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Oral health: A window to your overall health

Your oral health is more important than you might realize. Learn how the health of your mouth, teeth and gums can affect your general health.

Did you know that your oral health offers clues about your overall health? Did you know that problems in the mouth can affect the rest of the body? Protect yourself by learning more about the link between your oral health and overall health.

What's the link between oral health and overall health?

Like other areas of the body, the mouth is full of germs. Those germs are mostly harmless. But the mouth is the entry to the digestive tract. That's the long tube of organs from the mouth to the anus that food travels through. The mouth also is the entry to the organs that allow breathing, called the respiratory tracts. So sometimes germs in the mouth can lead to disease throughout the body.

Most often the body's defenses and good oral care keep germs under control. Good oral care includes daily brushing and flossing. Without good oral hygiene, germs can reach levels that might lead to infections, such as tooth decay and gum disease.

Also, certain medicines can lower the flow of spit, called saliva. Those medicines include decongestants, antihistamines, painkillers, water pills and antidepressants. Saliva washes away food and keeps the acids germs make in the mouth in balance. This helps keep germs from spreading and causing disease.

Oral germs and oral swelling and irritation, called inflammation, are linked to a severe form of gum disease, called periodontitis. Studies suggest that these germs and inflammation might play a role in some diseases. And certain diseases, such as diabetes and HIV/AIDS, can lower the body's ability to fight infection. That can make oral health problems worse.

What conditions can be linked to oral health?

Your oral health might play a part in conditions such as:

• Endocarditis. This is an infection of the inner lining of the heart chambers or valves, called endocardium. It most often happens when germs from another part of the body, such as the mouth, spread through the blood and attach to certain areas in the heart. Infection of the endocardium is rare. But it can be fatal.
• Cardiovascular disease. Some research suggests that heart disease, clogged arteries and stroke might be linked to the inflammation and infections that oral germs can cause.
• Pregnancy and birth complications. Gum disease called periodontitis has been linked to premature birth and low birth weight.
• Pneumonia. Certain germs in the mouth can go into the lungs. This may cause pneumonia and other respiratory diseases.

Certain health conditions also might affect oral health, including:

Diabetes. Diabetes makes the body less able to fight infection. So diabetes can put the gums at risk. Gum disease seems to happen more often and be more serious in people who have diabetes.

Research shows that people who have gum disease have a harder time controlling their blood sugar levels. Regular dental care can improve diabetes control.

• HIV/AIDS. Oral problems, such as painful mouth sores called mucosal lesions, are common in people who have HIV/AIDS.
• Cancer. A number of cancers have been linked to gum disease. These include cancers of the mouth, gastrointestinal tract, lung, breast, prostate gland and uterus.
• Alzheimer's disease. As Alzheimer's disease gets worse, oral health also tends to get worse.

Other conditions that might be linked to oral health include eating disorders, rheumatoid arthritis and an immune system condition that causes dry mouth called Sjogren's syndrome.

Tell your dentist about the medicines you take. And make sure your dentist knows about any changes in your overall health. This includes recent illnesses or ongoing conditions you may have, such as diabetes.

How can I protect my oral health?

To protect your oral health, take care of your mouth every day.

• Brush your teeth at least twice a day for two minutes each time. Use a brush with soft bristles and fluoride toothpaste. Brush your tongue too.
• Clean between your teeth daily with floss, a water flosser or other products made for that purpose.
• Eat a healthy diet and limit sugary food and drinks.
• Replace your toothbrush every 3 to 4 months. Do it sooner if bristles are worn or flare out.
• See a dentist at least once a year for checkups and cleanings. Your dentist may suggest visits or cleanings more often, depending on your situation. You might be sent to a gum specialist, called a periodontist, if your gums need more care.
• Don't use tobacco.

Contact your dentist right away if you notice any oral health problems. Taking care of your oral health protects your overall health.

