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Dental health has improved in adult Americans; Medicaid benefits must continue, to keep gains.

Among U.S. adults aged 60 years or older, 6% fewer lost all their teeth in 1999-2002, compared with 1988-1994, the Centers for Disease Control and Prevention reported.

The proportion of older adults with no natural teeth decreased from 31% in 1988-1994 to 25% in the most recent time period, a 20% improvement, according to an analysis of data from the National Health and Nutrition Examination Survey (MMWR 2005;54(SS-3):1-44).

Smokers were more likely than nonsmokers to have no natural teeth: 14% of current smokers had lost all their teeth, compared with 5% of people who had never smoked.

The dental health of U.S. adults as a whole had improved by the 1999-2002 survey, but there were still disparities based on race and income, the report shows. Among higher-income adults, 16% had untreated tooth decay in the most recent time period, compared with 41% of poor adults. Non-Hispanic blacks retained fewer teeth than Mexican Americans or non-Hispanic whites.

The study included data on 16.128 adults aged 20 years or older in 1988-1994 and 8,805 in 1999-2002. The mean number of permanent teeth among adults averaged 23 in the earlier time period and 24 in the more recent time period. A normal, full set includes 28 teeth.

The prevalence of root caries decreased from 23% in 1988-1994 to 18% in 1999-2002.

The report is the first by the CDC to look at the rate of enamel fluorosis, a disfiguring hypomineralization of enamel related to exposure to fluoride during tooth formation. Enamel fluorosis occurred in 23% of adults in the 1999-2002 survey, though most cases were mild, with white spots on the teeth. Moderate to severe fluorosis, which involves discoloration or pitting of teeth, was reported in about 2% of adults.

Physicians can contribute to adult patients' dental health by considering, for example, how medications might affect saliva flow and make teeth more susceptible to decay, said William R. Maas, D.D.S., director of the CDC's division of oral health. Smokers in the study had fewer teeth and more untreated decay. Tooth loss also is related to diet, nutritional status, and obesity.

"By attending to these issues, physicians can work in partnership with the dental profession" to help their patients maintain dental health, he said.

While the overall improvement in dental health is encouraging, the fact that lower-income adults have twice the rate of untreated tooth decay, compared with more affluent adults, is unacceptable, said Richard Haught, D.D.S., president of the American Dental Association.

As the federal and state governments consider reforming Medicaid, it's important to ensure that Medicaid will continue to cover dental benefits and will emphasize prevention of dental disease, he added.

BY SHERRY BOSCHERT

San Francisco Bureau
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Title Annotation:Infectious Diseases
Author:Boschert, Sherry
Publication:Internal Medicine News
Geographic Code:1USA
Date:Oct 15, 2005
Words:456
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