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Date: March 11, 1996 For Release: Immediate Contact: NIDR/Jody Dove, (301) 496-4261
Results from the first phase of a nationwide survey of oral health in children and adults were released today by the National Institute of Dental Research (NIDR), providing a snapshot of the nation's dental health status. The survey provides the most reliable estimates yet of dental disease in several population subgroups, including children under age 5, adults age 60 and over, and black Americans and Mexican Americans--the two largest minority groups in the U.S.
What emerges from the first three years, or Phase I, of the 1988-94 National Health and Nutrition Examination Survey--called NHANES III--is a more complete picture of the dental treatment needs of children and adults from Mexican American, non-Hispanic black, and non-Hispanic white backgrounds. The NIDR, which is one of the Federal government's National Institutes of Health, sponsored the oral health component of NHANES III in collaboration with the National Center for Health Statistics.
"While there has been remarkable improvement in the nation's dental health over the past couple of decades, the survey findings point to many challenges for the American public and the dental community," said NIDR Director Harold Slavkin, DDS. "For example, it appears that caries in permanent teeth continues to decline among school-aged children, and that's good news, but the other side of the coin is that 45 percent of children and adolescents still suffer from this preventable infectious disease: there is our shared challenge."
Unfortunately, tooth decay continues to affect millions of U.S. children and adolescents, with the majority experiencing caries by their late teens. Only 33 percent of 12- 17-year-olds were caries- free in their permanent teeth. Caries in the permanent teeth was not distributed evenly among children and adolescents, the survey showed. Most of the caries--80 percent-- was found in a quarter of the 5-17-year-olds.
The survey showed that most of the caries (80 percent) in the permanent teeth of children and adolescents had been treated, or filled. Although black and white youngsters had about the same amount of caries in their permanent teeth, black children had more than twice as much untreated decay as did white children.
Sixty-two percent of children aged 2-9 had no caries in their primary (baby) teeth, the survey found. While caries rates in primary teeth were similar for girls and boys, they increased with age and differed among race-ethnicity groups.
Among 2- 4-year-olds, more white children were caries-free in their primary teeth (87 percent) than either black or Mexican American youngsters (78 percent and 68 percent, respectively). Among 5- 9- year-olds, about half of white and black children had no caries in their primary teeth, while only about a third of Mexican American children were caries-free.
Untreated decay in primary teeth was a major problem uncovered by the survey. Nearly half (47 percent) of the caries in the primary teeth of 2- 9-year-olds had not been treated. Mexican American children had the highest percentage of untreated decay--62 percent, followed by 59 percent for black children and 41 percent for white children.
NHANES III revealed that use of dental sealants more than doubled since 1986-87, but still remained low. Sealants are plastic films painted onto the chewing surfaces of teeth to protect them from decay. The survey found sealants on the primary teeth of less than 2 percent of children, and the permanent teeth of 19 percent of children and adolescents. Use of sealants on permanent teeth was three times as common in white children (22 percent had sealants) as in black children (8 percent) or Mexican American youngsters (7 percent).
Women had more caries than men (24 decayed, missing, or filled surfaces, versus 21 in men), but they also had slightly less untreated decay. Whites had approximately twice
as much coronal caries (24 surfaces) as did blacks (12 surfaces) and Mexican Americans (14 surfaces); however, blacks and Mexican Americans had more tooth surfaces in need of treatment than did whites. Blacks had an average of 3.4 untreated surfaces, Mexican Americans had 2.8, and whites had 1.5.
When gums recede, tooth roots become exposed and subject to decay. The survey found root caries in 23 percent of adults. On average, adults had only one decayed or filled root surface. Decay of tooth roots was more prevalent in black and Mexican American adults than in whites. Half the root caries found in white adults had been treated, but most of the root caries in black and Mexican American adults was untreated.
The survey also showed that 10 percent of adults are missing all their teeth. The remaining 90 percent have, on average, 23.5 teeth. Almost a third of adults have all 28 teeth. Gender did not play a role in tooth loss, the survey found, but age and race- ethnicity did. Virtually none of the adults aged 18 to 24 were toothless, but 44 percent of those age 75 and older were missing all their teeth. Mexican American adults had an average of four more teeth than did black or white adults.
Removable complete or partial dentures are a fact of life for millions of Americans, the survey showed. About 20 percent of adults aged 18 to 74 wore some type of removable denture, with use more common in women than men and more common in white adults (22 percent) and black adults (21 percent) than in Mexican American adults (9 percent). As expected, denture use increased with age; half of Americans age 55 and older wore a partial or complete denture. A high percentage of denture wearers--60 percent-- reported problems with their appliances.
They found that more than 40 percent of adults who had teeth--or almost 62 million Americans--had at least one tooth or tooth space that might benefit from treatment. No differences were found by gender or race, but problems did increase with age.
Americans. NHANES III looked at such key indicators of periodontal disease as attachment loss--or loss of bone support for the teeth-- and bleeding gums, which indicate inflammation. Overall, women had better periodontal health than did men, and whites had fewer periodontal problems than did blacks or Mexican Americans. The survey found that the prevalence and extent of periodontal attachment loss increased with age. Moderate attachment loss of 3-4 mm was found in 30 percent of 25- 34-year-olds, 63 percent of 45- 54-year-olds, and 80 percent of people over 65. More severe periodontal destruction--attachment loss of 5 mm or more--was found in 15 percent of those surveyed. Bleeding gums were most prevalent among adolescents; three-fourths of 13- 17-year-olds had gums that bled on gentle probing.
The survey was the first national survey in 25 years to examine problems with occlusion, or positioning and alignment of the teeth. The results show that one-fourth of children and adults aged 8 to 50 had perfect alignment of the front teeth. A comparison of the survey findings to those of a survey conducted in 1966-70 showed a 20 percent increase in adolescents with a normal overbite.
The survey also revealed that 18 percent of children and adolescents and 20 percent of adults had undergone orthodontic treatment. Both malocclusion and orthodontic treatment were more common in whites than in blacks or Mexican Americans.
Note: Oral health results from Phase I of NHANES III, which was conducted from 1988 to 1991, are reported in the February 1996 Special Issue of the Journal of Dental Research. An article on dental caries and sealant use in children based on the NHANES data appears in the March 1996 issue of the Journal of the American Dental Association. Data from the second phase of NHANES III, conducted from 1991 to 1994, are not yet available. NHANES III was designed to collect nationally representative data on many aspects of health and nutrition, including oral health.
Abstracts for the papers in the February 1996 Special Issue of the Journal of Dental Research can be found on the Internet under the home page for the International Association for Dental Research (address: medhlp.netusa.net/iadr/iadr.htm). From the home page, select "Publications Information," then "Journal of Dental Research." Click on "Special Issue (NHANES)" to get a list of the 10 abstracts, then click on the abstract you wish to view.