Index

Page numbers followed by italicized b,f, and t
indicate boxes, figures, and tables, respectively.

A

Access
  barriers to

for elderly, 263, 265
insurance and, 12-13, 268
children and, 253
elderly and, 265

   as reason for nonutilization, 84t-86t
   removal of, 4, 12-13, 19, 268, 286
and dental care utilization, among military vs.
   civilian population, 83, 87, 88f
ACE See Administration for Children and Families
Acids

and caries, 37-38
saliva and, 27

  and tooth surfaces, 31
Actinobacillus actinomycetemcomilans
and adult periodontitis, 40
and bacteremia, 104
and early-onset periodontitis, 42, 205
and periodontal disease, 203t
Administration for Children and Families (ACF),
  226, 226t

Adolescents/young adults, 257-258. See also
  Children

Adult periodontitis, 40-42
bacterial activity in, 40, 203t, 204-205
diagnosis of, 204-205, 204t
immune response to, 40-41
progression of, 40
rapidly progressing, 40, 41, 207
refractory, 42
susceptibility factors, 41
systemic antibiotics for, 207
Adult respiratory distress syndrome CARDS), 105

African Americans. See also Race/ethnicity
  cancer in

incidence of, 68,68f
survival rates for, 68-69, 69f
children, insurance coverage of, 253, 278
congenital malformations in, 72, 72f
dental care among
nonutilization of, 83, 84t
utilization of, 80t, 81-82, 811
dental caries in, 63-64, 63f 64f
as dental personnel, 236-237, 237t
oral and pharyngeal cancers in
diagnosis of, 69, 69f
by sex, 68, 68f

oral health status of, 74-75
periodontal disease in, 65-66, 66f
and ratings of oral health, 144
tobacco use by, 260b
tooth loss in, by economic status, 67, 67f
toothaches among, prevalence of, 73
Age

and canker sores, prevalence of, 71, 71f
and dental care

  nonutilization, 83, 84t
  utilization, 80-81, 80t
and dental caries, by economic status and
racdethnicity, 63-64
and injuries, 72-73
and insurance coverage, 231
and oral-facial pain, prevalence of, 73, 73f
oral health data on, 2-3
oral health vulnerabilities according to,
  249-267

and oral herpes lesions, prevalence of, 70-71,
7v

and periodontal disease, 65-66, 65f, 203t
adult periodontitis, 41
by racdethnicity, sex, and economic status,
     65-66

ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL

289


Age (continued)

and ratings of oral health, 144
  and tooth loss, 66
Agency for Healthcare Research and Quality
  (AHRQ), 171, 172, 213, 225, 226t
Aging, and craniofacial complex, 3 1-32
AHRQ. See Agency for Healthcare Research and
Quality

AIDS. See also HIV infection
Candida infections with, 43
esophageal candidiasis with, 101
and oral cancer, 46
Alcohol, 191t

and disruption of oral homeostasis, oral
    candidiasis and, 42
systemic, for periodontitis, 206t, 207
Antibodies. See a/so IgA antibody; Immunoglobulins
in adult periodontitis, 40-41
in mucosal immune system, 28
oral fluids in diagnostic tests for, 103, 103t
Anticipatory guidance, for children, 256
Antigenic components, in identification of
periodontopathic bacteria, 205
Antimicrobial agents, for periodontal diseases, 206t,
  207

community programs, 171
as general health risk factor, 10
  in mouthwash, and oral cancer, 210
and oral cancer, 44-45, 46, 169, 208t, 209, 209t
tobacco and, combination of, and oral cancer,
    45, 208t, 209
Allodynia, 52

Antimicrobial components, in saliva, 27
Antioxidants, 47
Apert's syndrome, 49
Aphthous ulcers, recurrent, lesions caused by, 1OOt
Apoptosis

Allografts, 208-209
Alloplasts, 209

Allopurinol mouthwash, and mucositis, 106
Alpha tocopherol, 47, 251b
Alveolar bone. See also Jaw; Oral bone
aging and, 31-32
  loss of, 32

osteoporosis and, 102-103
risk factors for, 203t
smoking and, 41

  and oral cancer, 45, 46
Sjogren's syndrome and, 51
ARDS. See Adult respiratory distress syndrome
Arthritis, jaw manifestations of, 52
Ascorbate, and gingivitis, 250b
Asians/Native Hawaiians/Pacific Islanders. See also
  Chinese Americans; Vietnamese Americans
as dental personnel, 236, 237t
oral and pharyngeal cancers and, by sex, 68, 68f
  oral health status of, 76
Aspartate aminotransferase, in adult periodontitis,
  205

  nutrition and, 250b
regeneration of, 208-209
Amelogenesis imperfecta, 49, 278
American Indians/Alaska Natives
children of, oral health of, 76-77
as dental personnel, 236, 237~
oral and pharyngeal cancers and, by sex, 68, 68f
  oral clefts, 72
oral health status of, 76-77
Pima tribe, in diabetes-periodontal disease
   study, 113-l 14

Assaults. See Violence
ASSIST. See American Stop Smoking Intervention
Study for Cancer Prevention
Association of State and Territorial Dental Directors
  (ASTDD), 226-227
ASTDD. See Association of State and Territorial
  Dental Directors
Autografts, 208

Autoimmune disorders, 212
Sjogren's syndrome, 5 1

and precancerous lesions from smokeless (spit)
  tobacco, 70

B

and ratings of oral health, 144
American Society of Anesthesiologists. classification
of patients risk, 196, 197t
Americans Stop Smoking Intervention Study for
  Cancer Prevention (ASSIST), 17 1
Anaerobes, gram-negative, 39
Andersen behavioral model, 248-249, 248f
Anodontia

B cells, 28
Bacteremia

in ectodermal dysplasias, 50
hereditary, 49
Antibiotics

infective endocarditis and, 107-108
and microthrombosis, 117-l 18
  and oral infection, 104-105
Bacteria. See also specific bacteria
in adult periodontitis, 40,41, 204-205
  in dental caries, 37-38
in early-onset periodontitis, 42, 205
in gingivitis, 39
gram-negative, and adult periodontitis, 40
  in heart disease, 117-118

290         ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL


ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL

lesions caused by, 99t
in periodontal disease, 202, 203t. 204-205
in refractory periodontitis, 42
Bacteroidesforsythus
in adult periodontitis, 40, 205
in periodontal disease, 203t
BANA test, in identification of periodontopathic
  bacteria, 205

Behcet's syndrome
lesions caused by, 1OOt
  and RAU, 44
Benzpyrene, 45

Betel nuts, and oral cancer, 45
Biofilm, 26, 37, 104. See also Plaque
and gingivitis, 39
Biomarkers
  future of, 279

  for oral cancer, 210
Biomimetics, 279
Biopsy

for mucosal disease diagnosis, 212
for oral cancer diagnosis, 210
Birth control medication, and gingivitis, 39
Birth defects, craniofacial, 47-50
clinical management of, 210-211
  cultural reactions to, 141
point mutations and, 31
prevalence of, 71-72
prevention and control of, 172-173, 210-211
   strategies for, 156t
secondary to other developmental disorders, 49
Bone grafts, 20&209
Bone loss. See Alveolar bone, loss of; Oral bone, loss
  of

Boston-type craniosynostosis, 49
Brain abscesses, oral flora and, 105
Branchial arch(es), 29
altered morphogenesis of, birth defects caused
   by 47-48

