decay

21-3 No permanent tooth loss

21-4 Complete loss

21-5 Periodontal diseases

21-8 Dental sealants

21-9 Community water fluoridation

21-12 Dental services of for low-income children

21-13 School-based health centers with oral health components

21-14 Health centers with oral health service components

Children 8 years Adolescents 14 years

21-10 Use of oral health care system

21-11 Use of oral health system by long- term care facilities residents

21-15 Referral for cleft lip or palate

21-16 Oral and craniofacial State-based surveillance system

21-17 Tribal, State & local programs

Oral Health Objectives

21-6 Early detection of oral and pharyngeal cancers

21-1 Dental caries experience in children

21-3 No permanent tooth loss in adults

21-6 Early detection of oral and pharyngeal cancers

21-8 Sealants

21-10 Use of oral health care system

21-12 Dental services of for low-income children

21-14 Health centers with oral health services

Highlighted Objectives

21-1 Dental caries experience in children

21-3 No permanent tooth loss in adults

21-6 Early detection of oral and pharyngeal cancers

21-8 Sealants

21-10 Use of oral health care system

21-12 Dental services of for low-income children

21-14 Health centers with oral health services

5-15 Dental visits among persons with diabetes

Highlighted Objectives

0

20

40

60

80

Obj. 21-1c

Adolescents 12-18 Years Who Ever Had Caries in Permanent Teeth, 1988-94

Total Black MexicanAmerican

White MaleFemale

Percent2010 Target1988-94

Note: Target is for adolescents 15 years old. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.Source: National Health and Nutrition Examination Survey, NCHS, CDC.

0

20

40

60

80

Obj. 21-1c

Adolescents 12-18 Years Who Ever Had Caries in Permanent Teeth, 1988-94 and

1999-2000

Note: Target is for adolescents 15 years old. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.Source: National Health and Nutrition Examination Survey, NCHS, CDC.

Total Black MexicanAmerican

White MaleFemale

Percent2010 Target1988-94 1999-2000

0

10

20

30

40

50

Obj. 21-1aNote: Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.Source: National Health and Nutrition Examination Survey, NCHS, CDC.

Total Black MexicanAmerican

White MaleFemale

Percent

2010 Target

1988-94

Children 2-4 Years Who Have Ever Had Caries in Primary Teeth, 1988-94

0

10

20

30

40

50

Obj. 21-1a

Children 2-4 Years Who Have Ever Had Caries in Primary Teeth, 1988-94 and

1999-2000

Note: Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.Source: National Health and Nutrition Examination Survey, NCHS, CDC.

Total Black MexicanAmerican

White MaleFemale

2010 Target

1988-94 1999-2000Percent

Note: from Niendorff & Jones, JPHD 2000: 60: 245. Data are for IHS service areas. Source: 1991 Patient Survey, IHS.

24%

Early Childhood Caries (ECC) in American Indian/Alaska Native

Children 0-4 Years

1991

Early Childhood Caries (ECC) in American Indian/Alaska Native

Children 0-4 Years

Note: from Niendorff & Jones, JPHD 2000: 60: 245. and Kaste et al., JPHD 1999; 59: 199.Source: 1991 Patient Survey, IHS; National Health and Nutrition Examination Survey, NCHS, CDC.

1991

24%Less than 2% of all U.S. children 1-2 years in 1988-94 had ECC

Dental Sealants

0

10

20

30

40

50

Note: Targets are for children 8 years and 14 years. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.Source: National Health and Nutrition Examination Survey, NCHS, CDC.

Total

Percent2010

Targets

6-11 Years 12-18 Years

Black MexicanAmerican

White Total Black MexicanAmerican

White

Dental Sealants: 1988-94

Obj. 21-8

1988-94 1988-94

0

10

20

30

40

50

Total

2010Targets

6-11 Years 12-18 Years

Black MexicanAmerican

White Total Black MexicanAmerican

White

Dental Sealants: 1988-94 and 1999-2000

Obj. 21-8

1999-2000 1999-20001988-94 1988-94

Unreliable estimate, relative standard error >30%.Note: Targets are for children 8 years and 14 years. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.Source: National Health and Nutrition Examination Survey, NCHS, CDC.

Percent

0

20

40

60

Obj. 21-3

Total Black MexicanAmerican

White MaleFemale

1988-94

2010 Target

Note: Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.Source: National Health and Nutrition Examination Survey, NCHS, CDC.

Percent

No Permanent Tooth Loss in Adults35-44 Years: 1988-94

0

20

40

60

Obj. 21-3Note: Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.Source: National Health and Nutrition Examination Survey, NCHS, CDC.

No Permanent Tooth Loss in Adults35-44 Years: 1988-94 and 1999-2000

2010 Target

Total Black MexicanAmerican

White MaleFemale

1988-94 1999-2000Percent

Obj. 21-6

Early Detection of Oral and Pharyngeal Cancers: 1990-95

1990-95

0

20

40

60

2010 Target

Note: Data are for Stage 1 (localized) tumors, excluding Kaposi Sarcoma tumors. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.Source: Surveillance, Epidemiology, and End Results Program, NIH, NCI.

Percent

Total Black HispanicWhite MaleFemale

0

20

40

60

Obj. 21-6

Early Detection of Oral and Pharyngeal Cancers: 1990-95 and

1996-20001990-95 1996-2000

2010 Target

Note: Data are for Stage 1 (localized) tumors, excluding Kaposi Sarcoma tumors. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.Source: Surveillance, Epidemiology, and End Results Program, NIH, NCI.

Percent

Total Black HispanicWhite MaleFemale

2010 Target = 57%

20%

1996

Obj. 21-12Note: Data are for children under 19 years. Low income is less than 200% of poverty level. Preventive services include examinations, cleaning, x-rays, fluoride treatments and sealant applications.Source: Medical Expenditure Panel Survey, AHRQ.

Receipt of Preventive Services by Low Income Children

31%

2010 Target = 57%

20%

1996 2000

Receipt of Preventive Services by Low Income Children

Obj. 21-12Note: Data are for children under 19 years. Low income is less than 200% of poverty level. Preventive services include examinations, cleaning, x-rays, fluoride treatments and sealant applications.Source: Medical Expenditure Panel Survey, AHRQ.

0

20

40

60

Annual Dental Visits: 1996

Obj. 21-10Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: Medical Expenditure Panel Survey, AHRQ.

2010 Target

1996

Race/ethnicity

Percent

Total White Black Hispanic

Hispanic0

20

40

60

Obj. 21-10

1996

Race/ethnicity Disability status

Percent2010 Target

Annual Dental Visits: 1996

Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: Medical Expenditure Panel Survey, AHRQ.

Total White Black With Without

0

20

40

60

Obj. 21-10

Total White Black Hispanic

1996 2000

With Without

Percent2010 Target

Annual Dental Visits: 1996 and 2000

Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: Medical Expenditure Panel Survey, AHRQ.

Race/ethnicity Disability status

Community Health Centers with Onsite Dental Services

350

672

365

694

406

690

416

730

446

748

518

843

0

200

400

600

800

1000

0

20

40

60

80

100

Obj. 21-14Source: Bureau of Primary Health Care, HRSA.

1997 1998 1999 2000 2001 2002

NumberDental Services at Center Health Centers

Community Health Centers with Onsite Dental Services

59 5760 61

5352

0

200

400

600

800

1000

0

20

40

60

80

100Number

Obj. 21-14

Percent

2010 Target

Source: Bureau of Primary Health Care, HRSA.

1997 1998 1999 2000 2001 2002

Dental Services at Center Health Centers

0

20

40

60

80

Obj. 5-15Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: National Health Interview Survey, NCHS, CDC.

Annual Dental Visits for Personswith Diabetes: 2002

Total Black HispanicWhite RuralUrban

Persons withdiabetes

Race/ethnicity

100-199 >200<100

Poverty level (%)

Percent

2010 Target

Urbanicity

0

20

40

60

80

Obj. 5-15Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: National Health Interview Survey, NCHS, CDC.

Annual Dental Visits for Personswith and without Diabetes: 2002

Total Black HispanicWhite RuralUrban

Persons withdiabetes

Race/ethnicity Urbanicity

100-199 >200<100

Persons withoutdiabetes

Percent

2010 Target

Poverty level (%)

0

20

40

60

80

1997 1998 1999 2000 2001 2002

Obj. 5-15Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Source: National Health Interview Survey, NCHS, CDC.

Annual Dental Visits for Personswith and without Diabetes: 1997-

20022010 Target

Persons with diabetes

Percent

Persons without diabetes

Progress review data and slides

can be found on the web at:

http://www.cdc.gov/nchs/hphome.htmhttp://www.cdc.gov/nchs/hphome.htm

12 IHS Service Areas