THE IMPACT OF ORAL DISEASE IN

NEW YORK STATE

NEW YORK STATE DEPARTMENT OF HEALTH BUREAU OF DENTAL HEALTH

DECEMBER 2006

Acknowledgements: This report represents the combined work and contributions of staff of the Bureau of Dental Health and was made possible in part by funding from the Centers for Disease Control and Prevention, Division of Oral Health, Cooperative Agreement 03022.

Elmer L. Green, DDS, MPH Barbara J. Greenberg, MA, MS Bureau Director Research Specialist/Principal Author

Michelle Cravetz, RN-BC, MS Julie Reuther, RDH, BS Assistant Bureau Director Program Coordinator

Jayanth V. Kumar, DDS, MPH Junhie Oh, DDS Director, Oral Health Surveillance Dental Public Health Resident and Research

Donna L. Altshul, RDH, BS Timothy Cooke, BDS, MPH Program Coordinator Program Coordinator Additional and related information is also available from the New York State Department of Health website: http://www.nyhealth.gov

Comments regarding the format or content of this report are welcomed and can be sent to the New York State Department of Healths Bureau of Dental Health, Empire State Plaza, Corning Tower Building, Room 542, Albany NY 12237.

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http://www.nyhealth.gov/

A Message

Dear Colleague: I am pleased to present this comprehensive report on the Impact of Oral Disease in

New York State. The report summarizes the most current information available on the

burden of oral disease on the people of New York State and was developed by the New

York State Department of Health in collaboration with the Centers for Disease Control

and Prevention, Division of Oral Health.

New York State has a strong commitment to improving oral health care for all New

Yorkers and in reducing the burden of oral disease, especially among minority, low

income, and special needs populations. This report not only highlights the numerous

achievements made in recent years in the oral health of New Yorkers and in their ability

to access dental services, but also describes groups and regions in our State that

continue to be at highest risk for oral health problems and provides a roadmap for future

prevention efforts.

We hope that the information provided in this report will help raise awareness of the

need for monitoring oral health and the burden of oral diseases in New York State and

guide efforts to prevent and treat oral diseases and enhance the quality of life of all New

York State residents.

Sincerely,

Antonia C. Novello, M.D., M.P.H., Dr. P.H.

Commissioner

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TABLE OF CONTENTS I. INTRODUCTION... II. EXECUTIVE SUMMARY.. III. NATIONAL AND STATE OBJECTIVES ON ORAL HEALTH.. IV. THE BURDEN OF ORAL DISEASES

A. PREVALENCE OF DISEASE AND UNMET NEED i. Children. ii. Adults.

B. DISPARITIES i. Racial and Ethnic Groups... ii. Womens Health... iii. People with Disabilities iv. Socioeconomic Disparities..

C. SOCIETAL IMPACT OF ORAL DISEASE i. Social Impact.... ii. Economic Impact.. iii. Oral Disease and Other Health Conditions..

V. RISK AND PROTECTIVE FACTORS AFFECTING ORAL DISEASES A. COMMUNITY WATER FLUORIDATION.

B. TOPICAL FLUORIDES AND FLUORIDE SUPPLEMENTS.

C. DENTAL SEALANTS..

D. PREVENTIVE VISITS.

E. SCREENING FOR ORAL CANCER

F. TOBACCO CONTROL

G. ORAL HEALTH EDUCATION

VI. PROVISION OF DENTAL SERVICES A. DENTAL WORKFORCE CAPACITY

B. DENTAL WORKFORCE DIVERSITY..

C. USE OF DENTAL SERVICES i. General Population.. ii. Special Populations.

D. DENTAL MEDICAID AND STATE CHILDRENS HEALTH INSURANCE PROGRAM i. Dental Medicaid at the National and State Level...

ii. New York State Dental Medicaid.. iii. State Expenditures for the Treatment of Oral Cavity and Oropharyngeal Cancers..... iv. Use of Dental Services by Children in Medicaid and Child Health Plus B.

E. COMMUNITY AND MIGRANT HEALTH CENTERS AND OTHER STATE, COUNTY, AND LOCAL PROGRAMS.

F. BUREAU OF DENTAL HEALTH, NEW YORK STATE DEPARTMENT OF HEALTH PROGRAMS AND INITIATIVES...

i. Preventive Services and Dental Care Programs ii. Dental Health Education. iii Research and Epidemiology..