Bruxism, 52, 190, 191t
Burkitt's lymphoma, viral causes of, 45

C

Calcium

metabolism of, disturbances in, oral
   manifestations of, 101
and periodontal disease, 203t, 250ti251b
Calcium channel blockers, and gingivitis, 39, 107
Calculus

and adult periodontitis, 40
and gingivitis, 39
Campylobacter, and gingivitis, 39

Index

Canadian Task Force on the Periodic Health
  Examination, 156-158
Cancer. See also specific type
oral and pharyngeal, 4447, 209
   health care providers' knowledge about, 179
   HPV and, 43,4546,20Bt, 209,210
   prevention and management of, 47,
       169-172

community-based interventions,
  170-171

early diagnosis in, 171-172
nutrition in, 210, 251b
provider-based, 210
strategies for, 156t
public knowledge about,`178-179
quality of life with, 136, 142
risk factors in, 4447, 208t, 209-210,209t
nutrition and, 251b
statistics on

incidence rates, 67,68,68f, 74
mortality rates, by state, 70, 70t
site-specific, 69-70
sources for, 62

stage of diagnosis of, by racdethnicity,
69, 691

   survival rates, 67-69, 74
tobacco and, 259b, 260b
therapies. See also Chemotherapy; Radiation
   treatment

combined, and oral mucositis, 106-107
types of

   incidence rates for, 68,68f
   survival rates for, 69, 69f
Candida albicans
and oral cancer, 46, 209
and oral candidiasis, 42
Candida infections, 4243
Candidal angular cheilosis, 43
Candidiasis

esophageal, 101
lesions caused by, 99t
oral, 42-43

with HIV, 42, 43, 71, 101
prevalence of, 71

Canker sores, 4344. See Recurrent aphthous ulcers
  mm
prevalence of, 71, 71f
Capnocytophaga, and prepubertal periodontitis, 42
Capnocytophaga ochracea, and localized juvenile
periodontitis, 42
Capsaicin, 25

for oral mucositis pain, 106
Carbamazepine, and tic douloureux, 52

291


Index

Cardiovascular disease, oral infection and, 115-120
animal studies, 117-l 18
mechanisms of action in, 115-l 17
population-based studies, 118-120, 119t
Caries. See Dental caries
Carious lesions, precavitated, in restored teeth,
diagnosis of, 198

Carotenoids, 47, 251b
Cavities, 37. See also Dental caries
CDC. See Centers for Disease Control and
  Prevention

Celiac disease, oral manifestations of, 101
Cements, glass ionomer, in dental caries treatment,
  201

Center for Policy Alternatives, 268
Centers for Disease Control and Prevention (CDC),
  225, 226t

Cervical cancer, human papillomavirus (HPV) and,
  43,45

Cervicofacial actinomycosis, lesions caused by, 99t
Chediak-Higashi syndrome, and periodontal
  disease, 41

Chemotherapeutic agents, in plaque reduction, 199
Chemotherapy

oral candidiasis and, 42
oral infections from, 105
oral ulcers and oral mucositis from, 26
Chickenpox, oral lesions with, 98t
Children

anticipatory guidance for, 256
craniofacial birth defects in. See Birth defects,
  craniofacial

dental caries in, 2, 38, 252
by economic status and race/ethnicity,
    63-64

dental risk and protective factors for, 257~
dental sealants for, 167-168, 168t
with disabilities, 79, 253
enamel fluorosis in, 160
fluoride for

in dietary supplements, 162-165, 164t
  in mouthrinses, 165
  in school water, 162
from supplement programs, 164-165
future of oral care and, 277-278
injuries and, 258t, 722
insurance coverage, 231, 253, 277-278
Medicaid, 2, 253-255, 268
State Children's Health Insurance Program,
    13,233-234, 255, 277
malocclusion in, risk and protective factors for,
  258t

oral health of, 2, 249-253
barriers to, 13, 286

preventive environment for, 255-257,256t,
  257t, 258t

periodontal diseases in, risk and protective
  factors for, 256t

poverty and, 2, 252
violence and abuse, 51
Chinese Americans, nasopharyngeal cancer
incidence and mortality, 76
Chlorhexidine

to limit gingival inflammation, 205, 206~
to prevent mutans streptococci transmission,
  200

and remineralization, 199
teeth stains from, 107
Chronic and disabling oral cbnditions, 51-53, 73
Cigarettes, and oral and pharyngeal cancer, 259b.
  See also Tobacco

Cigars. See also Tobacco
and oral and pharyngeal cancer, 259b
  and oral cancer, 208r, 209
trends in smoking, 260b
Cleft lip/palate, 47-48
cost of, 228
prevalence of, 72, 721
quality of life with, 141-142
in Waardenburg syndrome, 50
Cleft palate, 47-48
Clefting abnormalities
from altered branchial arch morphogenesis,
     4748

incisive foramen and, 30
Cleidocranial dysplasia, 50
Cochrane Collaboration, 213, -214t, 246
Collagenase, in adult periodontitis, 205
COMMIT. See Community Intervention Trial for
Smoking Cessation

Community Health Centers, 227, 237
Community health programs. See also Public health
  programs
for craniofacial birth defects, 172-173
  for dental caries, 158-168
evidence of effectiveness of, 155-158
glossary of terms, 157b
for injury, 173-176
for oral and pharyngeal cancers, 169-172
for periodontal diseases, 168-169
strategies used, 156t

Community Intervention Trial for Smoking
  Cessation (COMMIT), 171
Corticosteroids, and disruption in oral homeostasis,
  oral candidiasis and, 42

Cosmetic dentistry, increased demand for, 137-138
Coxsackievirus, oral lesions with, 98t
Cranial bones, birth defects involving, 48-49

292         ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL


Craniofacial complex
aging of, 31-32

contact and communication in, 23-25
diagram of, 22
functions of, 1. 17
oral cavity in, 25-28
origins and development of, 28-31
   early development of, 29-30
   genetic controls in, 30-31
    nutrition in, 250b
  research on, 4, 19
sensory functions of, 23
Craniofacial defects. See Birth defects, craniofacial
Craniosynostosis, 49, 278
and gene mutations, 31
Crohn's disease, and RAU, 44
Crouzon's disease, 49, 278
Cryotherapy, for mucositis, 106
Cuban Americans, oral health of, 75
Cyclosporin, and gingivitis, 39, 107
Cytokines, 28

and adult periodontitis, 40-41
and periodontal diseases, 203
and pregnancy, 120-l 2 1
Cytomegalovirus, and chemotherapy, 106

D

Demineralized bone, freeze-dried, in bone grafts,
  208-209

Dental appliances, 201
and chewing function, 135-136
  and oral candidiasis, 43, 71
Dental care. See also Oral health care system
active personnel in, 223-224, 224t, 235-236,
   2351
   composition of, by sex and racefethnicity,
      236-237, 237t

annual expenditures on, 223, 228, 228t, 231f,
  231t

per capita, 228, 2291
vs. total health care expenditures, 227,
   227f, 228f
costs of

indirect, 142-144, 143t
per capita, 228, 229f
as reason for nonutilization, 83, 84t-86t
vs. other medical services, 228, 230t, 231f
disciplines in, 224
evidence-based, 213, 246, 277
expenditures on, 227-228
by source
   1960-1996, 231f
    1998, 228t

vs. total health care expenditures, 227J
  228t

financing and reimbursement for, 228t,
   229-234, 231f, 231t, 232f
managed, 231-233, 233t, 254
among military personnel, vs. civilian
   population, 83, 87, 88f
nonutilization of, reasons for, 83, 84t-86t
population-to-dentist ratio, 224, 2245
for underserved populations, 239
unmet needs in, 83, 87t
   for children, 252-253
utilization of, 80-81, 190-191
   by sex, race/ethnicity, income, and
     insurance, 80t, 81-82, 81t
   variation by oral health status, 82, 82t
Dental caries, 37-39
changing clinical approach to, 196-201
   diagnosis of, 198, 2OOt
   multifactorial model in, 196, 197f
   prevention of, 198-200, 200t
   risk assessment in, 197, 198f, 198t, 199t,
       2OOt

treatment of, 201
in children, 2, 38, 252
by economic status and racdethnicity,
    63-64

risk and protective factors for, 257t
classification of, 201
nutrition and, 250b
prevalence of
by age, economic status, and racdethnicity,
     63-65
prevention of
community approaches to, 158-168
    dental sealants, 166-168
   dietary fluoride supplements, 162-165
   fluoridated drinking water, 160-162
    fluoride mouthrinses, 159t, 165
    fluoride varnishes, 165-166
    school water fluoridation, 162
  fluoride in, 2-3, 10, 18, 27, 38, 155,
     158-160
health care professionals' knowledge about,
     177-178
provider-based, 198-201
public's knowledge about, 177
  saliva and, 27, 38
strategies for, 156t
target population for, 159t
daily hygiene, 39, 189-190
progression of, 198
  rate of, 38-39
smokeless (spit) tobacco and, 39, 259b

ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL

293


Index

Dental caries (continued)
susceptibility to, 39
  tobacco and, 259b
  vaccine for, 200