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• Gross EL. Oral and systemic health. https://www.uptodate.com/contents/search. Accessed Feb. 1, 2024.
• Oral health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/oral-health. Accessed Feb. 1, 2024.
• Gill SA, et al. Integrating oral health into health professions school curricula. Medical Education Online. 2022; doi:10.1080/10872981.2022.2090308.
• Mark AM. For the patient: Caring for your gums. The Journal of the American Dental Association. 2023; doi:10.1016/j.adaj.2023.09.012.
• Tonelli A, et al. The oral microbiome and the pathophysiology of cardiovascular disease. Nature Reviews Cardiology. 2023; doi:10.1038/s41569-022-00825-3.
• Gum disease and other diseases. The American Academy of Periodontology. https://www.perio.org/for-patients/gum-disease-information/gum-disease-and-other-diseases/. Accessed Feb 1, 2024.
• Gum disease prevention. The American Academy of Periodontology. https://www.perio.org/for-patients/gum-disease-information/gum-disease-prevention/. Accessed Feb. 1, 2024.
• Oral health topics: Toothbrushes. American Dental Association. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/toothbrushes. Accessed Feb. 1, 2024.
• Issrani R, et al. Exploring the mechanisms and association between oral microflora and systemic diseases. Diagnostics. 2022; doi:10.3390/diagnostics12112800.
• HIV/AIDS & oral health. National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/health-info/hiv-aids. Accessed Feb. 1, 2024.
• Dental floss vs. water flosser
• Dry mouth relief
• Sensitive teeth
• When to brush your teeth

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Oral Health in America: Advances and Challenges [Internet]. Bethesda (MD): National Institute of Dental and Craniofacial Research(US); 2021 Dec.

Oral Health in America: Advances and Challenges [Internet].

In 2000, the landmark report, Oral Health in America: A Report of the Surgeon General ( U.S. Department of Health and Human Services 2000 ), emphasized that oral health is integral to the health and well-being of all Americans. That conclusion remains crucially important today. Over the last 2 decades, mounting evidence has demonstrated the essential role of oral health in a long and healthy life. Good oral health represents not only the ability to eat, speak, and smile, but also freedom from pain that can interfere with normal functioning—including sleep, work, and learning. Oral health problems can occur at any point across the lifespan, but more often than not, they are preventable through individual, family, and community efforts. Social and commercial determinants of health can support or interfere with these efforts to achieve better oral health, and we are just beginning to understand what is needed to support positive outcomes in this regard. Many individuals and families continue to struggle with accessing oral health care. If there is one overarching challenge for oral health that has persisted over the last 20 years, it would certainly be the inadequate access to dental care that tens of millions of Americans experience. This lack of access to oral health care leads inevitably to untreated disease and, by association, to pain. Even so, the future for oral health in America is promising. Steps taken over the last 2 decades have revealed the promise and potential of a variety of innovative strategies. Consequently, the collective actions we take today can ensure that everyone in this country will have the opportunity to enjoy the benefits of good oral health tomorrow.

Reflections on the 2000 Surgeon General’s Report on Oral Health

One of the closing sections of the 2000 Surgeon General’s Report on Oral Health in America was titled “Facing the Future.” It summarized briefly what were believed to be the major themes—or six “cultural movements”—that would influence the course of oral health over the coming years; it also described a basic framework for oral health that would be driven by those themes. Our first impression on rereading that section after completion of one of the later drafts of the current report was that it had truly been prescient. The “future” challenges and opportunities embodied in the six themes identified in 2000 reflect the same major influences and challenges that are described in this report. While those themes may have changed their shape slightly in some cases, there is no question that they continue to represent major factors provoking us, energizing us, and directing us toward new approaches and new efforts to improve oral health for all. It is worthwhile to look back now to that 2000 report and consider the six major influences they described and how those are reflected in various sections of the current report.

• The biological and biotechnology revolutions;
• A redistribution of the world’s people by rapid and sizable migrations within countries and across borders;
• Changing demographics in industrialized as well as developing nations;
• Changing patterns of disease, including the emergence and reemergence of infectious diseases, and changes in the organization of health care;
• Instant worldwide communication through the internet, cable, satellite, and wireless technology; and
• A continuing exponential rate of growth in information technology, specifically in computer speed, memory, and complexity.

Although the current report was not written with the intention of addressing these influences, it is now easy to see that each section herein has, indeed, reflected at least one or two of these influences in the descriptions of the advances, challenges, and promising new directions around which the report’s content has been organized. It seems quite correct, therefore, to say that these six influences represent important patterns of change that have shaped oral health over the last 20 years. Because the six influences overlapped in a number of ways, we will discuss them here in just three groupings: (1) Advances in Biology, Technology, and Computing Capacity (Influences 1 and 6); (2) Changing Population Patterns and Demographics (Influences 2 and 3); and (3) Instant Communication and Contagion (Influences 4 and 5).

