Defining the Need for Dental Care in North Carolina: Contributions of Public Health Surveillance of Dental Diseases and Conditions

Abstract

long-standing principle held by epidemiologists who study the health status of human populations is that any disease can demonstrate important variation among people with different characteristics, across different geographic locations, and over time. Substantial fluctuations in the amount of disease can occur as the relative importance of diseases rises and falls, usually in response to scientific breakthroughs and widespread application of effective interventions, but often for unknown reasons. The prevalence of dental diseases and their consequences are particularly prone to change because of the complex and interacting nature of their many biological, environmental, and social determinants. Dental diseases were at record highs during the first half of the 20th Century. Few people went unaffected, and most could expect to loose some of their teeth by middle age. In the early 1960s, almost 3,000 students graduated from high school in North Carolina having lost all their teeth to the ravages of dental disease. In the mid-1970s, the number of missing teeth among those in their sixth decade of life was two and onehalf times greater than the number of filled or decayed teeth. National trends through the 1990s demonstrated several significant advances in oral health status during the last half of the 20th Century. Primary among these changes were substantial declines in dental caries (tooth decay) in permanent teeth beginning in childhood and extending through young adulthood, modest reductions in destructive periodontal (gum) disease, and improvements in tooth loss and oral cancer mortality. Even with these improvements, however, dental disease still is recognized as a silent epidemic, with dental caries and periodontal diseases being among the most common of all diseases. Particularly hard hit are the poor, minorities, those living in remote geographic areas and those with special healthcare needs, creating large disparities in disease and in access to preventive and treatment services. Important changes in public health practice, the field of dentistry, and the North Carolina population have occurred during the last few decades that should substantially affect the oral health of North Carolina residents. In this commentary, we briefly review the current status of dental diseases and trends that