Dental hygienists, 235
knowledge of dental caries prevention, 177-178
knowledge of periodontal disease prevention,
     178
Dental implants, 201
Dental plans. See Insurance
Dental plaque. See Plaque; Biofilm
Dental practice, 223-224
Dental schools

curriculum needs of, 237-238
enrollment, 235

   of minorities, 236
faculty vacancies, 237
graduate indebtedness, 237-238
Dental sealants, 38, 166-168
for children, 167-168, 168t
combined with fluoride-use, 167
cost-effectiveness of, 168
  in dental caries treatment, 201
effectiveness of, 159t, 166-167
prevalence of use, by racefethnicity, 82
Dentrifice, 159t, 176, 177, 179, 189-190
Dentinogenesis imperfecta, 49
Dentists

availability of, 224
charitable care by, 239
compensation of
from elderly in long-term care, 265
from Medicaid, 254
increased importance of, 191-192
knowledge of dental caries prevention, 177-178
knowledge of periodontal disease prevention,
  178

numbers of, 223-224, 224t, 235-236, 235f
visits to. See also Dental care, utilization of
   and susceptibility to adult periodontitis, 41
Denture sore mouth, 43
Denture stomatitis, 43, 71
Depression

atypical facial pain with, 52
with cancer, 142
with TMD, 140

Dermatologic diseases, lesions caused by, 1OOt
Developmental disorders, 47-50
clinical management of, 2 10-2 11
cultural reactions to, 141
prevalence of, 71-72
prevention and control of, 172-173
   strategies for, 156t
dfs, definition of, 62b

dft, definition of, 62b
Diabetes mellitus

and adult periodontitis, 41
and periodontal disease, 2, 17, 109-115
  research used in, llOt, lilt-113t
  treatment of, 206

type 1, and periodontal disease, 41, 110-113,
  114, 203t

type 2, and periodontal disease, 113-l 14, 203t
Diagnostic codes, dentistry, 216
Diagnostics, saliva and oral fluids in, 103-104, 103t,
  279, 280t

Diet. See also Nutrition
  effect on oral health, 191t'
and oral and pharyngeal cancer, 209t
poor, as general health risk factor, 4, 10, 18
DiGeorge syndrome, 48
Digital radiography, 196
Dilantin, and gingivitis, 39
Disability days, due to dental conditions, vs. other
conditions, 143, 143t
Disabled population, oral health of, 78-79
DMFS, definition of, 62b
DMFT, definition of, 62b
DNA

in identification of periodontopathic bacteria,
  205

saliva as source for, 103-104, 103t
Down syndrome, and periodontal disease, 41
Drug abuse, oral fluids for diagnosis of, 103, 103t
Dry mouth. See Xerostomia
  and dental caries, 38
and chewing function, 136
and Sjogren's syndrome, 51, 136
Dysplasia, 46

E

Early and Periodic Screening, Diagnostic and
  Treatment Service (EPSDT), 254
Early childhood dental caries (ECC), 38, 228
Early-onset periodontitis, 42
  bacteria linked to, 205
by sex and race/ethnicity, 66
systemic antibiotics for, 207
Eating problems, and quality of life, 135-136, 136t
ECC. See Early childhood dental caries
Ectodermal dysplasias (EDs), 49-50, 211
Edentulism

by age, economic status, sex and race/ethnicity,

  66-67
by economic status, 82
and heart disease, 119
by state, 67t

294         ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL


and stroke, 120

EDS. See Ectodermal dysplasias
Education level

and dental care wants, 87t
and dental visits, 80t, 81, 81t
and insurance coverage, 23 1. 232f
and knowledge of periodontal disease, 178
and susceptibility to adult periodontitis, 41
Educational debt, 237-238
Efficacy, of health programs, vs. effectiveness,
  155-156

EGE See Epidermal growth factor
Egg polarity genes, 30
Eihenella corrodens
and adult periodontitis, 41
and prepubertal periodontitis, 42
Elastase, in adult periodontitis, 205
Elderly adults. See also Age
chronic health problems of, 266, 2661
eating problems of, 135-136, 136t
oral health of, 3, 262-266, 263t, 264t.
    trends in, 265-266
  research on, 262, 263t, 264t
sleep problems of, 137
social functioning of, 138-139, 139t
  women, 266-267
Electrical resistance measurement, 196
Enamel
age and, 31

demineralization of, 38. 199
remineralization of, 199
   fluoride and, 159
    saliva and, 27, 3 1. 38
Enamel fluorosis, 160
Enamel hypoplasia, 10 1
from tetracycline, 107
Endocarditis. infective, oral infection and, 107-108
Endocrine system
and disruption in oral homeostasis. oral can-
   didiasis and, 42
and immune system, 28
nicotine and, and oral and pharyngeal cancers,
     46-47
Environment

importance of, 248-249. 248f
improvement of, 268
   for children, 255-257, 268
Epidemiologic data, need for. See Data
Epidemiology< definition of, 62b
Epidermal growth factor (EGF), 27
and oral and pharyngeal cancers, 46
Epidermolysis bullosa-recessive dystrophic type, 49
Epithelial cells. cancers of. See Squamous cell carci-
  nomas, oral

In&s

Epithelium, 25-26
aging and, 32

nutrition and, 250b
EPSDT. See Early and Periodic Screening, Diagnostic
  and Treatment Service
Epstein-Barr virus

and chemotherapy, 106
and oral cancer, 45
and oral lesions, 98t
Erythema multiforme, lesions caused by, 1OOt
Erythroplakia lesions, 209
and squamous cell carcinoma, 44
Estrogen replacement therapy, and adult periodonti-
  tis, 41

Ethnicity See Race/ethnicity
Evidence-based practice, 213, 246, 277
Explorer, visual examination with, for dental caries
diagnosis, 198, 2OOt

F

Face. See also Craniofacial complex
appearance of, social responses to, 140-141
embryonic formation of, 29
as reflection of general health, 97-104
Falls, 50, 72-73. See also Injury
FDA. See Food and Drug Administration
Federal oral health infrastructure, 226-227, 226t
Federal support

for dental school programs, 235-236
  for educational debt, 237
Fibromyalgia, jaw manifestations of, 52
Fillings. See also Restorations
  materials used in, 201
Flossing, 39, 176, 190
  and bacteremia, 104
and dental caries prevention, 178
dental professionals' knowledge of, for dental
   caries prevention, 178
public knowledge of
   for dental caries prevention, 177
   and gum disease, 178
by tobacco users vs. nonusers, 178
Fluoride, 155, 158-160
dental professionals' knowledge about, 177
in dentifrices, 159t, 176, 177, 179, 189-190
in dietary supplements, 162-165
   dosage of, 163, 164t
    effectiveness of, 159t, 163-164
   public knowledge of, 177
in drinking water, 2-3, 18, 159t, 160-162
   access to, 161, 162f 162t, 163t
    costs of, 161

effectiveness of, 159t, 160-161

ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL

295


Indcs

Fluoride (continued)
   history of, 159

public knowledge of, 177
recommended concentration levels, 160
in schools, 159r, 162
enamel hypoplasia from high levels of, 101
in mouthrinses, 159r, 165
professionally applied, 159-160, 198-199
public knowledge about, 177
and rate of dental caries progression, 38-39
safety of, 160
in saliva, dental caries protection from, 27, 38,
  159

in varnishes, 159t, 165-166
Folate, and gingivitis, 250b
Folic acid

birth defects and, 47-48, 172
  cancer and, 251b
Food and Drug Administration (FDA), 225, 226t
Fungal diseases, lesions caused by, 99t
Fusobacterium nucleatum
and gingivitis, 39
and smoking, 41