Advances in Biology, Technology, and Computing Capacity

The biological and technological revolution that was heralded in the Surgeon General’s Report on Oral Health 20 years ago has unquestionably transformed our thinking about what is possible for oral health. Section 6 of this report focuses on “Emerging Technologies and Promising Science” and describes some of the discoveries related to genomics and the microbiome that have begun to reveal relationships among diseases and suggest possibilities for personalized treatment. Research on the oral microbiome has led to a far better understanding of the processes underlying periodontal disease and its consequences as well as its relationship to systemic disease. The “big data” thinking that was necessary to pave the way for identifying and mapping the human genetic structure, as realized through the Human Genome Project, required improvements in analytic techniques, as well as expanded knowledge in cellular and genomic biology. These advances, in turn, have facilitated new discoveries related to oral health and every other field of medicine. Although new and exciting areas of scientific discovery were underway in 2000, much of what we now are seeing—in regenerative techniques, for example—had not yet been imagined. The laboratory development of living materials for use in restoring bone structure, for example, is becoming a reality in the practice of implant dentistry, and three-dimensional printing techniques are now being used in the production of several different types of dental prostheses and restorations. Other advances that have made an impact on the delivery of dental care during the last 20 years include digital radiographs, intraoral cameras, and other technological devices used in diagnostic applications.

The continuing explosion of scientific knowledge, as reflected in this report, also is related to the sixth and last bullet in the list of influences above, “exponential growth in … computer speed, memory, and complexity.” Today, we take for granted this exponential growth in computing and sometimes struggle to make use of the capacity it reflects. Electronic health records (EHRs) present a very simple example of this. The integration of dental and medical records could result in moving more quickly toward the use of individual health information to inform treatment and prevention of oral diseases, although this potential has not yet been fully realized. Section 4 , which addresses “Oral Health Integration, Workforce, and Practice,” provides descriptions of some excellent early efforts to do this. These initiatives also recognize the benefits that integrated records can bring to health care providers responsible for patient care related to systemic diseases, such as diabetes, that have known oral health implications. Section 6 also reminds us of the need and ongoing efforts to improve our EHR infrastructure and how truly integrated health information can advance individual and public health. The biological and computer technological revolutions are challenging—not only because they continue to transform what we know but also because they continually create both new goals and new obstacles to surmount on the way to achieving those goals.

Changing Population Patterns and Demographics

The second and third major influences listed in the 2000 report referred to redistribution of people by migration and changing demographics in both industrialized and developing nations. These changes, indeed, have come to pass and, in all likelihood, they will continue to reshape the racial and ethnic profile of our country as well as those of many other nations. These influences reflected the major role that population-based disparities were beginning to have on strategies to improve oral health across our country in 2000. Today, however, these disparities represent an overarching challenge that can be seen throughout the current report. As we confront the urgency of addressing disparities in patterns of oral disease that reflect our population’s profile, we are compelled to seek a greater understanding of the factors underlying disparities and to develop skills for tailoring treatments to address these factors. Moreover, we cannot escape the importance of building a health care workforce that mirrors the people for whose oral health care they are responsible. Various aspects of these challenges are described in all six sections of this report.

In Section 1 , the concept of upstream variables that create disparities in oral health status and also in access to regular dental care was introduced, and the manifestations of these differences were explored in terms of their impact on health care systems and on our national economy. The complex relationships among social, cultural, commercial, and other influences on individuals and families underscore the fact that oral health depends on more than the availability of dental care. Social determinants of health play a vital role in influencing oral health outcomes; these determinants represent not only a variety of factors reflecting where people live, learn, and work, but also the economic and social systems within society that affect all of us. Social determinants for some are associated with insufficient resources and opportunities to maintain health, leading to persistent health inequities that impact both individuals and the communities where they live. Observing these inequities compels us also to confront the ways in which perceptions of group differences have created and built unconscious bias and structural racism into our social and health care systems. These systemic biases play out in many ways—for example, in the differential availability and marketing of a variety of products that can harm or support oral health. Because of the disparate associations of financial and other social determinants with various population groups, commercial motivations may exacerbate oral health disparities and inequities. Policy implications are important in this discussion, and issues such as taxation of health-harming products and other governmental and community-level actions that have been suggested also are discussed.

