David Satcher, M.D., Ph.D.
Assistant Secretary for Health and Surgeon General
Office of Public Health and Science

Thursday, May 25, 2000

[This text is the basis for the Assistant Secretary for Health and Surgeon General’s oral remarks. It should be used with the understanding that some material may be added or omitted during presentation.]

It is my pleasure to welcome you to Shepherd Elementary School for the release of the first-ever Surgeon General's report on oral health.

This is the 51st Surgeon General's report issued since 1964, when Luther Terry issued his landmark report on tobacco and health. These reports have helped frame the science on vital health issues in a way that have helped educate, motivate and mobilize the public to more effectively deal with those issues.

It is my hope that this report will have a similar impact. The key points of this report are:

• That oral health means much more than healthy teeth;
• That oral health is integral to general health;
• That safe and effective disease prevention measures exist that everyone can adopt to improve oral health and prevent disease, not all Americans; even so, there are profound disparities in the oral health of Americans;
• And that general health risk factors, such as tobacco use and poor dietary practices, also effect oral and craniofacial health.

I will review the science contained in this report a bit later in this program. But first, I would like to call your attention to the other people with me on stage.

First, we have Charles E. Frock of Pinehurst, North Carolina, who has been part of a Community Voices partnership that has been instrumental in providing oral health services to underserved communities.

Next, we have first-graders from Shepherd Elementary School and their teacher, Janet Crockett, who have been testing a pilot program of an oral health curriculum developed by the National Institute of Dental and Craniofacial Research.

We had originally planned to have a distinguished representative of the past state of American oral health, in the form of the actual dentures worn by President George Washington 200 years ago, compliments of the National Museum of Dentistry in Baltimore. Unfortunately, some last-minute insurance concerns prevented that from taking place. However, I think the experience of our first President is still worth noting, and I hope you can someday take the opportunity to view the dentures at the museum.

George Washington was a vigorous man of substantial wealth, but he had only one natural tooth left in his head by the time he was sworn in as our first President. Indications are that he suffered from periodontal disease. He also had at times been given heavy doses of the drug calomel - for which tooth loss was a known side effect—to treat various illness in his lifetime.

All told, he had six different pairs of dentures, but he found none of them satisfactory. Contrary to myth, none of these dentures were made of wood, but they were made of just about everything else—animal bone, ivory, even human teeth that had been extracted from other people. This particular set was made for Washington by John Greenwood in about 1795. The plates were carved from walrus tusk.

Washington's oral health problems were a major factor in his daily activity. In a letter to Greenwood, Washington said, "...they are uneasy in my mouth and bulge my lips out in such a manner as to make them appear considerably swelled."

His dentures were held in by springs, which required him to exert forward pressure on his teeth. This seems to have deterred him from public speaking. Thomas Jefferson said he had never heard Washington speak for 10 minutes at a time. By 1791, one observer noted, "His voice was hollow and indistinct, owing as I believe, to artificial teeth before his upper jaw, which occasions a flatness." Could you imagine a President in such a situation today?

I believe Washington's experience underscores the relationship between oral health and overall health, as well as oral health and quality of life. It is a lesson worth heeding today.

But just as George Washington represents the past, we have people here today who represent the present and the future of oral health.

For a look at the present, I would like to turn the podium over to Mr. Frock. He is President and CEO of First Health of the Carolinas and will talk to us about the difference the Community Voices partnership&151;with the assistance of the Kellogg Foundation&151;has made in his community. These are the types of partnerships that can make an important difference in improving oral health in America. Mr. Frock:

Charles Frock speaks.

Thank you Mr. Frock. The future of oral health is being played out, in part, here at Shepherd Elementary. I would like to play a brief video which explains the oral health curriculum that has been implemented with these fine children behind me. Would you please start the video?

Video is played.

I would now like to introduce the teacher who has been involved in this project, Mrs. Janet Crockett

Mrs. Crockett speaks.

Thank you, Mrs. Crockett, and thank you to the first-graders of Shepherd Elementary.

I would now like to discuss the actual findings of our report. When we speak of oral health, we are talking about more than healthy teeth. We are talking about all of the mouth&151;including the gums, the hard and soft palates, the tongue, the lips, the chewing muscles, the jaws; in short, all of the oral tissues and structures that allow us to speak and smile; smell, taste, touch, chew and swallow; and convey a world of feelings through facial expressions.

