Public Health

The Case for Oral Health

Former Surgeon General David Satcher explains how to improve oral health in the U.S. and why the 80/20 rule remains, even after years of education and improvements, stubbornly difficult to break.

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October 19, 2016

Scientific American Custom Media: As Surgeon General in 2000, you published the Oral Health in America report. What inspired you to address this issue?

David Satcher: I grew up in a situation where we didn’t have access to oral health care, and I’ve paid a price for that throughout my life in terms of tooth decay and needing dental work. But also, there was a growing movement…pushing for a report on oral health. There had never been [one].

SACM: What were the main issues at the time—and today?

DS: Children who live in poverty in this country and around the world…don’t get good oral health care. If they are eating too much sugar and not enough fruits and vegetables, they’re more likely to have tooth decay. Tooth decay is among the leading causes of days missed from school. Also, there are kids in this country…where [oral health] supervision is not up to par, like making sure children brush their teeth on a regular basis.

SACM: Since your report was published, what steps have been taken to improve oral health in the U.S.?

DS: Something I’m excited about is the integration of primary care and oral health care. We have problems with reimbursement…but I think ultimately it will make a world of difference to take your child to the pediatrician and know that child will get oral health care that he or she needs in the same facility and with the same team. Also, people underestimate the impact that smoking has on oral health. The smoking [rate] continues to go down [in the U.S.]—now at 15 percent, compared to 43 percent in 1964. That, in and of itself, is great for oral health. The other thing is that people are improving their eating habits—and things that are generally good for prevention of chronic diseases like cardiovascular disease and diabetes are also good for oral health. Sugar, tobacco and alcohol [consumption] are major factors in oral health care.

SACM: What are the major disparities in dental care today—and what do we need to do to improve oral health in the future?

DS: The figures that were in our report are still fairly true: 80 percent of oral health problems affect about 20 percent of the population—the poor and minorities in this country. The fact that we still have the only health system [among developed countries] that doesn’t provide universal access to care is really unfortunate. I’m supportive of the Affordable Care Act but critical of the fact that while…it improves oral healthcare access for children, it does not for adults. Our health system has to incorporate easy access to oral health care.

Also, too many children are not getting the nutrition [they need] for good oral care. If we can reduce sugar intake for children and increase intake of fruits and vegetables…it will have a dramatic effect on reducing tooth decay, and ultimately, periodontal disease. The same things we are doing to reduce childhood obesity are going to be good for oral health.

The most important thing is to improve [dental care], and parents and children need to be educated about the importance of oral hygiene and regular tooth brushing.

Credit: NYU Dentistry

David Satcher
Interview with David Satcher