G

Gastroenteritis, oral manifestations of, 101
Gene therapy, 276
Genes

and periodontal disease, 203, 203t
and resistance to dental caries, 39
Genetic derangements. See also Developmental
  disorders

and clefting abnormalities, 48
and oral cancer, 46
and periodontal disease, 41
Genetics

and control of embryonic development, 30-31
and future of oral health, 276, 278-279, 2785
and understanding craniofacial development, 28
Genomic databases, 279
Geographical region. See also Residence, place of
and dental care wants, 87t
Germ cell layers, in craniofacial development, 29
Gingiva

bleeding and inflammation of, as diagnostic
  test, 204, 204t

lesions of, diseases and conditions causing,
  98t-99t

recession of, age and, 31
surface of, 25

Gingival crevicular fluid, periodontal infection and,
  204t, 205

Gingival erythema, linear, and HIV, 101
Gingivitis, 3940
with adult periodontitis, 40
  and heart disease, 119
  from medication, 107
and pregnancy, 122
prevention of, 10, 168-169, 190, 191t, 205-206
by race/ethnicity, 66
Global ratings, of oral health, 144
Glossary, 62b
P-glucuronidase, in adult periodontitis, 205
Glutathione, 47
Glycemic control, affected by periodontal disease,
  114-115, 116t-117t
Gonorrhea

lesions caused by, 99t
pharyngeal, 109

Growth factors, 27
and oral cancer, 46-47
in reducing mucositis, 106
Guided tissue regeneration, 209
Guidelines, for clinical practice, 213-214, 215t
Guidelines for School Health Programs to Prevent
Tobacco Use and Addiction (CDC), 170
Gum disease, prevention of, public knowledge of,
178. See also Gingivitis; Periodontal disease
Gums. See Gingiva

H

Hand, foot, and mouth disease, oral lesions with,
  98t

HCFA. See Health Care Financing Administration
Head Start, 226
Health

biopsychosocial model of, 134
broadened meaning of, 2, 17-18
cultural perspectives on, 134-135
determinants of, theories and models of,
246-248,246f

  historical trends in
   life expectancy, 275-276
   science and technology, 275
World Health Organization (WHO) definition
   of, 133
Health care

evidence-based, 213, 246, 277
expenditures on, 227-228
Consumer Price Index for, 230t, 231f
per capita, 229f
by source of funds, 228t
by type of service, 227f 228t, 230t
federal and state programs for, 233-234

296

ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL


oral care in. See Dental care; Oral health care
  system

personnel in, collaboration with dental care
providers, 225, 227
trends in, 277

unmet needs in, 83, 87t
  utilization of, 190-191
Health Care Financing Administration (HCF,4), 225
Health Field Concept, Lalonde's, 247
Health maintenance organizations (HMOs), 229,
  232, 233t

Health Plan Employer Data and Information Set
  (HEDIS), 233

Health professional schools, future of, 276-277. See
  also Dental schools
Health Professional Shortage Area (HPSA), 227, 237
Health Resources and Services Administration.
  (HRSA), 225, 226t
Healthy People 2000, progress in meeting objectives
of, 180t

Healthy People 2010, 4, 19, 247-248, 248f
objectives of, by age, 268t
Heart disease. See Cardiovascular disease
HEDIS. See Health Plan Employer Data and
  Information Set

Herpangina. oral lesions with, 98t
Herpes labialis lesions
location, features, and course of, 98t
prevalence of, by racdethnicity, 71
Herpes simplex virus, 43
and chemotherapy, 106
lesions from, by population group, 70
and oral cancer, 4546, 209, 210
  oral lesions with, 98t
as pharyngeal infection, 109
type 1 (HSV-11, 43
   lesions from, 70, 71f
    and oral cancer, 45
type 2 (HSV-21, 43
Herpes zoster, oral lesions with, 98t
Herpetic gingivostomatitis, primary acute, oral
  lesions with, 98t

Herpetic stomatitis, primary, 43
Herpetiform recurrent aphthous ulcers, 44
HHANES. See Hispanic Health and Nutrition
Examination Survey
Hispanic Health and Nutrition Examination Survey
  (HHANES), 75

Hispanics. See also Cuban Americans; Mexican
  Americans; Puerto Ricans
  children of

insurance coverage of, 278
oral health of, 75

It&s

ORAL HEALTH IN AMERICA: A REPORT OF THE SLlRGEON GENERAL

dental care among
   nonutilization by, 84t-85t
   utilization by, BOt, 81-82, 81~
as dental personnel, 236-237, 237t
oral and pharyngeal cancers and, by sex, 68, 68f
oral health status of, 75-76
and ratings of oral health, 144
toothaches among, 73
Histoplasmosis, lesions caused by, 99t
HIV/AIDS Dental Reimbursement program,
  238-239
HIV infection

human papillomavints (HPV) and, 43, 71
and oral candidiasis, 42, 43, 71, 101
oral lesions with, 98t, 101-102
oral manifestations of, 97, 101-102
oral transmission of, 108-109
and periodontal disease, 41
  and RAU, 44
  and trench mouth, 40
HMOs. See Health maintenance organizations
Hodgkin's lymphoma, 46
Horn genes, 30
Homeotic genes, 30
Hormones, oral fluids in diagnostic tests for, 103,
  103t

Hospice patients, 263, 266, 266t
Hospitalized patients, and systemic complications
  due to oral bacteria, 105
Hospitals, oral health care at, 225
Hox genes, 30
HPSA. See Health Professional Shortage Area
HPV See Human papillomavirus
HRSA. See Health Resources and Services
  Administration

HSV- 1. See Herpes simplex virus, type 1
HSV-2. See Herpes simplex virus, type 2
Human genome, in understanding craniofacial
development, 28

Human Genome Project, 53, 278
Human immunodeficiency virus. See HIV infection
Human papillomavirus (HPV), 43
and oral cancer, 43,4546, 208t, 209, 210
prevalence of, 71
Hypodontia

in ectodermal dysplasias, 50
hereditary, 49

Hypoparathyroidism, oral manifestations of, 101

I

IFN-y. See Interferon y
IgA antibody, 32

297


IHS. See Indian Health Service
IL-l. See Interleukin 1
IL-lp. See Interleukin lb
Imaging technologies, 196
for dental caries diagnosis and treatment, 201
for oral cancer diagnosis, 210
  for TMD, 212t
Immune cells

in adult periodontitis, 40-41
and oral cancer, growth factors and, 46-47
types of, 28. See also B cells; T cells
Immune system, 27-28
disorders of, Sjiigren's syndrome, 51
and disruption in oral homeostasis, oral
   candidiasis and, 42
microbial genome research and, 279
  mucosal, 27-28

loan repayment program, 237
Infection, oral. See also Mucosal infections;
  Periodontal disease
  bacteremia and, 104-105
from cancer therapy, 105-107
infective endocarditis and, 107-108
protection against. See also Immune system
   by mucosal immune system, 27-28
   by saliva, 26-27

nutrition and, 25Ob
and RAU, 44

Immunoglobulins. 28. See also IgA antibody
smoking and, 41

respiratory disease and, 108
Inflammation, gingival. See Gingivitis
Injury, oral-facial, 50-51. See also Falls; Trauma
  in adolescents, 258
  in children, 2, 72, 258t
prevalence of, 72-73
prevention and control of, 191t
   community-based, 173-176, 174t-175t
    future of, 276
   helmet use, 173, 174t-175t, 176b
from sports, 50, 73, 173-176, 174t-175t, 176b,
     258

Immunosuppression
and bacteremia, 104-105
oral signs of, 97-100
Immunosurveillance and control, loss of, and oral
  cancer, 46

in young adults, 258
Insurance

changing market in, 231-233
coverage, 12-13, 229-231
by age, 231

Implants. See Dental implants
Incidence, definition of, 62b
Incidence rate, definition of, 62b
Incisive foramen, embryonic formation of, 29-30
Income

for children, 2, 253-255, 277-278
and dental care nonutilization, 86t
and dental care utilization, BOt, 81-82, 811,
  229

and adult periodontitis, 41
and children

dental caries and, 63-64, 63/ 64f
and insurance coverage, 253
  oral health and, 2, 252
dental care and

among children, 253
and dental care wants, 87t
by education level, 231, 232f
for elderly, 265

nonutilization of, 85t-86t
utilization of, BOt, 81-82, Bit
wants, 87t

and dental caries, 63-64, 63f, 64f
and edentulism, 82
and insurance coverage, 231, 2321
  for children, 253
low-income communities
dentists in, educational debt and, 237
expansion of care to, 239
and oral health, 249

employer-provided, 229-23 1, 26 l-262
    children and, 253
future goals in, 286
by income, 231, 232f
by sex and race/ethnicity, 230-231, 232f
Medicaid, 87t, 229, 233
for children, 2, 253-255, 268
for elderly, 265

Medicare, 234, 234t, 265
performance measures in, 232-233
as source of expenditures on dental services,
228t, 231f, 231t

among Hispanics, 75

and periodontal disease, 65-66, 66f
  and toothaches, 73
Indemnity plans, 232. 233t
Indian Health Service (IHS), 76-77, 225, 226~

