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Tooth Retention and Edentulism. Mean number of teeth was inversely correlated with age: Non-Hispanic white and Mexican-American adults had more teeth Adults with more than a high school education had more teeth Persons who reported never smoking had more teeth Prevalence of edentulism increased with age: Mexican-American adults had a lower prevalence of edentulism 5.
An inverse correlation was observed between edentulism and education: A correlation also was observed between edentulism and smoking: Overall, edentulism decreased from The prevalence of fluorosis was lowest among persons aged years Figure Non-Hispanic blacks had higher proportions of very mild and mild fluorosis than did non-Hispanic white participants Figure Posterior teeth were more affected by enamel fluorosis than were anterior teeth Figure A nine percentage point increase in the prevalence of very mild or greater fluorosis was observed among children and adolescents aged years when data from were compared with those from the NIDR survey of school children from Dental caries and tooth loss were among the most common causes for rejection of young men from military service during the Civil War and the two World Wars So widespread was the disease in the early 20th century that Klein designed and introduced the DMFT index as a sensitive tool to describe the distribution of the disease by counting the number of decayed, missing, and filled teeth affected 6.
The introduction of fluorides for preventing dental caries, starting with water fluoridation in the mids, changed the pattern of disease occurrence. During , NCHS conducted the first national survey that included clinical assessments of dental caries in adults This was followed by two similar national surveys during among children aged years and youth aged years 21, Historically, a decline in dental caries in primary teeth was reported until the mids, when data from the two NIDR surveys were compared However, later reports have suggested that this decline has slowed or reversed in the United States and elsewhere 26, Data from this report support those findings.
These reductions in dental caries also are reflected in increased tooth retention and reduced levels of edentulism, as has been reported elsewhere for selected populations However, as the population ages and persons retain more teeth, more root surfaces become exposed and are at increased risk for tooth decay These findings highlight the importance of developing strategies for preventing and controlling dental caries in older adults.
Despite gains in oral health associated with dental caries, disparities remain. Overall, non-Hispanic white survey participants had a lower prevalence and severity of disease and lower prevalence of untreated decay compared with non-Hispanic black and Mexican-American participants.
In addition, these results also support an association between tobacco use, dental caries, and tooth loss , which might have both a biologic and socioeconomic etiologic link.
Dental sealants are highly effective in preventing dental caries that occur on the surfaces of teeth that have pits and fissures. School-based sealant programs also are cost-saving In , the Task Force on Community Preventive Services strongly recommended school-based or school-linked sealant programs for the prevention and control of dental caries The increase in sealant prevalence might be attributable to increases in both dental office-delivered and school-based and -linked sealant programs.
The increased prevalence of sealants from to was observed across all sociodemographic groups and might have contributed to the reported decrease in dental caries in permanent teeth. Despite these gains, profound disparities still exist.
School-based and -linked programs in the United States generally target vulnerable populations less likely to receive private dental care e. An expansion in the number of these programs might decrease disparities in the prevalence of sealants The findings in this report indicate that the prevalence of tooth loss continues to decline in the United States and provides further evidence that edentulism is not inevitable with advanced age.
The decrease in the prevalence of edentulism between the two surveys might in part be attributed to the increased adoption of preventive regimens such as dental sealants, community water fluoridation, use of fluoride toothpaste and mouth rinse, and support for these approaches by health-care providers, health decision makers, and public health officials.
Despite improvements in tooth loss and edentulism, disparities remain. Older adults and smokers were consistently worse off than their counterparts. These population subgroups are probably at increased risk for adverse consequences of tooth loss and other dental problems on quality of life and general health. These consequences can include limitations in chewing, dissatisfaction with appearance, avoidance of social contacts, and trouble speaking 30, Findings also suggest that Mexican-Americans continue to have the lowest prevalence of edentulism, although non-Hispanic whites also have experienced a decline in edentulism since Tooth loss and edentulism reflect differences in healthy behaviors, attitudes toward oral health and dental care, and access to and use of dental services and types of treatment received 30, In addition, tooth loss is influenced by expectations about health.
Further research is needed to determine why Mexican-Americans retain more teeth than non-Hispanic blacks and non-Hispanic whites despite having more dental caries in the younger cohorts.
Certain studies have focused on tooth loss and its relation to diet and nutritional status. Two studies have documented that the intake of fruits and vegetables was negatively affected by the loss of teeth 44, Persons who have lost all or a substantial number of their teeth consumed fewer important nutrients, including dietary fiber 44, Biochemical levels of important nutrients were lower among those missing all or a substantial number of teeth In addition, persons who had lost a substantial number of teeth were more likely to be obese than those with more teeth 48, These findings underscore the concept of a possible threshold number of teeth necessary for a "functional dentition" Despite the overall decrease in tooth loss, continued research and tailored preventive efforts to eliminate those disparities are needed.
Enamel fluorosis is a hypomineralization of enamel, characterized by greater surface and subsurface porosity than normal enamel, and is related to fluoride ingestion during periods of tooth development by young children 55 first 6 years of life for most permanent teeth. Although use of fluoride in various modalities has been important in the prevention and control of dental caries, it also introduces the risk for enamel fluorosis.
