Image: 020128dentist_hup3p.jpg
updated 10/15/2003 6:04:17 PM ET 2003-10-15T22:04:17

At least a third of Americans fail to see a dentist even once a year. Tooth decay is the most common chronic childhood disease — half of first-graders already have a cavity. Large swaths of the country don’t have fluoridated drinking water, considered one of the most important health advances of the 20th century. Two years after the surgeon general labeled Americans’ bad oral health a “silent epidemic,” a new report — using government data to assess each state — finds that the mouth is getting too little medical attention.

But there are small signs of progress. Some states are raising the fees they pay dentists for treating Medicaid patients, key to getting poor children dental care. Most states have hired dental directors to push improvements locally. And the government is developing a national oral health plan — with a string of public meetings across the country starting in San Diego on March 5 — to spread the word that your mouth is a mirror to your overall health.

“The jaw bone is connected to the toe bone, and what happens in the jaw bone is just as important as every other bone in the body,” says Dr. Caswell Evans of the National Institutes of Health.

The new report grades each state on how its residents do in 22 measures — from how many kids have cavity-blocking sealants on their teeth to how often the poor see a dentist.

Overall, the nation gets a “C,” says Oral Health America, a nonprofit advocacy group that wrote the report with help from federal health officials.

LACK OF ACCESS

The biggest problems are access to care and lack of proper preventive services.

For example, in 10 states, less than half the population drinks fluoridated water, one of the best ways to prevent tooth decay. They are California, Hawaii, Idaho, Mississippi, Montana, New Hampshire, New Jersey, Oregon, Utah and Wyoming. California recently began increasing supplies of fluoridated water but it still reaches less than a third of residents.

Some 108 million Americans have no dental insurance, more than twice the 40 million without medical insurance.

Medicaid pays for poor children to see a dentist, yet most states pay the dentists so little that few participate. The result: In no state did at least half of Medicaid-eligible children get an annual dental visit, the report found. In the best states — Kentucky, Massachusetts, Nebraska and Vermont — only about 40 percent of these impoverished children saw a dentist.

Nation's oral health in decay
Cavities aren’t a trivial problem. “Children go to bed at night in great tooth pain that no adult would ever put up with,” says Robert Klaus, president of Oral Health America.

Indeed, cavities cause an estimated 50 million hours of missed school each year, says Surgeon General David Satcher. Lack of regular dental care too often means they wind up in emergency rooms screaming in pain.

As for adults, at least a third don’t see a dentist annually. That number jumps to well over half of the poor.

“Many people don’t see regular care as an important part of overall health until they run into problems,” Satcher says.

TOO EXPENSIVE FOR MANY SENIORS

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Some 24 percent of the elderly have have lost all their teeth, even more in Kentucky, North Dakota and West Virginia. Aside from the obvious suffering, many poor older people can’t afford comfortable dentures and in turn don’t eat properly, setting them up for numerous diseases.

Plus, almost 30,000 Americans will get oral cancer this year and 8,000 will die.

If you don’t see a dentist to check for early signs of cancer, make sure your primary care physician does it properly, Satcher cautions: “You really have to stick your finger in patients’ mouths and feel the salivary glands to detect tumors.”

The report did uncover some good news:

Some states, such as Alabama and Georgia, have come up with funds to get more Medicaid children to the dentist. Hawaii is opening a special comprehensive dental clinic for Medicaid-eligible children and adults.

Ohio, New York and Illinois have launched successful, innovative programs to get cavity-blocking sealants placed in tens of thousands of children’s teeth.

Only California, Kansas, Louisiana and South Dakota have yet to follow the surgeon general’s recommendation that every state hire a dental director to make improvements.

© 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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