State Children's Health Insurance Program,
   (SCHIP) 2, 13,233-234, 255, 277
  and utilization, Bit, 82
Interferon y (IFN-y), and adult periodontitis, 41
Interleukin 1 (IL-l)
and adult periodontitis, 41, 205
and periodontal disease, 203

298         ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL


Interleukin 1 p (IL- l@)
and adult periodontitis, 41
and periodontal disease. 203
Interleukin 6, and adult periodontitis, 205
Interleukins, and heart disease, 115
Irrigation, to control gingival inflammation, 206t,
  207

J

Jaw (mandible and maxilla). See also Alveolar bone;
  Oral bone

aging and, 31-32
bone loss in, osteoporosis and, 102-103

K

Kaposi's sarcoma, 46, 101
Keratin, 25

Keratin genes, mutations in, and epidermolysis
  bullosa. 49

Keratinocytes, and oral cancer, 46
Killer cells, and oral cancer, 46

L

Lacrimal glands, Sjogren's syndrome and. 51
Lalonde Report, 246-247
Langerhans cells, and immunosurveillance, 46
Language

mechanisms of, 25
skills. of oral and pharyngeal cancer patients,
  136

Laser technologies, in dental caries diagnosis and
  treatment. 201

Leukoplakias, 44, 209
Lichen planus, lesions caused by, 1OOt
Life expectancy, 275-276
Lifestyle

of adolescents/young adults, 257-258
as determinant of health, 190, 191t, 246f,
    247-248
Lip cancer

incidence of, 69. 70
risk factors, 2081. 209t, 210
sun exposure, 169

Lips, lesions on, diseases and conditions causing,
  98t, 1OOt

LJP See Localized juvenile periodontitis
Local public health departments, 226, 286
Localized juvenile periodontitis (LJP), 42
Lymphocytes, and immunosurveillance, 46.

See also B cells; T cells

In&s

M

Macrophages, cytotoxic, and immunosurveillance,
  46

Magnetic resonance imaging (MRI), 196
Malocclusions

prevalence of, 72
quality of life with, 141-142
risk and protective factors for, 258r
Mandibulofacial dysostosis, 48
Marijuana, oral cancer and, 45, 208~ 209t
Masseter muscle, 26
Mastication, muscles of, 26
Mechanoreceptors, 24
Medicaid, 229, 233
for children, 2, 253-255, 268
  dental vs. other health expenditures for,
       254

and dental care wants, 87t
for elderly, 265
Medical care, in oral health care system, 225
Medicare, 234, 234t, 265
and dental care wants, 87t
Medications

and dental caries, 38
and disruption in oral homeostasis, oral
   candidiasis and, 42
and elderly oral health, 265-266
and gingivitis, 39
oral complications of, 107
Men

and adult periodontitis, susceptibility to, 41, 65,
w
cancer in

oral and pharyngeal, by racdethnicity and
sex, 68, 68f

types of, by racefethnicity, 68, 68f
and dental care nonutilization, 84t
and injuries, 73
and pain, 25

  prevalence of, 73, 73f
and periodontal disease, 203t
Metabolites, in detection of periodontal disease, 205
Mexican Americans
  children

insurance coverage of, 253
oral health of, 75
dental care utilization by, BOt, 81-82, Bit
and dental caries, susceptibility to, 63-64, 63f,
64f

tooth loss by, by economic status, 67, 67f
Microbes

genome research on, 279
oral transmission of, 108-109

ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL         299


lndes

Microbes (continued)
protection against. See also Immune system
   by saliva, 26-27
Micronutrients. See also Nutrition
and cancer prevention, 47
fluoride as, 160
Military personnel, dental care among, vs. civilian
population, 83, 87, S8f
Mononucleosis, infectious, oral lesions with, 98t
Mortality rate, definition of, 62b
Motor vehicle collisions, 50, 73, 173
Mouth. See also Craniofacial complex; Oral cavity
  elements of, 1, 17. 25
embryonic formation of, 29
as gateway, 37
   for infection, 104-109
lesions in, diseases and conditions causing,
     98t-100t
as reflection of general health, 1-2, 10-11, 17,
    97-104, 284
Mouthguard use, 173-175, 174t-175t, 176b
Mouthrinses, fluoride, 159t, 165
MRI. See Magnetic resonance imaging
Mucins, 27
aging and, 32
Mucosal immune system, 27-28
Mucosal infections, 42-44, 70-71, 212
by race/ethnicity, socioeconomic status, and sex,
     70-71
Mucous membrane pemphigoid, lesions caused by,
  loot
Multiple sclerosis, and tic douloureux, 52
Mumps, swollen parotid glands with, 97
Mutans streptococci, 37, 38
median age of acquisition of, 39
  mother as source of, 199-200
as primary predictor of dental caries incidence,
    196-197, 198t
Mutations
and craniofacial syndromes, 3 1, 278-279
in keratin genes, and epidermolysis bullosa, 49
  and oral cancer, 46
and periodontal disease, 41

N

Nasopharyngeal carcinoma, 45, 76
National Facial Protection Month, 173
National Health and Nutrition Examination Survey
  (NHANES), 61,62
National Health lnteniew Survey (NHIS), 61
National Health Service Corps (NHSC), 237
National Institute for Dental and Craniofacial
  Research (NIDCR), 213

-

National Institutes of Health (NIH), 225, 226t
National Oral Cancer Strategic Planning
  Conference, 169-l 70
National Oral Health Plan, 21, 284-286
components of, 11-13, 284-286
National Preventive Dentistry Demonstration
Program, 167
Necrotizing ulcerative gingivitis, acute, lesions
caused by, 99t
Necrotizing ulcerative periodontitis, and HIV, 101
Nervous system, and immune system, 28
Neural crest, 29
defective development of, Treacher Collins
   syndrome and, 48    '

Neural tube, 29
Neutrophils
in adult periodontitis, 40-41
   smoking and, 41
in early-onset periodontitis, 42
NHANES. See National Health and Nutrition
Examination Survey
NHIS. See National Health Interview Survey
NHSC. See National Health Service Corps
Nicotine, endocrine effects of, and oral and
pharyngeal cancers, 46-47. See Tobacco
NIH. See National Institutes of Health
NIDCR. See National Institute of Dental and
  Craniofacial Research
4-nitroquinoline-N-oxide, 45
Nitrosamines, 46
N-nitrosonornicotine, 45
Nociceptors, 24
Non-Hodgkin's lyrnphoma, 46
misdiagnosis of, 101
Sjiigren's syndrome and, 5 1
Nonneuronal tissues, 29
Nose. See also Olfactory system
embryonic formation of, 29
Notochord, 29
Nursing homes, in oral health care system, 225
Nutrition, 191t, 250b. See also Diet
  and birth defects, 47-48, 172, 211
and cancer prevention, 47, 169, 25lb
and dental caries, 250b
  micronutrients in
   cancer prevention properties, 47
   fluoride as, 160
and oral cancer prevention, 209t, 210, 25lb
  oral tissue as reflection of, 100-101
and periodontal disease, 25Ob-25 1 b
prenatal and perinatal, 198
and quality of life, 135-136, 136t
  and RAU, 44

300         ORAL HEtLTH IN AMERIC.4: A REPORT OF THE SURGEON GENERAL


0

Olfactory system, 24
aging and, 32
Oncogenes
discovery of, 45

and oral and pharyngeal cancer, 46
Oral, definition of, 1, 17
Oral bone, loss of, osteoporosis, 102-103
Oral cavity. See also Mouth
  elements of, 25-28
manifestations of systemic disease in, 37,
    97-101, 98t-100t
Oral flora, 37

  and brain abscesses, 105
Oral fluids, diagnostic value of, 103-104, 103t, 279,
  280t
Oral health

barriers to, removal of, 4, 12-13, 19, 286
broad definition of, 2, 17-18, 133-134
costs of, 4, 19, 227-228, 227f, 228t, 229j, 230t
  indirect, 142-144, 143~
determinants of, 248-249
income inequality, 249
lifestyle, 190, 191t, 246f, 247-248, 283
workplace effects, 249
disparities in, 1, 4, 10, 17, 19, 88, 239, 284
enhancement of, 267-268
for adolescents and young adults, 257-258
  for adults, 258-262
  for children, 249-257
    insurance and, 253-255
   social and professional environment
      and, 255-257

for elderly adults, 262-267, 263t-264t
for elderly women, 266-267
expenditures for, 227-228, 227f, 228t
financing for, 228t, 229-234, 231f, 231&,
   232f

vs. total health care expenditures, 227,
   227f, 228t
future of, 280

diversity of diseases and patients in, 276
National Oral Health Plan, 284-286
  new treatments in, 276
and general health, 2, 4-5, 10-11, 17-18, 19,
  53, 285-286
in elderly, 265
implications of linkages between, 122
  risk factors in, 4, 10, 18
historical trends and, 275-276
meaning of, 5, 17-21, 20
of military personnel, vs. civilian population,
  83, 87, 88f

