FUTURE OFDENTISTRY
The dental profession's success in reducing caries,
periodontitis, and tooth loss has dramatically
improved the oral health status of the United States
population. Tooth loss can be categorized by extent
––complete loss of teeth (or complete edentulism)
and partial loss of teeth, ranging from one to many
(partial edentulism). Many factors have contributed
to this improvement in the nation's oral health
including the widespread use of fluoride, an increase
in preventive services, and more clinical time dedicat-
ed to the prevention and treatment of oral diseases.
Despite these advances, demand for dental serv-
ices is at an all-time high. Higher income and edu-
cational levels and increased access to dental insur-
ance have resulted in increased care and changing
expectations among both dental professionals and
patients. In 1996, 65% of persons two years of age
and older visited a dentist (U.S. Department of
Health and Human Services [USDHHS], 2000a).
DENTAL DISEASE PATTERNS
AND USE OF DENTAL SERVICES
Clinical dental care is influ-
enced largely by the demograph-
ics of the population, patterns of
dental disease, and the expecta-
tions of both patients and
providers. The population is
growing. Demographically, it is
becoming older and more cultur-
ally diverse. The average Ameri-
can has fewer caries and is retain-
ing more teeth into old age. As
measured by DMFS (decayed,
missing, and filled surfaces) the
decline in caries was 64% from
1971-1974 to 1988-1994 (USD-
HHS, 2000b; and Miller et al,
1987). According to Healthy
People 2010, 25% of children
have 80% of pediatric dental
caries.
However, poor people contin-
ue to experience more caries than
non-poor people and they are less
likely to receive treatment (USD-
HHS, 2000b). See Figure 3.1.
Epidemiological evidence demon-
strates that dental disease rates and dental needs are
highest in low-income and special needs popula-
tions.Oral Health Status and TrendsThe proportion of untreated dental caries in
school children has been declining overall, but has
increased among children six to eight years old. The
average number of DMFS (decayed missing filled
surfaces) per child among children 6-18 years old
was 1.9 in 1991, down from 4.4 in 1974. By age 17,
only 16% of children are caries free in their perma-
nent dentition. However, 85% of 14 year-olds do
not have dental sealants (USDHHS, 2000a). As
shown in Table 3.1, complete edentulism is decreas-
ing for all ages, with a corresponding increase in
ratio of partial edentulism versus complete eden-
tulism (Miller et al, 1987).Clinical Dental Practice and ManagementPercentage of People with at least
One Untreated Decayed Tooth, by Age and Economic StatusSource: USDHHS, 2000 b.50454035302520151050Poor
Non-PoorAGE GROUPPERC
E
NTOF
PEOPLE2 to 9
(primary teeth only)3 6.817. 35 to 17
(primary and permanent teeth)43 .623. 418 +
(permanent teeth only)34. 411. 3F I GURE 3. 1