there have been notable successes, dental caries remains a common chronic disease across the life span in the United States and around the world. There is a measure of tragedy in this situation because dental caries is a highly, if not entirely, preventable disease.

There are a wide range of both acute and chronic conditions that manifest themselves in or near the oral cavity, including inherited, infectious, neoplastic, and neuromuscular diseases and disorders. This report focuses predominately on dental caries and periodontal diseases, which cause significant morbidity.


The surgeon general’s report referred to the mouth as a mirror of health and disease occurring in the rest of the body in part because a thorough oral examination can detect signs of numerous general health problems, such as nutritional deficiencies, systemic diseases, microbial infections, immune disorders, injuries, and some cancers. In addition, there is mounting evidence that oral health complications not only reflect general health conditions but also exacerbate them. For example, periodontal disease may be associated with adverse pregnancy outcomes, respiratory disease, cardiovascular disease, coronary heart disease, and diabetes.

Popular attention to the connection between oral health and overall health increased dramatically in 2007 with the death of Deamonte Driver, a 12-year-old Maryland boy who died when bacteria from an untreated tooth infection spread to his brain. Driver’s death transformed the oral health discussion as more people—including members of Congress—recognized the potential seriousness of untreated oral disease. His enduring story has contributed to the sustained interest in oral health seen in recent years.


HHS’ efforts to improve oral health and oral health care have been wide ranging, but the priority placed on these endeavors, including financial support, has been inconsistent. Enduring areas of attention include support for community water fluoridation, research on the etiology of oral diseases, dental education, oral health financing, workforce demonstrations, oral health surveillance, and recruitment of oral health care professionals2 to work in underserved areas. For example, HHS oversees the provision of oral health care to select populations through the Indian Health Service


2 In this report, the committee uses the term oral health care professional to refer to any health care professional who provides oral health care. This may include, but not be limited to, dental hygienists, dentists, nurses, physician assistants, and physicians.

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