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Oral Health

Oral health is a critical component of overall health and well-being. Poor oral health impacts a person's ability to eat, speak, work, communicate and learn. Although many oral diseases and conditions are preventable, periodontal disease and tooth decay (severe gum disease and cavities) are the biggest threats to dental health. Tooth decay is the most common chronic disease among both children and adults in the United States. Chronic untreated tooth decay and periodontal disease can lead to severe tooth loss which can impact speech, eating, and appearance thereby limiting employment opportunities.

Healthy People 2030 focuses on reducing tooth decay and other oral health conditions and helping people get oral health care services.

Regular preventive dental care can catch problems early, when they are usually easier to treat. However, many people do not get the care they need because they cannot afford it. Untreated oral health problems can cause pain and disability and are linked to other diseases.

Strategies to help people access dental services can help prevent problems like tooth decay, gum disease, and tooth loss. Individual-level interventions like topical fluorides and community-level interventions like community water fluoridation can also help improve oral health. In addition, teaching people how to take care of their teeth and gums can help prevent oral health problems.

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. 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.

Children with poor oral health miss more school and receive lower grades than those with better health, while adults lose more school or work hours for urgent, unplanned dental visits. On average, 34 million school hours are lost each year because of emergency dental care, and over $45 billion is lost each year in US productivity due to untreated dental disease.

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. Also, there is a shortage of oral health care providers in Hawai'i and Maui Counties compared to Honolulu and Kauai Counties.

There is limited data about actual caries among adults and children in Hawai'i but survey data reveals the following:
  • 74% of Hawai'i adults report visiting a dentist in the past year (BRFSS 2018), but there are significant differences in access by
    • County - 77% in Honolulu compared to 70% each in Kauai and Maui, and 64% in Hawai'i
    • Race/ethnicity - 60% among Native Hawaiians and Other Pacific Islanders compared to 86% among Chinese
    • Poverty level - 58% among those 0-130%, 72% for those 131-185%, and 83% for those 186+% of the federal poverty level
    • Health care coverage - 76% among those with any insurance compare to 55% among those without

  • 82% of high school students and 78% of middle school students report visiting a dentist in the past year (YBRS 2017), but there were significant differences by county and race/ethnicity
    • Honolulu County students (84%) were more likely to have seen dentist than students in Kauai (79%), Maui (78%) or Hawai'i counties (77%) (based on high school data)
    • Only 64% of Other Pacific Islander and 79% of Native Hawaiian students visited a dentist compared to 94% of Japanese students (based on high school data)

  • 28% of Hawai'i high school students and 27% of middle school students report having a toothache in the past year, but Other Pacific Islander students (39% high school and 34% middle school) were significantly more likely to report toothache than the state as a whole.

Poor dental hygiene (insufficient tooth brushing and flossing), lack of regular dental care, and not having access to fluoridated water are risk factors for poor oral health.

There are disparities in access to oral health care and preventive services. More than 56.7 million people in the US live in areas where there are not enough dentists. 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.

Smoking and increased age are risk factors for both periodontal disease and tooth loss. 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.

Diabetes, tobacco use, a weakened immune system, and poor oral hygiene all increase a person's risk for gum disease which is the leading cause of tooth loss. 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.

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

There are several data sources that can be used to track measures of oral health. Nationally, NHANES data is the key source. Hawai'i relies on self-reported data from the BRFSS and the YRBSS.
  • Behavioral Risk Factor Surveillance System (BRFSS)
  • Youth Risk Behavior Surveillance System (YRBSS)
  • State Oral Health Surveys
  • National Health and Nutrition Examination Survey (NHANES)
  • Water Fluoridation Reporting System (WFRS)
  • Medical Expenditure Panel (MEPS)

Hawai'i Health Matters Indicator Dashboards