Index

objectives for, 267-268, 267~
personal approaches to, 189-191
care seeking, 190-191
daily hygiene, 189-190
   among elderly, 262-263
healthy lifestyle, 190, 191t
prevention measures, 3-4, 7-9, 10, 18. See also
  Oral health care system
in public health programs, 12
ratings of, 144
status of, 35-93

    and dental care wants, 87t
  trends in, 87-89
Oral health care system. See also ,Dental care
active personnel in, 223-224, 224t, 235-236,
   235f, 286
   by sex and racdethnicity, 11, 236-237,
      237t, 286

community approaches in
for craniofacial birth defects, 172-173
  for dental caries, 158-168
effectiveness of interventions by, 155-158,
     156t

glossary of terms for, 157b
for injury, 173-176
for oral and pharyngeal cancers, 169-172
for periodontal diseases, 168-169
expanding base of, 216
future of, 239-240
capacity to meet needs in, 234-239
molecular, and genomics, 278, 278f, 279
individual approaches in
care seeking in, 190-191
daily hygiene in, 189-190
   among elderly, 262-263
healthy lifestyles in, 190, 191~ 246f
   247-249, 248f

knowledge of and practice in, 176-179
professional components of
  dental care, 223-224
  medical care, 225
overlap among, 227
public health programs, 225-227
progress in, 179-180, 180t
provider-based care in, 191-212. See also
  Provider-based care
diagnostic tests in, 193, 193t
  future of, 212-216
  oral health assessment in, 193-196,
   194f-195f, 197t

risk assessment in, 192-193
public-private partnerships in, 13, 286
strategies for, 156t
underserved in, 239

ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL          301


Index

Oral hygiene, 189-190, 191t
and bacteremia, 104
and dental caries, 39, 189-190
among elderly, 262-263
and gingivitis, 39
and periodontal disease, 168-169, 190, 191t,
     203t

public practices survey, 178
workplace effects on, 249
Oral mucosa, 25-26
aging and, 32

lesions of, diseases and conditions causing,
  98t-100t

  nutrition and, 250b
staining of, 107
ORN. See Osteoradionecrosis
Osteogenesis imperfecta, 49
Osteoporosis

and adult periodontitis, susceptibility to, 41
and oral bone loss, 102-103
and periodontal disease, 203~
Osteoradionecrosis (ORN), 106
Ottawa Charter for Health Promotion, 247

P

Pain

facial, atypical, 52
oral, chronic, 24
oral-facial, 24-25, 52
   clinical management of, 211
    control of, 24
   impact of, 139-140
   prevalence of, 73, 73f
   sex differences, 25, 77
   sleep problems with, 137
Palate, 25

embryonic formation of, 29
lesions of, diseases and conditions causing,
  98t-100t

Papillae, as oral mucosa, 25
Papillomavirus, oral lesions with, 71, 98t
Papillon-Lefevre syndrome, and periodontal disease,
  41

Parotid glands, 26
aging and, 32
  swollen, 97

Pathogens, protection against. See also Immune
  system
by saliva, 27

Pathology, systemic, craniofacial disease as model
  of, 53

Pemphigus vulgaris, lesions caused by, 1OOt
Periodontal attachment

loss of

by age, sex, race/ethnicity, and income,
  65-66

   definition of, 62b
osteoporosis and, 102
Periodontal disease, 39-42
adult periodontitis. See Adult periodontitis
by age, sex, racdethnicity, and income, 65-66
from bone marrow radiation, 105
and cardiovascular disease, 115-120
clinical management of, 20 l-209
   diagnosis of, 203-205, 204t, 278
   prevention of, 205-206, 206t
   risk assessment in, 202-203, 203t
   treatment of, 206-209, 206t
  diabetes and, 2, 17, 109-114
   glycemic control affected by, 114-l 15,
       116t-117t

  research used in, 1 lot, 11 It-1 13t
early-onset. See Early-onset periodontitis
heart disease and stroke with, 115-120
  animal studies, 117-118
mechanisms of action in, 115-l 17
population-based studies, 118-120, 119t
nutrition and, 250b-25 1 b
pathogenesis of, 202
preexisting, as risk factor, 202, 203t
and pregnancy, adverse outcomes in, 120-122
prevention of, 10, 168-169, 256~
daily oral hygiene and, 168-169, 190, 191t,
     203t

   dental professionals' knowledge about, 178
   history of, 3, 18
   provider-based, 205-206, 206t
   public's knowledge about, 178
   strategies for, 156t
risk and protective factors for, 256~
  tobacco and, 259b, 260b
Periodontal ligament
regeneration procedures for, 208
sensitivity of, 24
  teeth in, 26
  tissue turnover in, 31
Periodontitis
adult. See Adult periodontitis
  and heart disease, 118-120
as mixed infection, 205
necrotizing ulcerative, and HIY 101
pathobiology of, 202, 2021
  and stroke, 119-120
Perioral skin, lesions of, diseases and conditions
causing, 98t
Pfeiffer's disease, 49
PGE,. See Prostaglandin E,

302         ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL


PH

in dental caries risk assessment, 197
saliva and, 27

Phagocytes, in adult periodontitis, smoking and. 41
Pharmaceuticals. See Medications
Pharyngeal cancer. See Cancer, oral and pharyngeal
Pharynx, 25

herpes simplex virus and, 109
lesions of, diseases and conditions causing, 98t,
  loot

Phenytoin, and gingivitis, 39, 107
Phosphate metabolism, disturbances in, oral
  manifestations of, 101
Pierre Robin syndrome, 48
Pigmentation, of soft or hard oral tissue, as sign of
  disease, 100

Pipe smoking, and cancer, 208t, 259b
Plaque, 37, 104. See also Biofilm
control of, 39, 205-206, 206~
    chemical, 205
   with daily hygiene, 190
   professional, 206
  fluoride in, 159
public knowledge about, 178
subgingival, 40

Pocket depths, and periodontal disease diagnosis,
  204, 2041

Point mutations, birth defects and, 31
Polymeric resin composites, in dental caries
  treatment, 201

Population, trends in, 275-276, 280
Population groups
characteristics of, as determinant of health, 248,
    248f

data on, 10, 61-62. 88
disabled, oral health of, 78-79
diversity of, future of oral care and, 277
oral health disparities among, 1, 4, 10, 17, 19,

88, 239, 283-284

oral health services targeted to, 225, 239
racial/ethnic minorities. See Race/ethnicity;

   speciJc tninority group
  women. See Women
Pot~hyromonas gingivalis
in adult periodontitis, 40, 41, 205
in adverse pregnancy outcomes, 121
  and bacteremia, 104
  in heart disease, 117
in periodontal disease, 203t
Poverty: 249. See also Income
children in, oral health of, 2, 252
  and dental care utilization, 80, 80t, 81
and dental caries, susceptibility to, 63-64
and tooth loss and edentulism, 66, 67f

Index

  and toothaches, 73
PPOs. See Preferred provider organizations
Precancerous lesions
  HPV and, 45

  and oral cancer, 44-45
and smokeless (spit) tobacco. 70, 7Of
Precavitated carious lesions, in restored teeth, diag-
  nosis of, 198

Preferred provider organizations (PPOsI, 229, 232,
  233t
Pregnancy

adverse outcomes of, periodontal disease and,
  120-122

and dietary fluoride supplements, 163-164
gingivitis in, 39

Prenatal care, 172, 198, 210-211
Prenatal syphilis, lesions caused by 99t
Prepubertal periodontitis, 42
Prevalence, definition of, 62b
Prevalence rate, definition of, 62b
Prevotella intennedia
in adult periodontitis, 40, 41
in periodontal disease, 203t
in prepubertal periodontitis, 42
smoking and, 41
Private practice, 223-224, 227
Probes/instrumentation, sensitivity of, 40
Probing depths, and periodontal disease diagnosis,
  204. 204t

