Dental caries is a very common chronic disease that affects all age groups in the United States. If left untreated, dental caries leads to pain and infection, tooth loss, and possibly edentulism. Dental sealants are effective in preventing dental caries in occlusal and other pit and fissure areas of the teeth. Exposure to fluoride is effective in preventing dental caries; however, excessive exposure to fluoride during tooth formation - the first six years of life for most permanent teeth - can lead to hypomineralization of enamel (fluorosis).
The Centers for Disease Control and Prevention (CDC) recently reported the results of a nationwide surveillance study that, for the first time, addressed the rate of caries and dental sealant use, tooth retention, edentulism, and enamel fluorosis. Two sampling periods - 1988-1994 and 1999-2002 - were compared.
During 1999-2002, among children ages two to 11, 41 percent had dental caries in their primary teeth. Mexican-Americans had the highest caries rate (54.9 percent) as compared to blacks (43.3 percent) and non-Hispanic whites (37.9 percent). The overall caries rate was higher among children from families with lower incomes. The caries prevalence from 1999-2002 was the same as observed from 1988-1994.
Approximately 21 percent of children ages two to 11 had untreated tooth decay in their primary teeth. Mexican-American children had the highest rates. Only 13.2 percent of children from families with higher incomes had untreated caries. The prevalence of untreated tooth decay in primary teeth was the same in both observation periods.
More than 42 percent of children and adolescents ages six to 19 had caries in their permanent teeth. Among children ages six to 19, about one third had received dental sealants. Prevalence of dental sealants among children and adolescents ages 12 to 15 (37.4 percent) was higher than among those ages six to 11 (29.5 percent) and 16 to 19 years (31.4 percent). Sealants were more common among non-Hispanic whites, and those with higher incomes. Molars accounted for 85 percent of all sealed teeth. Among children with at least one sealed tooth, 98.2 percent had a sealed molar.
Adults 20 years or older had, on average, 24 of 28 natural teeth with only eight percent being edentulous. Approximately 91 percent of dentate adults experienced caries with 23 percent having untreated tooth decay. Dentate adults had a mean of 8.0 decayed and filled permanent teeth (DFT), and 20.9 decayed and filled permanent surfaces (DFS). More than 18 percent had root caries. This includes untreated and restored lesions. Prevalence of root caries increased with age. For example, 31.6 percent of adults ages 60 or older experienced root caries while only 9.4 percent of 20- to 39-year-olds were affected.
For persons ages six to 39, 23 percent had mild to greater enamel fluorosis. The prevalence of fluorosis was lowest among persons ages 20 to 39. Posterior teeth were more affected than anterior teeth. When 1999-2002 results were compared to a study done from 1986-1987, a 9 percent increase in fluorosis was noted.
The CDC reported four major trends that occurred from 1988-1994 to 1999-2002. These were: 1) no change in the prevalence of dental caries in primary teeth of children ages two to 11; 2) a reduction in the prevalence of dental caries in permanent teeth of about 10 percent in persons ages six to 19, and approximately 6 percent fewer dental caries in dentate persons ages 20 or older; 3) an increase of more than 13 percent in the use of dental sealants among persons ages six to 19; and 4) a 6 percent reduction in total tooth loss among persons ages 60 or older.
The CDC report documents improvements in the oral health of the civilian, American population. However, no reductions were observed in the prevalence and severity of dental caries in primary teeth. Findings indicate that the status of dental caries in permanent teeth has improved since the 1988-1994 survey. The use of dental sealants among children and adolescents increased substantially. Interest in sealant use as a method to prevent tooth decay continues to increase with treatment afforded privately and through public funding. Declines occurred in crown and root caries and benefited children, adolescents, and adults.
Despite the decrease in the caries prevalence and severity in permanent dentition, and the increase in the number of children and adolescents who benefit from dental sealants, disparities among different groups remain. Racial-ethnic minorities, those with lower incomes, lower education levels, and current smokers across all age groups had more unmet needs compared with their counterparts.
Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik is the co-author of the popular “Infection Control and Management of Hazardous Materials for the Dental Team.” He serves as chair of the OSAP publications committee. Questions about this article or any infection-control issue may be directed to [email protected].