Oral Health in America - April 2022 Bulletin

Section 3A Summary

Oral Health Across the Lifespan: Working-Age Adults

In adulthood, the relationship between oral health and overall health becomes more apparent and manifests in various ways, impacting quality of life. Oral diseases can affect individuals’ ability to eat, speak, and smile, and are associated with certain health conditions. Oral health literacy programs that inform decision-making and efforts to ensure access to regular dental care can help working-age adults, especially those with lower incomes and from ethnic and racial minority groups, overcome obstacles to achieving better oral health.

Status of Knowledge, Practice, and Perspectives

While adults today lose fewer teeth than previous generations, the oral health of American adults generally has not changed much in the past 20 years. Tooth decay, affecting 90% of adults aged 20 to 64 years, and gum disease, affecting almost 50% of adults aged 45 to 64 years, remain two of the most prevalent oral diseases. Untreated tooth decay cost the US about $45.9 billion in lost productivity in 2015 and often results in visits to hospital emergency rooms where care is often palliative but does not treat the root cause of problems. Gum disease is a risk factor for nearly 60 other adverse health conditions, including Alzheimer’s disease, diabetes, and heart disease.

High-risk behaviors in adults, including consumption of tobacco, opioids, and alcohol, threaten oral health and contribute to oral cancers, gum disease, dental trauma, tooth loss, and more. Radiation therapy for head and neck cancer can permanently damage the salivary glands, which can lead to chronic dry mouth, dental decay, and oral infections.

Advances and Challenges

Over the past 20 years, advances in dental technology and knowledge about the relationship between oral health and overall health have enabled development of more effective and less-invasive restorative materials and techniques, as well as improvements in preventative care and dental treatments. However, more than 1 in 4 working-age adults lack dental insurance, hindering their access to dental care and widening oral health disparities.

The incidence of tobacco-related oral cancers has declined due to public health measures that discourage tobacco use, however human papillomavirus (HPV)-related oral and pharyngeal cancers have doubled over the past 20 years, with men experiencing 3.5 times more of these cancers than women. In a response to the opioid epidemic, oral health professionals have been prescribing fewer opioids and opting more often for nonaddictive pain management, while researchers have generated new insights into mechanisms of oral and facial pain.

Promising New Directions

Digital technologies like those used for teledentistry and implementation of electronic health records that integrate patients’ dental and medical data can make clinical dental care faster, easier, and more precise, as well as facilitate collaborations among dental, medical, and behavioral health professionals. Lack of dental insurance and other means to pay for dental care is a primary reason adults forgo needed dental care. Efforts to lower financial barriers and increase access to dental services, along with health literacy programs that help individuals navigate health care systems, present opportunities for improving adults’ oral health.

Additional Takeaways

It is essential to provide support for populations that face unique challenges in taking care of their oral health. A growing body of research shows that poor oral health during pregnancy is linked to adverse health outcomes for both mother and baby. Nearly 1 in 5 US adults experience moderate to high dental fear and anxiety that prevent them from seeking oral health care. There is also a need to better understand and address the needs or obstacles faced by certain groups, including veterans, people experiencing homelessness, immigrants, people who are incarcerated, and adults with special health care needs.

Q&A with Section Editor

Q&A with Jocelyne Feine, DDS, MS, HDR, senior editor, Section 3A: Oral Health Across the Lifespan: Working-Age Adults.

What are some important takeaways from this section?

The oral health of American working-age adults has not improved over the past 20 years. While complete tooth loss has declined, untreated caries, periodontal disease, and individual tooth loss are still very common. Predictably, substantial oral health disparities exist, based on social determinants of health and lack of access to care by many who have low incomes and lack insurance coverage. As important as it is to study disorders that can lead to death, we also need to address conditions that contribute to poor general health and negatively impact quality of life; oral diseases do both.

What was a surprising finding?

Because the combined use of alcohol and tobacco is a significant contributor to oropharyngeal cancers, I was surprised that oral cancer hasn’t declined with the reduction in smoking. But in fact, even with the notable decrease in tobacco use and its associated oropharyngeal cancers, HPV-associated oropharyngeal cancers have markedly increased.

What should the American people know about this section of the report?

We know there’s a connection between oral health and general health, and they need to be seen as one. While great improvements have been made in a variety of new technologies for oral health provision and care, those advances have not resulted in better oral health for working-age adults. This is principally because dental care is not focused on prevention, is expensive, and many Americans cannot afford it. People who have been disenfranchised, whether due to skin color, background, culture, etc., have often been shut out of the health care system, including oral health care.

What is the main call to action?

Policy changes at all levels, including state and federal governments, are essential to address the various inequities that impede access to oral health care for working-age adults. At the level of education, for example, in addition to teaching dental students how to provide new restorations in the mouth, we can also train students to repair teeth, rather than to replace them; this may be more affordable for patients from lower-income backgrounds.

Jocelyne Feine, DDS, MS, HDR, is a professor in the faculty of Dental Medicine and Oral Health Sciences at McGill University, Canada. She received her dental and master’s degrees from the University of Texas at Houston and was awarded the Habilitation à deriger des recherches (HDR) degree from the Universite d’Auvergne, France. Her research emphasizes chronic orofacial conditions, pain, tooth loss, and patients’ quality of life.

Did You Know?

• About 9 out of 10 adults aged 20 to 64 years have experienced tooth decay. Dental practitioners are shifting to less-invasive approaches to manage the disease. See context.
• Periodontal (gum) disease affects more than 2 in 5 adults between the ages of 45 and 64 and is associated with nearly 60 other health problems, including diabetes, heart conditions, and Alzheimer’s disease. See context.
• More than half of working-age adults experiencing poverty have untreated caries, whereas only 1 out of 5 adults with incomes above the poverty level have untreated caries. See context.
• Nearly 1 in 5 US adults experience moderate to high dental fear and anxiety that can prevent them from seeking needed oral care. Dental clinicians can help these patients by building trust and creating a positive environment for behavior change. See context.

Learn more about Oral Health in America: Advances and Challenges