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23 26

36 36 37 38

38 39 44

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46 47

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57 63

65 68

74 75 75 78 79

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92 93 95 95

101 VII. CONCLUSIONS.. 103 VIII. REFERENCES.

IX. APPENDICES A. INDEX TO TABLES.

B. INDEX TO FIGURES..

C. COMMUNITY WATER FLUORIDATION - FACT SHEET

D. DENTAL SEALANTS - FACT SHEET..

E. CHILDRENS ORAL HEALTH IN NEW YORK STATE - FACT SHEET.

F. CHILDRENS ORAL HEALTH IN NEW YORK STATE AND ACCESS TO DENTAL CARE FACT SHEET

G. NEW YORK STATE: USING COMMUNITY-BASED SURVEILLANCE TO PROMOTE ORAL HEALTH AND EXPAND SERVICES. .

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I. INTRODUCTION

The burden of oral disease is manifested in poor nutrition, school absences, missed workdays, and increasing public and private expenditures for dental care. Poor oral health, which ranges from cavities to cancers, causes needless pain, suffering, and disabilities for countless Americans. The mouth is an integral part of human anatomy, with oral health intimately related to the health of the rest of the body. A growing body of scientific evidence has linked poor oral health to adverse general health outcomes, with mounting evidence suggesting that infections in the mouth, such as periodontal disease can increase the risk for heart disease, put pregnant women at greater risk for premature delivery, and can complicate the control of blood sugar for people living with diabetes. Additionally, dental caries in children, especially if untreated, can predispose children to significant oral and systemic problems, including eating difficulties, altered speech, loss of tooth structure, inadequate tooth function, unsightly appearance and poor self-esteem, pain, infection, tooth loss, difficulties concentrating and learning, and missed school days. Behaviors that affect general health, such as tobacco use, excessive alcohol use and poor dietary choices are also associated with poor oral health outcomes. Conversely, changes in the mouth are often the first signs of problems elsewhere in the body, such as infectious diseases, immune disorders, nutritional deficiencies, and cancer. Our mouth is our primary connection to the world. In addition to providing us a way to take in water and nutrients to sustain life, it is our primary means of communication and the most visible sign of our mood and a major part of how we appear to others. Oral health is more than just having all your teeth and having those teeth being free from cavities, decay, or fillings. It is an essential and integral component of peoples overall health throughout life. Oral health refers to your whole mouth: not just your teeth, but your gums, hard and soft palate, the linings of the mouth and throat, your tongue, lips, salivary glands, chewing muscles, and your upper and lower jaws. Good oral health means being free of tooth decay and gum disease, but also being free from conditions producing chronic oral pain, oral and throat cancers, oral tissue lesions, birth defects such as cleft lip and palate, and other diseases, conditions, or disorders that affect the oral, dental and craniofacial tissues. Together, the oral, dental and craniofacial tissues are known as the craniofacial complex. Good oral health is important because the craniofacial complex includes the ability to carry on the most basic human functions such as chewing, tasting, swallowing, speaking, smiling, kissing, and singing. This report summarizes the most current information available on the burden of oral disease on the people of New York State. It also highlights groups and regions in our State that are at highest risk for oral health problems, and discusses strategies to prevent these conditions and provide access to dental care. Comparisons are made to national data whenever possible, and to Healthy People 2010 objectives when appropriate. For some conditions, national data, but not State data, are available at this time. It is hoped that the information provided in this report will help raise awareness of the need for monitoring oral health and the burden of oral diseases in New York State and guide efforts to prevent and treat oral diseases and enhance the quality of life of all New York State residents.

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II. EXECUTIVE SUMMARY

Over the last five decades, New York State has seen a dramatic improvement in the oral health of its residents through the actions of individuals, professionals, policy makers, State and local governments, educational institutions and health care organizations. Efforts of the Bureau of Dental Health, New York State Department of Health, to promote oral health through research, community-based prevention interventions and programs are a testament to its commitment to achieve optimum oral health for all New Yorkers. Borrowing from the World Health Organizations definition of health, oral health is a state of complete physical, mental and social wellbeing, not merely the absence of tooth decay, oral and throat cancers, gum disease, chronic pain, oral tissue lesions, birth defects such as cleft lip and palate, and other diseases and disorders that affect the oral, dental and craniofacial tissues. The mouth is our primary means of communication, the most v