ProstaglandinG)
and adult periodontitis, 40-41
  and heart disease, 115
and pregnancy, 121
Prostaglandin E2
and adult periodontitis, 4041, 205
  and mucositis, 106
and periodontal disease, and low birth weight.
     121

Proto-oncogenes
discovery of, 45
  and oral cancer, 46
Provider-based care, 191-212
changing approach by
   to birth defects, 210-211
    to dental caries, 196-201
   to oral and pharyngeal cancers, 209-210
   to periodontal diseases, 201-209
for chronic craniofacial pain and sensorimotor
    conditions, 211

diagnostic tests in, 193, 193t
  dental caries, 198, 2OOt
oral and pharyngeal cancer, 210
periodontal diseases, 203-205, 204t
future of

ORAL HEALTH IN AMERICA: ,4 REPORT OF THE SURGEON GENERAL

303


Provider-based care (cot~ti~ud)
   broadening base in, 216
   clinical practice guidelines. 213-214, 215~
   evidence-based practice, 213
   science and technology contributions, 216
  for mucosal and autoimmune diseases, 212
oral health assessment by, 193-196, 194f-195f,
     197t
prevention by

oral-facial pain and, 139-140
social function and, 138-139, 139t
research on, 144-146, 146t

  of birth defects, 210-211
of dental caries, 198-200
of oral and pharyngeal cancer, 210
of periodontal diseases, 205-206, 206~
risk assessment by, 192-193
of dental caries, 197, 198t, 200t
of oral and pharyngeal cancer, 208~
    209-210, 209t

RaceIethnicity. See also specific minority group
and adult periodontitis, 41
and congenital malformations, 72, 72f
  and dental care

nonutilization, 84t-85t
utilization, 80t, 81-82, 81t
wants, 87t

and dental caries, suscepibility to, 63-64, 63f,
w

   of periodontal diseases, 202-203, 203t
for temporomandibular disorders, 211-212
Pseudomembranous candidiasis, 43
Pterygoid muscle, 26
Puberty gingivitis, 39
Public

future of oral care and, 277
and insurance coverage, 230-231, 2325
and malocclusions, 72
in oral health workforce, 12, 236-237, 237t,
  286

knowledge, attitudes, and practices of, 177-179,
  239, 280

perceptions of, 11, 285
Public health programs. See also Community health
programs; Medicaid; Medicare
for elderly, 265

                        R









facial appearance, 140-141
oral and phar)-ngeal cancers, 142




  ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL

and periodontal disease, 41, 65-66, 66f
Radiation treatment
  oral candidiasis and, 42
  oral infections from, 106
oral ulcers and oral mucositis from, 26
periodontal disease from, 105
Radiographs, 196

  essential services for, 181b
in oral health care svstem, 12, 225-227, 286
Public-private partnerships, 13. 286
Puerto Ricans. oral health of, 75
Pulmonary disease. obstructive, and oral health, 108
Pulp tissue

infections in, 24, 38
tissue turnover in, 31

Q

Quality of life

cultural perspectives on, 134-135
heightened expectations of, 146
oral health in, 133-134
  functional dimensions of
   eating problems and. 135-136, 136~
   sleep problems and, 137
indirect costs of, 142-144, 143t
need for measurement of, 133-134
psychosocial dimensions of, 137-142
   cleft lip/palate and malocclusion,
       141-142

bite-wing, 198, 2OOt
in periodontal disease diagnosis, 204, 204t
Rapidly progressive periodontitis, 40, 41
systemic antibiotics for, 207
Ratings, of oral health, 144
RAU. See Recurrent aphthous ulcers
Recurrent aphthous ulcers (RAW, 43-44
prevalence of, 71, 71f
Refractory adult periodontitis, 42
systemic antibiotics for, 207
Reimbursement, direct, 230. See also Dental care,
financing and reimbursement
Relative survival rate, definition of, 62b
Remineralization, 27, 38, 159, 199
Research. See also Science base
  current, 4, 5, 11, 19, 20
in evidence-based practice, 213, 246
federal studies of oral health, 268
need for expansion of, 285-286
on quality of life, 144-146, 146t
surveys used for health data, 61-62
  trends in, 214-216

Respiratory disease, oral infections and, 108
Restorations

precavitated carious lesions in, diagnosis of, 198
procedures for, 201
Retinoids, 47

304


Rous sarcoma virus (RSV), and oral cancer, 45
RSV: See Rous sarcoma virus
Rural/urban status, and dental care wants, 87t
Ryan White Comprehensive AIDS Resources
  Emergency Act, 225

S

S-IgA, 28

Saethre-Chotzen syndrome, 49
Saliva, 26
aging and. 32

and cariogenic bacteria, 38
decreased flow of

  in dental caries risk assessment, 197
and chewing function, 136
diagnostic value of, 103-104, 103t, 279, 280t
fluoride and, 27, 38, 159
functions of

   barrier and buffering properties, 27
   dental caries prevention, 27
   tissue protection, 26-27
   wound healing, 27
and general health, 1, 17
immunoglobulins in, smoking and, 41
Salivary glands, 26
and aging, 32
and general health, 1, 17
  involvement in infections, 97
Sjogrens syndrome and, 51
Satisfaction ratings, of oral health, 144
Scaling and root planing, for plaque removal, 206,
  206t

SCHIP See State Children's Health Insurance
Program

School-based programs. See also Dental schools;
Health professional schools
dental sealant programs in, 167
dietary fluoride supplements in, 164-165
fluoridated drinking water in, 159t, 162
  fluoride mouthrinses in, 165
oral and pharyngeal cancer prevention
   programs in, 170

strategies employed by, 156t
tobacco prevention programs in, 170
Science base. See also Research
and evidence-based practice, 213, 246
need for expansion of, 11-12, 285-286
  in oral health, 5, 19-20
Scientific worldviews, 134-135
Scurvy, oral signs of, 101
Sealants. See Dental sealants
Secretory leukocyte protease inhibitor (SLPI), 27
Self-care. See Oral health care system, individual

Index

approaches in
Senses, 23-25, 32
Sex

and adult periodontitis, susceptibility to, 41, 65,
  65f
and dental care

nonutilization, 84t
utilization, 80t, 81-82, 81t
wants, 87t

of dental personnel, 236-237
and injuries, 73

and insurance coverage, 231, 232f
and oral and pharyngeal cancers, by race/eth-
nicity, 68, 68f

and oral clefts, 72
and oral health, 77-78
ratings of, 144
and pain, 25, 77

prevalence of, 73, 731
and periodontal disease, 203t
and Sjogren's syndrome, prevalence of, 73
and taste, 78

and TMDs, prevalence of, 73
  and tooth loss, 66
Sex hormones

and adult periodontitis, susceptibility to, 41
pain and, 25

Sexually transmitted diseases (STDs), oral transmis-
  sion of, 109

Single-gene defects, 49-50
Sjogren's syndrome, 51
prevalence of, 73

swollen parotid glands with, 97
Skin, lesions of, diseases and conditions causing,
  98t, loot

Sleep problems, and quality of life, 137
SLPI. See Secretory leukocyte protease inhibitor
Smell
aging and, 32
development and function of, 23, 24
Smokeless (spit) tobacco. See Tobacco
Smoking. See also Tobacco
  and birth defects, 48
  cessation of, 210
community intervention models, 171
  and oral cancer, 46
and periodontal disease, 203t, 206
  school-based intervention models, 170
  and trench mouth, 40

Social function, and dental problems, 138-139, L39r
Socioeconomic status. See Income
Sonic instruments, for plaque removal, 206, 206t
Spinal chord, early development of, 29
Spirochetes, and trench mouth, 40

ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL

305


Index

Sports injuries. 50, 73. 173-176. 17St-175t, 176b,
  258

Squamous cell carcinomas, oral. t-t
  HP\. and, 43, $5

Stannous fluoride. to limit gingixpal inflammation,
  205. 206t

State Children's Health Insurance Program (SCHIP),
  2. 13. 733-234, 255. 277
States

data from. need for. 10. 88. 284, 285
on edentulism. 67t
income of, and population-per-dentist ratio.
224. 224J

on mortality rates for oral and pharyngeal
  cancer, 70. 701

public health systems in, 226-227, 286
STDs. See Sexually transmitted diseases
Steroid hormones, and gingivitis, 39
Stevens-Johnson syndrome, lesions caused by, 100~
Streptococci. 39. See also Mutans streptococci
St)-cytocorcus snnguis. in heart disease, 107, 117
Stt~cptococcus Viriclatts, oral infections from, 105
Stress

and immune system, 28
and periodontal disease. 203~. 206
Stroke. oral infection and, 115-120
  animal studies. 117-l 18
  mechanisms of action in, 115-l 17
population-based studies. 118-120, 119~
Student indebtedness, 237-238
Sublingual glands, 26
Submandibular glands, 26
aging and. 32

Submucous fibrosis, and oral cancer, 45
Sugars

  and dental caries, 38, 250b
  intake reduction of, 199
in smokeless (spit) tobacco, 39
Surveillance data. 61-62
  need for. 12, 88-89
on quality- of life, 14-I-146, 146t
surveys used for. 61-62
Suni\.al rate. definition of, 62b
S!-philis. lesions caused by, 99t. 109

T

T cells. 78
smoking and, -41
Tar. tobacco
  carcinogens in, 45
dysplasia and. $6
Tartar. and gingtvttis, 39. See also Calculus

Task Force on Community Preventive Services, 158,
  180
Taste

development and function of, 23-24
  sex differences in, 78
Tear glands, Sjdgren's syndrome and, 51
Technology, future of, 278-279
Temperature, sensitivity to, 24-25
Temporalis muscle, 26
Temporomandibular disorders (TMDs), 52-53
and chewing function, 136
clinical management of, 211-212
diagnosis of, 211-212,212t
pain from, impact of, 139-140
prevalence of, 73
and quality of life, 145-146
  treatment for, 212
Temporomandibular joint, 26
Teratogens, 47-48
Tetracycline, enamel hypoplasia from, 107
TGF-(x. See Transforming growth factor 01
Therapeutics, oral fluids in diagnostic tests for, 103,
  103t

Thermoreceptors, 24
Thrombosis, from oral cavity bacteria, 117
Thromboxane B2, and heart disease, 115
Thrush, 43. See Candidiasis
prevalence of, 71

Tic douloureux, 52
TMDs. See Temporomandibular disorders
TNF-o. See Tumor necrosis factor OL
Tobacco, 191t

among adolescents, 259b
and adult periodontitis, susceptibility to, 41
and alcohol, combination of
  and oral cancer, 45, 208t, 209
and dental caries, 259b
as general health risk factor, 4, 10, 18
and oral and pharyngeal cancer, 259b, 260b
and oral cancer, 44-45, 169, 170, 208t, 209,
  209~

and oral candidiasis, 42
oral effects of, 101
and oral mucosal lesions, 70
and periodontal diseases, 169, 259b, 260b
and saliva, 27
smokeless (spit) tobacco
among adolescents, 257
  and dental caries, 259b
and oral and pharyngeal cancer, 44-45,
    208t, 259b

and oral mucosal lesions, 70, 7Of
and periodontal diseases, 259b

306         ORAL HEALTH 1N AMERICA: A REPORT OF THE SURGEON GENERAL


   prevention programs for, 170
   and tooth decay, 39
  trends in use of, 259b-260b
Tongue
  cancer in, 70
lesions of, diseases and conditions causing,
    98t-100t
Tooth/teeth, 26
aging of, 31
birth defects involving, 48-49, 50
   clenching of, 190, 191t, 212
conically shaped, in ectodermal dysplasias, 50
cultural significance of, 137-138
decay in. See Dental caries
embryonic development of, 30
grinding of, 52, 212
  loss of

by age, socioeconomic status, sex, and
   racdethnicity, 66-67
and chewing function, 135-136
malocclusions. See Malocclusions
nutrition in development of, 250b
pain in, 24
primary, 26

restored. See Restorations
staining of, 107
thermal sensitivity in, 24
trauma to
  from falls, 50
prevalence of, 72

Toothbrushing, 39, 176, 179, 190
  and bacteremia, 104
public knowledge of
   for dental caries prevention, 177
   for gum disease prevention, 178
public practices, 178
Toothaches, prevalence of, 73, 73f
Toothpaste. See Dentifrice
Touch, sense of, in mouth, 24
Toxic-shock-like syndrome (TSLS), 105
Toxins, saliva and, 27, 103, 103t
Transforming growth factor (Y (TGF-cy), and oral
and pharyngeal cancers, 46,47
Trauma. See nfso Injury, and oral-facial
prevention of, strategies for, 156~
  and R-IU, $4

Traumatic ulcers, lesions caused by, 1OOt
Treacher Collins syndrome, 48
Treatment(s). See also specqic disease
  future of, 276
   outcomes

as determinant of health, 248, 248f
measurement of, 133

Index

Trench mouth, 40
  lesions with, 99t

Treponema, and gingivitis, 39
Treponema denticola, in adult periodontitis, 40, 205
Triclosan copolymer, to limit gingival inflammation,
  205, 206t

Trigeminal ganglion, oral herpes and, 43
Trigeminal neuralgia, 52
TSLS. See Toxic-shock-like syndrome
Tuberculosis, lesions caused by, 99t
Tumor necrosis factor cx (TNF-o)
and adult periodontitis, 41, 205
and glycemic control, 114
and heart disease, 115
and pregnancy, 12 1
Tumor suppressor genes, mutations of, in oral and
pharyngeal cancer, 46

U

Ulcerative colitis, and RAU, 44
Ultrasonic instruments, for plaque removal, 206,

206t

U.S. Department of Agriculture, 225
U.S. Department of Defense, 225
U.S. Department of Health and Human Services

  (USDHHS), 225,226, 2261
U.S. Department of Justice, 225
U.S. Department of Transportation, 225
U.S. Department of Veterans Affairs, 225
U.S. Preventive Services Task Force, 156-158
USDHHS. See U.S. Department of Health and

Human Services

V

Van der Woude syndrome, 48
Varicella-zoster virus

and chemotherapy, 106
oral lesions with, 98t
Vascular endothelial growth factor (VEGF), 27
VEGF See Vascular endothelial growth factor
Veillonella pawula, and gingivitis, 39
Velocardiofacial syndrome, 48
Venereal warts, 71

VGS. See Viridans group streptococcei
Vietnamese Americans, nasophatyngeal cancer inci-
dence and mortality, 76
Vincent's infection, 40
lesions caused by, 99t
Violence, 51, 72-73
Viridans group streptococci (VGS), 105
Viridans streptococcal shock syndrome (VSSS), 105

ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL           307


Viruses. See also spec$c virus
chemotherapy and, 106
lesions caused by, 98t
  oral cancer and, 45-46
Vitamin B deficiency, oral signs of, 101
Vitamin C deficiency
  and cancer, 25 1 b
oral signs of, 101
Vitamin D deficiency, oral signs of, 101
Vitamin E, 47

cancer and, 25 1 b
and mucositis, 106

VSSS. See Viridans streptococcal shock syndrome

W

Waardenburg syndrome, 50
Warts, viral, 43

  oral lesions with, 98t
Water fluoridation. See Fluoride, in drinking water
Well-being

  and oral diseases, 10, 11
and oral health, 2, 4-5, 18, 19
in World Health Organization (WHO)
   definition of health, 133
Western scientific worldviews, 134-135
WHO. See World Health Organization
WIC. See Women, Infants, and Children program
Wolinella recta, in adult periodontitis, 41
Women

and adult periodontitis, susceptibility to, 41, 65,
65f

and dental care nonutilization, 84t
as dental personnel, 236
in dentistry, 223-224, 224t
elderly, risk factors for, 266-267
and injuries, 73
and oral and pharyngeal cancers, 68, 68f
and oral bone loss, 102-103
oral health of, 77-78, 266-267
areas of study in, 78, 78f
and pain, 25, 77-78
prevalence of, 73, 73f
  TMDs, 52, 73

and Sjogren's syndrome, prevalence of, 73
Women, Infants, and Children (WIG) program, 225,
  256

Workplace effects, on oral health, 249
World Health Organization (WHO) 18, 133

X
Xenografts, 208
Xerostomia. See Dry mouth
  and dental caries, 38
  and oral candidiasis, 42
Xerostomic side effects, of medication, 107

Y

Yeast. See Candida albicans

308

ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL