Oral Health for the Poor and Underserved

169 Presentation ORALHEALTHFORTHE POOR AND UNDERSERVED RUEBEN C WARREN, DJDJS* MJPA, DrJVR AS&SMRf UmOmWf&MWUIUyiMÊm Lentetsfor utseaseLonuOi Agency for Toxk Substances and Disease Registry U.S. PuMk Health Service Y cet judge AFBXiE by how they treat the poor, the oppressed, the nnderservecL You judge a nation by how it treats its chiktrerv for they are the mostpreckmsiesourœanynationcanhave. Howarepoorpeopletreatedinthe United States? More specifically, how does America treat poorddldren? WQl the next decade be better or worse than the last? fa trte spring of 19^, the federal government issued its am^ erf the nation's health. Its report entitled "Health United States, 1968,'highlighted Medicare and Medicaid programs, veterans' medical care, and state mental health services, among many other items.2 The report indicated that the Uu. health care expenditures in 1988 totaled $458 billion, an average of $1337 per person, 11 percent of the Gross National Product This was an expenditure far higher man that of many other industrialized nations. Ih 1986, inpatient hospital expenses per day rose to $499, and hospital expenses per inpatient stay rose to $3^30. Little was written in this widely read federal document on US. health care concerning oral and dental health, senrices, expenditures, or need. Unfortunately, most reports cm federal health care expenditures do not adequately address the topic of the oral health of the American public, although oral health is dearly a part of the nation's physical well-being.*40 The National Institutes of Health has as one if its research institutes the National Institute for Dental Research (NIDR). This institute is specifically responsible for oral and dental health, primarily through the reseanb enterprise. The National Institute for Dental Research is the third oldest of eleven institutes at the National Institutes of Health. This federal agency is responsible for providing much of the scientific basis for oral health and oral health care throughout the world. The National Institute for Dental Research Director, Dr. Horold Loe, details the oral health spectrum by listing dental caries, periodontal diseases, congenital craniofacial malrelations, soft tissue diseases, orofacial Journal of Health Carefor the Poor and Underseroed,Wol 1,No. !,Summer 1990 170 Oral Health pain, and sensory-motor dysfunctions in his research plan document entitled "Challenges for the Eighties."11 The report, published in 1985, reviews current and future research within the dental community. The report also highlights the adverse results of oral disease and disorders —an estimated 32 million lost work days because of dental-related problems , more than the time lost from strikes (20 million days in 1979): The estimated cost in lost wages is $3 billion, and that does not include the loss to the employer in reduced productivity. In addition, there are the personal expenses for dental treatments and medications. There is often the gloomy realization that the condition may be ongoing or recurrent. These factors—time and expense, pain and distress, embarrassment or depression at one's appearance, chronicity or recurrences—are what make oral health disorders the severe and taxing health issues they are. All told, Americans are spending $20 billion a year to treat their dental/oral woes. Here's what those conditions represent in incidences and prevalences. • 10.7 percent of the U.S. population aged 6 to 74 were missing all their teeth, according to surveys conducted in 1971-74. • The average American child had at least one carious lesion by age eight; four by age 12; and 11 by age 17 (1979-80 data). • Gingivitis and periodontitis are endemic in the United States, affecting 75 percent of adults, 68 percent of youths, and 39 percent of children, based on a review of studies from 1957 to 1978. • Cleft lip and palate affect one out of 600 white infants. The incidence is higher among Asians, Native Americans, and Eskimos, and lower among blacks, based on studies conducted between 1965 and 1975. • Approximately 9.6 million persons received medical care for craniofacial injury during each year of a two-year study (1975-76). • Gose to 30 percent of youths aged 12 to 17 had malocclusions severe enough to warrant treatment—but only 10 percent of this population was receiving corrective treatment, according to data collected from 1966 to...