Oral Health

What Is Known

Oral health problems are common. Over half of US children (52%) have had a cavity in at least one of their primary (baby) teeth by age 8, and low income children are twice as likely to have cavities as higher income children.⁵ More than 1 in 4 US adults (26%) aged 20-64 currently have cavities, and nearly half (46%) of all adults aged 30 or older show signs of gum disease.⁶

Hawai’i survey data reveals the following:

• 74.7% of Hawai’i adults report visiting a dentist in the past year (BRFSS 2020). There are differences in access by:
  • County–67.2% in Hawai‘i compared to 76.6% in Honolulu
  • Race/ethnicity–58.5% among Other race compared to 83.4% among Chinese
  • Poverty level –57.0% among those 0-130% compared to 82.1% for those 186+% of the federal poverty level
  • Employment Status–75.6% among employed compared to 62.8% among unemployed
• 14.1% of children aged 1-17 years had decayed teeth or cavities in the past 12 months, which is higher than the US average of 11.8% (NSCH 2019-2020).
• 80.2% of high school students and 80.5% of middle school students report visiting a dentist in the past year (YBRS 2019), but there were significant differences by county and race/ethnicity which closely resembled those seen in adults.
• 81.5% of women needed a dentist during pregnancy, but only 13.8% visited a dentist for a problem during pregnancy (PRAMS 2019).
• 8.8% of the public water supply population receives fluoridated water, compared to 73.0% nationally (Water Fluoridation Statistics 2018).

Who Is at Risk

There are many factors that can negatively impact a person’s oral health, from individual behaviors to social and economic factors:

• Poor dental hygiene (insufficient tooth brushing and flossing), lack of regular dental care
• Increased age and smoking: While 1 in 6 adults aged 65 and older have lost all their teeth, smokers were three times more likely than non-smokers to have total tooth loss.⁷
• Diabetes, tobacco use, a weakened immune system, and poor oral hygiene: These factors increase a person’s risk for gum disease which is the leading cause of tooth loss.⁸ Severe tooth loss is also associated with lower general health status and having other chronic diseases including: asthma, diabetes, emphysema, heart disease, liver conditions, rheumatoid arthritis and a history of stroke.⁷
• Lack of fluoridated drinking water: Public water systems in Hawai’i are not fluoridated so residents must rely on sources of fluoride other than drinking water to prevent tooth decay.
• Shortage of oral health care providers: More than 64 million people in the US live in areas where there are not enough dentists.⁹ Access to care is also limited for adults on Medicaid and children who rely on the Children’s Health Insurance Program because only about one-third of US dentists accept public insurance. As a result, low-income children are twice as likely to have cavities as higher-income children.

How To Reduce Risk

There are things that individuals can do to maintain a healthy mouth and strong teeth.¹⁰

• Drink fluoridated water and brush with fluoride toothpaste.
• Practice good oral hygiene by brushing teeth twice a day and flossing daily to remove dental plaque.
• Visit a dentist regularly (at least once per year, preferably twice).
• Do not use any tobacco products. If you do use tobacco, quit.
• Limit alcohol consumption.
• Manage your chronic conditions, especially diabetes.

Community water fluoridation and school-based dental sealant programs are both cost-saving, proven strategies to prevent tooth decay. Community water fluoridation reduces and aids in preventing tooth decay among all socioeconomic, racial and ethnic groups. Sealants are thin plastic coatings applied to the tiny grooves on chewing surfaces of teeth. Once applied, sealants protect against 80% of cavities for 2 years and continue to protect against 50% of cavities for up to 4 years. School sealant programs provide sealants to children who are less likely to receive private dental care.¹¹