With that in mind, oral health means being free of oral-facial pain conditions, oral and pharyngeal cancers, soft tissue lesions, birth defects such as cleft lip and palates, and a host of other conditions.

We also found that oral health is integral to overall health. Simply put, that means you cannot be healthy without oral health. New research is pointing to associations between chronic oral infections and heart and lung diseases, stroke, low birth-weight, and premature births. Associations between periodontal disease and diabetes have long been noted. Oral health must be a critical component in the provision of health care, and in the design of community programs.

Looking at the oral health of our country, there is good news and bad news. The good news is that there have been dramatic improvements in oral health over the last 50 years. Great progress has been made in understanding the common oral diseases, such as tooth decay and gum diseases. This has resulted in marked improvements on our oral health. Today, most middle-age and younger Americans expect to retain their natural teeth over their lifetimes.

Even so, the bad news is that we still see a "silent epidemic" of dental and oral diseases across the country. Many of us still experience needless pain and suffering, complications that devastate overall health and well-being, as well as financial and social costs that diminish the quality of life at work, at school, and at home.

Some examples:

• Tooth decay is currently the single most common chronic childhood disease—five times more common than asthma and seven times more common than hay fever;
• Oral and pharyngeal cancers are diagnosed in about 30,000 Americans each year, and 8,000 people die annually from these diseases;
• Nearly one in four Americans between the ages of 65 and 74 have severe periodontal disease;
• And, oral clefts are one of the most common birth defects in the United States, with a prevalence rate of about 1 per 1,000 births.

Another concern we found is that not all Americans are achieving the same degree of oral health. Although safe and effective means exist of maintaining oral health for a majority of Americans, this report illustrates profound disparities that affect those without the knowledge or resources to achieve good oral care. Those who suffer the worst oral health include poor Americans, especially children and the elderly. Members of racial and ethnic groups also experience a disproportionate level of oral health problems. And people with disabilities and complex health conditions are at greater risk for oral diseases that, in turn, further complicate their health.

Major barriers to oral health include socioeconomic factors, such as lack of dental insurance or the inability to pay out of pocket, and access problems including a lack of transportation or the ability to take time off work to seek care. While about 44 million Americans lack medical insurance, about 108 million lack dental insurance. Only 60 percent of baby boomers receive dental insurance through their employers, while most older workers lose their dental insurance at retirement. Meanwhile, uninsured children are 2.5 times less likely to receive dental care than insured children, and children from families without dental insurance are three times as likely to have dental needs compared to their insured peers.

We also found that, safe and effective measures for preventing oral disease exist, including water fluoridation, dental sealants, proper diet, and regular professional care, as well as tobacco cessation. However, they are underused. For example, 100 million Americans do not have fluoridated water. And the smoking rate in America remains at about 23 percent, even though every practically every Surgeon General's report on tobacco since 1964 has established the connection between tobacco use and oral diseases.

So what can we do improve oral health in America?

For one thing, it is important that we continue further research and build the science base on oral health concerns. Such research has been at the heart of scientific advances in oral health over the past several decades. Our continued investment in research is critical to obtain new knowledge about oral health needs if improvements are to be made.

We also must build an effective health infrastructure that meets the oral health needs of all Americans and integrates oral health effectively into overall health. We must work to change perceptions about oral health among the general public, among policymakers, and among health providers. We must remove the barriers between people and oral health services.

We must build public-private partnerships to provide opportunities for individuals, communities, and health professionals to work together to maintain and improve the nation's oral health. We must expand initiatives to prevent tobacco use, promote better dietary choices, and encourage the use of protective gear to prevent sports injuries.

In the past half-century, we have come to recognize that the mouth is a mirror of the body, it is a sentinel of disease, and it is critical to overall health and well-being. The challenge facing us today—to help all Americans achieve oral health—demands the best efforts of public and private agencies as well as individuals.

With that in mind, we recently partnered with an outstanding individual—Bill Cosby—to produce a new public service announcement about oral health. We are formally launching this PSA today, and I would like to share it with you now.

Video is played.

Thank you very much for being here today.

Back to Oral Health

Last revised: January 5, 2007