Experts pinpoint areas for further improvement
Oral disease, primarily dental caries, is the most common pediatric disease and can lead to physical and psychological disabilities as well as significant morbidity in adulthood. In May 2000, Dr David Satcher's landmark report, Oral Health in America: A Report of the Surgeon General, highlighted the state of oral health for children and adults in the United States and offered strategies to improve oral health outcomes. The November/December issue of Academic Pediatrics, devoted entirely to children's oral health, represents a ''midterm examination'' of how far the US has come since the 2000 Surgeon General's report in meeting Healthy People 2010 oral health objectives and other key recommendations.
Bringing together 19 contributions from experts in dentistry, medicine, nursing, and public policy, guest editors Wendy E. Mouradian and Rebecca L. Slayton have assembled an impressive summary of the state of children's oral health in the US and urge healthcare professionals to make oral health a pediatric priority. A number of papers were presented at the landmark American Academy of Pediatrics' (AAP) National Summit on Children's Oral Health: A New Era of Collaboration, held November 7-8, 2008 in Chicago.
In his commentary, Editor-in-Chief Peter G. Szilagyi, University of Rochester Medical Center, asks the question, "Why should Academic Pediatrics devote an entire issue to children's oral health now?" His answers: "First, oral health is health, and children's oral health is part of pediatrics...Second, we are far from achieving our Healthy People 2010 oral health objectives in reducing the prevalence of caries in children...Third, substantial disparities exist in children's oral health and access to care...Fourth, oral health represents an excellent paradigm in which the traditional pediatric community needs to work more closely with other health professionals-in this case dental professionals-to advance the health of children."
Szilagyi continues, "I look forward to the day when a future issue of Academic Pediatrics or a future Surgeon General's report proclaims victory on the plight of dental caries and declares that children's mouths are largely absent of dental or oral disease."
Wendy E. Mouradian and her co-authors then present an overview of the papers and comment on progress made in meeting Surgeon General David Satcher's goals set in 2000, calling for "dentists, physicians, and other health professionals who work with children to embrace a shared responsibility for children's oral health and work to overcome the historic separation between dentistry and medicine...." Dr. Satcher himself follows with a renewed call to arms to improve children's oral health.
Rebecca L. Slayton and Harold C. Slavkin address how scientific and technological advances in sequencing of the human genome, tissue engineering and saliva diagnostics may have significant potential to impact oral health.
Paul S. Casamassimo relates the medical history of a young man with special-needs, to illustrate how oral health may be mishandled by both community dentists and physicians in a health care system with too many gaps, in "A Life Without Teeth."
The Science and Surveillance section includes articles that discuss tooth decay, especially in younger children, and the lack of improvement in reducing this disease. Children's diets, a subject of recent concern for obesity, can also increase dental caries.
Three articles dealing with Access and Barriers to Care are included. These review current measures of access to dental care for children, including those with special health care needs, and the ethical and policy issues in the care of children with craniofacial conditions including quality of life, costs of care, and prenatal diagnosis of craniofacial defects,
The Oral Health Workforce, including dental and medical education issues, is covered in six articles. Authors review the state of the oral health workforce, including new models of mid-level dental practitioners, and stress the need to better educate both dentists (especially general and pediatric dentists) and primary care medical providers (pediatricians, family physicians, nurse practitioners, physicians' assistants) to promote children's oral health and ensure they have adequate access to dental care.
Finally, two articles on Policy Achievements and Challenges discuss how government actions and policy decisions have affected children's oral health. Burton Edelstein writes about congressional action to reauthorize CHIP (Child's Health Insurance Program) and to include funding for oral care. James J. Crall discusses how the Surgeon General's Report on Oral Health drove Congress and State Legislatures, Federal and State Agencies, the Federal Courts, and various professional societies and associations to adopt policies and procedures to enhance children's oral health, and reflects on the work remaining to fully address children's oral health needs.
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