(May 2000) Today, most middle age and younger Americans expect to retain their natural teeth over their lifetimes. Even so, we still see a "silent epidemic" of dental and oral diseases across the country. These were among the major conclusions of the first-ever Surgeon General's Report on Oral Health, which was released earlier this year. This is the 51^st 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 has 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.

When we speak of oral health, we are talking about more than healthy teeth. We are talking about all of the mouth, 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, smile, smell, taste, touch, chew, swallow, and convey a world of feelings through facial expressions. Oral health also 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, 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 common oral diseases, such as tooth decay and gum diseases. This has resulted in marked improvements in our oral health.

But 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 among the most common birth defects in the United States, with a prevalence rate of about 1 per 1,000 births.

Another concern 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 inability 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 two-and-one-half 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 practically every Surgeon General's report on tobacco since 1964 has established the connection between tobacco use and oral diseases.

For all the progress we have made in public health over the last century, we still have much to do to ensure that everyone shares in that progress. That is why we have made the elimination of disparities in health status one of the primary objectives of Healthy People 2010-the nation's health goals for the next 10 years. This commitment to eliminate disparities has already galvanized communities, states, and non-governmental organizations throughout the country to develop their own commitments and strategies.

Eliminating disparities is not only good for our country, it is fundamentally right. It is something that we can and must accomplish. The pursuit of this goal will bring Americans closer together in health and commitment, and it will improve our system of medicine and public health.

This begs the question of "how?" Or, to put it more broadly, how will we accomplish our objectives? In short, this will be accomplished by working together at every level of government and community, with a balanced community health approach.

So what can we do improve oral health in America? For one thing, it is important that we continue to research and build on the scientific knowledge of oral health. 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, policymakers, and health providers. We must remove the barriers between people and oral health services.

We must expand initiatives to prevent tobacco use, promote better dietary choices, and encourage the use of protective gear to prevent sports injuries. And 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.

The Kellogg Foundation's Community Voices initiative is the type of partnership that can make an important difference in improving oral health in America. At the release of my oral health report, I was fortunate to be joined by 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 in his area.

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. I commend the people involved with Community Voices for the leadership you have shown, and I wish you the best as you continue your efforts.