The milder forms of enamel fluorosis typically are not noticeable; however, more severe levels might be objectionable for cosmetic reasons. Historically, a low prevalence of the milder forms of fluorosis has been accepted as a reasonable and minor consequence balanced against the substantial protection afforded by dental caries from the use of fluoridated drinking water and foods, beverages, and oral care products that contain fluoride.
Reported risk factors for the more severe forms of fluorosis include drinking water with high natural fluoride levels, dietary fluoride supplements particularly when prescribed for children with other sources of systemic fluoride , ingestion of fluoride toothpaste, and having multiple sources of ingested fluoride These two surveys are the only sources of national data on enamel fluorosis.
The surveys differed in sampling and representation schoolchildren versus household survey and in procedures followed 14 examiners during versus four during Examiner reliability was considered acceptable in both surveys 4, The cohort aged years had fewer premolars and molars erupted, limiting comparison to other cohorts Figure In analyzing these cohort effects and their causes, two things need to be considered: Studies on use of fluorides exist , but they do not provide information on combined exposures.
Furthermore, not until the early s were public health approaches introduced to limit the exposure to systemic fluoride from toothpaste and supplements 66 , when the risk for fluorosis for most teeth in the age year cohort was no longer subject to change. A potentially important source of fluoride is toothpaste. By , proportionately more young children were using fluoride toothpaste than were earlier cohorts 62, In addition, although professional interest in limiting the amount of fluoride toothpaste delivered to young children and supervising their toothbrushing was expressed earlier in the s 65 , only during the early s was this approach adopted broadly as a public health measure 66 , which was too late to alter the risk for fluorosis among the year age cohort in NHANES No clear explanation exists why fluorosis was more severe among non-Hispanic black children than among non-Hispanic white or Mexican-American children.
This observation has been reported elsewhere , and different hypotheses have been proposed, including biologic susceptibility or greater fluoride intake Anterior teeth were less affected by enamel fluorosis than were posterior teeth.
This finding also was reported in the NIDR survey 71 and has been attributed to cohort effects, attrition, or a combination of the smaller anatomical surface and longer formation time of posterior teeth compared with anterior teeth 18, Further research also is needed to improve public health surveillance of fluoride exposure. The difficulties observed in comparing data from the NIDR and NHANES surveys and the time lapse between exposure and clinical presentation suggest the need for new and more timely methods to measure total fluoride exposure.
Methods such as fingernail analysis and urinary fluoride excretion have shown promise, but only with limited samples. Research in these areas could result in the development of valid and reliable techniques to monitor total fluoride exposure in children, allowing adjustment in public health practice and recommendations to reduce the cosmetic consequences of fluoride exposure while preventing and controlling dental caries.
Epidemiologic data from Australia indicate that targeting reduction in discretionary intake of supplements and toothpaste can reduce the prevalence of enamel fluorosis Information is not available to evaluate the effects of these changes in the United States after they were implemented in the early s.
Increased efforts are needed to disseminate published recommendations about appropriate use of fluoride to health professionals and the public. This report documents improvements in the oral health of the civilian, U. The report documented important differences in disease prevalence and severity by sociodemographic characteristics that public health officers, the dental profession, and the community should consider in implementing interventions to prevent and control disease and to reduce the disparities observed.
The following is a list of seven important findings in this report:. The authors thank former members of the U. Dushanka Kleinman and Dr. We would also like to thank Dr. Finally, our thanks to Dr. Mean number of decayed and filled surfaces in primary teeth Sum of individual dfs values divided by the population.
MT Number of missing permanent teeth due to caries or periodontal disease does not count teeth extracted for reasons other than caries or periodontal disease.
FT Number of filled permanent teeth teeth with carious lesions decayed teeth that have been restored. Missing teeth are excluded because in adults, some missing teeth may have been lost due to reasons other than caries, including periodontal diseases and extracted for prosthetic reasons.
DS Number of decayed surfaces in permanent teeth. MS Number of missing tooth surfaces due to caries or periodontal disease does not count surfaces of teeth extracted for reasons other than caries or periodontal disease. FS Number of filled surfaces in permanent teeth carious surfacesdecayedthat have been restored.
Missing surfaces are excluded because in adults, some missing teeth might have been lost because of reasons other than caries, including periodontal diseases and extracted for prosthetic reasons.
Mean number of decayed, missing due to disease , and filled surfaces in permanent teeth Sum of individual DMFS values divided by the population. Mean number of decayed, missing due to disease , and filled teeth Sum of individual DMFT values divided by the population. Dental fluorosis See enamel fluorosis. Dental sealants Also called pit-and-fissure sealants, these are thin plastic coatings that are applied to pits and fissures in teeth to prevent decay.
Dentate Having one or more natural permanent tooth present in the mouth excluding third molars. Edentulous Having no natural permanent teeth in the mouth excluding third molars.
Also called complete tooth loss or edentulism. Enamel fluorosis A hypomineralization of enamel, characterized by greater surface and subsurface porosity than normal enamel caused by fluoride ingestion during periods of tooth development first 6 years of life for most permanent teeth. FPL Federal poverty level. Federal poverty thresholds are defined by the U. Census Bureau based on family income and size of family. A series of surveys fielded by the National Center for Health Statistics.
Root caries Tooth decay in the tooth root that it is exposed to the oral environment because of gum recession this part of the tooth that is normally below the gums in a healthy mouth.
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An original paper copy of this issue can be obtained from the Superintendent of Documents, U. Contact GPO for current prices. Reliability of Examinations Dental examiners were calibrated periodically by the survey's reference dental examiner. Diagnostic Criteria A list of terms and abbreviations is included to facilitate the reading and interpretation of the diagnostic criteria and results. Discussion Dental Caries Dental caries and tooth loss were among the most common causes for rejection of young men from military service during the Civil War and the two World Wars Dental Sealants Dental sealants are highly effective in preventing dental caries that occur on the surfaces of teeth that have pits and fissures.
Tooth Retention and Edentulism The findings in this report indicate that the prevalence of tooth loss continues to decline in the United States and provides further evidence that edentulism is not inevitable with advanced age. Enamel Fluorosis Enamel fluorosis is a hypomineralization of enamel, characterized by greater surface and subsurface porosity than normal enamel, and is related to fluoride ingestion during periods of tooth development by young children 55 first 6 years of life for most permanent teeth.
Conclusions This report documents improvements in the oral health of the civilian, U. The following is a list of seven important findings in this report: The decline in the prevalence and severity of dental caries in permanent teeth, reported in previous national surveys, continued during and It has benefited children, adolescents, and adults. A notable proportion of untreated tooth decay was observed across all age groups and sociodemographic characteristics.
No reductions were observed in the prevalence and severity of dental caries in primary teeth. The use of dental sealants among children and adolescents increased substantially.
This increase was probably the result of both public and private efforts and denotes a continuing interest in using dental sealants for the prevention of tooth decay. Older adults are retaining more of their teeth and fewer are losing all their teeth. Prevalence of enamel fluorosis has increased in cohorts born since This increase should be evaluated in the context of total fluoride exposure. Recommendations for Public Health Action Appropriate public health interventions to prevent dental caries should extend to all age groups and sociodemographic categories.
Factors related to the lack of reduction of dental caries in primary teeth need to be studied. Programs designed to promote oral health e. Timely surveillance tools are needed to monitor fluoride exposure from multiple sources. Acknowledgments The authors thank former members of the U. A coefficient of agreement for nominal scales.
Educ Psychol Meas ; Percent agreement, Pearson's correlation and kappa as measures of inter-examiner reliability. J Dent Res ;5: J Dent Res in press. Criteria for diagnosis of dental caries. American Dental Association; Studies on dental caries: Dental status and dental needs of elementary school children. Public Health Rep ; A measurement of dental caries prevalence and treatment service for deciduous teeth. J Dent Res ; Coronal caries in the primary and permanent dentition of children and adolescents years of age: Coronal and root caries in the dentition of adults in the United States, The prevalence of dental sealants in the US population: Tooth retention and tooth loss in the permanent dentition of adults: The investigation of physiological effects by the epidemiological method.
Fluoride and dental health. American Association for the Advancement of Science; The differential diagnosis of fluoride and non-fluoride enamel opacities. Oral health of United States children. The national survey of dental caries in U. National and regional findings. US Public Health Service; National Health and Nutrition Examination Survey, Age adjustment using the projected U. National Center for Health Statistics; Healthy People Statistics Notes.
Schenker N, Gentleman JF. On judging the significance of differences by examining the overlap between confidence intervals. Prevalence and trends in enamel fluorosis in the United States from the s and s. J Am Dent Assoc ; Oral health status in the United States: J Dent Edu ; Decayed, missing, and filled teeth in adults, United States, Decayed, missing, and filled teeth among children, United States. HSM , Series 11, No.
Decayed, missing, and filled teeth among youths years, United States. HRA , Series 11, No. The prevalence of dental caries in United States children, Oral health of United States adults. The national survey of oral health in U. The future of the caries decline. J Public Health Dent ; Trends in caries prevalence in North American children. Int Dent J ;44 4 Suppl 1: Caries prevalence in the United Kingdom. Trends in dental care among insured Americans: Estimating rates of new root caries in older adults.
Oral health in America: Relationship between smoking and dental status in , , , and year-old individuals. J Clin Periodontol ; Tobacco use and oral disease.
J Dent Educ ; Ten-year cross-sectional and incidence study of coronal and root caries and some related factors in elderly Swedish individuals. National Institutes of Health. Consensus development conference statement on dental sealants in the prevention of tooth decay. Factors influencing the effectiveness of sealantsa meta analysis. Community Dent Oral Epidemiol ; Task Force on Community Preventive Services.
Recommendations on selected interventions to prevent dental caries, oral and pharyngeal cancers, and sport-related craniofacial injuries. Am J Prev Med ;23 1 Suppl: Non-personal information is aggregated information, demographic information, IP addresses and any other information that does not reveal your specific identity. We may collect the following types of personal information:. When you visit the Site, we may collect non-personal information, such as a catalog of the Site pages you visit.
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