Introduction

It is difficult to believe that preventive dentistry has only been in practice since the 1960s in the United States. Prior, dentistry did not include routinely scheduled patient care. Although preventive dentistry is common practice in the U.S., we only saw a decline of caries in children aged 2-11 in some socioeconomic populations. In the 2021 report of the National Institute of Dental and Craniofacial Research (NIDCR) Oral Health in America: Advances and Challenges, we continue to a see a decline in dental caries of children under the age of 12 years, since the report was last updated 20 years ago. However, children in lower income households have seen less improvement in caries, compared to higher income families. Currently more than 1 in 5 Mexican American and non-Hispanic Black children experience caries, compared to less than 1 in 7 non-Hispanic White children. In fact, nearly 1 in 4 children in poverty experience caries. There is also a higher prevalence of caries in other minority racial and ethnic populations. Native American and Alaska Native children aged 6-8 years are twice as likely to have untreated caries in their primary dentition and five times more likely to have untreated caries in their permanent dentition, compared to all U.S. children. With periodontal disease, it’s reported that nearly 1 in 10 Americans aged 65 year and older have experienced severe periodontitis, especially for populations who are poor, fewer years of education, who are Hispanic or African American. Although we have seen a decrease in oral diseases in some populations the last 20 years, the 2021 report found an unusual pattern in regards to gender, where researchers found a significant increase of primary dentition caries in male children 2-11 years of age compared to girls. With permanent teeth, we saw girls aged 6-11 years had a greater decline in caries than boys.

The U.S. Census reports by 2060 the number of seniors is expected to reach almost 95 million or 24% of the overall U.S. population. For the first time in U.S. history, older adults will outnumber children by 2035. With seniors aged 65 years and older, approximately 5% are edentulous and 93% of seniors have had dental caries in their permanent teeth. The National Center for Health Statistics (NHANES) of the Center for Disease Control (CDC) indicates the average older adult takes 4-5 prescription drugs. In addition, seniors reported also taking 2-3 over-the-counter drugs. Drugs most commonly prescribed for our patients include statins, antihypertensive agents, analgesics, drugs for endocrine dysfunction, e.g., hypothyroid and diabetes, anticoagulant and antiplatelet agents, and drugs for respiratory and gastrointestinal dysfunction. We know there are hundreds of drugs that contribute to xerostomia. A 2018 systematic review and meta-analysis examined medications that cause the reduction of saliva in the older population. The researchers found seniors who took medications for urinary incontinence had the greatest risk for xerostomia. Researchers also found antidepressants and psycholeptic prescription drugs significantly affected saliva production. To learn more about pharmacological effects, see the additional resources section at the end of the course.

The American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) recommend children be seen by a dentist in their first year of age. We know that evidence-based prevention, early detection and management of oral conditions greatly benefit children. Delayed care can exacerbate oral conditions, leading to the potential for future oral pain and costly dental care. A 2018 national survey conducted on behalf of the AAPD revealed 74% of parents do not take their children to the dentist by their first birthday. Even though 96% of parents surveyed indicated oral health is important, 3 in 10 parents considered toothaches a less serious ailment than earaches, tummy aches, and sore throats. The National Cancer Institute (NCI) of the National Institutes of Health (NIH) indicates oral cancer kills one American every hour of every day and only 50% of those diagnosed with oral cancer will survive more than 5 years. As dental providers, we know early detection of oral cancer is critical. However, NCI indicates only 1/3 of oral cancer is found in the early stages, with 1/3 of oral cancer occurring in patients younger than 55 years of age. Recent studies by John Hopkins indicates 1 in 7 people diagnosed with oral cancer were younger than 40 years of age, with 25% of these patients not having the traditional risk factors for oral cancer. About 2/3 of oral cancer occurs in the floor of the mouth and tongue and 1/3 of cases are diagnosed as oropharyngeal cancer. We know that tobacco use places our patients at high-risk for cancer. Current statistics indicate people who use tobacco are six times more likely to develop oral cancer, where 8 in 10 patients diagnosed with oral cancer have smoked. This course includes current data for dental clinicians as they determine patient treatment.