In Sections 2 and 3 , which focus on oral health across the lifespan, the data related to changing population patterns were central for virtually every topic. This focus on population-based social and environmental disparities is perhaps most obvious in the presentation of data related to childhood caries. Income and race are among the most powerful predictors of dental disease in young children, and this continues to occur despite tremendous strides in the overall reduction of dental caries. The same is true for access to dental care, where minority racial identification and lower incomes are clearly associated with unmet oral health needs in children. New research in social determinants of oral health is suggesting that, among recent immigrant populations, acculturation may be an important, albeit complex, factor in determining oral health.

Population data also demonstrate notable disparities in the oral health of adults. Throughout the adult years, the ability to pay for oral health care is likely to determine the status of oral health—especially for those who are members of minority racial groups. Although important initiatives of the past 20 years have supported improved oral health for most young children, the outcomes of this progress diminish as those children move through adolescence and into adulthood. As a group, working-age adults have seen little change in oral health; this is clearly related to the ongoing challenges of financing and accessing dental care, as well as to the dearth of oral health promotion initiatives aimed at preventing the initiation of dental caries in adolescents and young adults.

Changing demographics also help to explain the increased numbers of rural-dwelling individuals who have little access to dental care and who may lack access to such preventive oral health measures as water fluoridation. Finally, because our population is aging rapidly, we see new patterns of disease and growing demand for oral health care for those in institutional settings. Older Americans now have far lower rates of edentulism and fewer problems of maintaining functional dentition, but those rates do not apply to all groups within the population. The fact that our population is aging may represent the single most important change that we will see during the next 20 years. The number of people who will be 65 or older by 2035 will be greater than those who are 18 or younger. Preparing for this shift in the composition of our society demands greater attention and new strategies for addressing the changing needs of the older population.

Section 4 focuses on oral health integration, workforce, and practice—all important topics when considering changing population demographics. Most compelling from that section are the recommendations for innovative models of care that include new types of providers; expanded responsibilities across medicine and dentistry; and the introduction of oral health care and preventive services into new settings where people live, work, and learn. These innovations in care delivery notwithstanding, our ability to respond to oral health care needs is hindered by cost factors related to pursuing dental education or, later, to practicing in high need areas. When dentists graduate with education debt at unprecedented levels, they may feel pressured to practice only in higher-demand and higher-income areas, and the maldistribution of essential oral health services is simply exacerbated. The content of professional training, too, must be adapted to address a changing population’s needs and to emphasize prevention, rather than treatment. Finally, in Section 4 , we benefited from an in-depth look at the problems of financing oral health care and the ways in which the separation of this aspect of health has created particular burdens for the underserved within our new population demographics. For instance, dental coverage is not as widespread as medical insurance because it is treated as an add-on to health insurance, rather than an essential part of it. The demand for oral health care, and with it, the oral health status of the nation, would be elevated if oral health services were considered an essential health benefit for individuals of all ages.

Although the focus of Section 5 might appear at first glance to represent a topic apart, the issues of pain, mental health, and substance use are inextricably tied to a variety of issues and concerns for oral health and the practice of oral health care. The same barriers encountered by those who are disadvantaged by social and environmental determinants of oral health also are experienced by individuals who live with mental illness or cope with substance use disorders. Section 5 represents an unprecedented attempt to coalesce and synthesize information on pain, mental illness, and substance misuse in the context of oral health. This section explicates patterns of substance use and the relationship of various substances and use patterns to oral disease; in doing so, it informs oral health research, as well as patient care issues and provider behaviors related to these problems.

Even with respect to emerging science and technology, which is the focus of Section 6 , issues of health disparities in relation to population demographics are a salient topic. The development and evaluation of evidence-based oral health practices depend on the testing of those practices in a manner that addresses our changing population demographics. Only with this approach will advances in research help to address, rather than exacerbate, existing disparities in oral health. The contributors to Section 6 also underscore the need for increasing the numbers of oral health scientists and academics who reflect the many racial backgrounds, cultures, and other characteristics of the population at large.

The impact of rapid changes in population demographics and associated health disparities and inequities—both within our country and around the world—as well as greater reliance on technology to deliver dental care, represent a growing concern. Recently, global oral health was described in a Lancet editorial as being at a “tipping point,” where technological changes and consumer demands for esthetic dentistry were changing the perception of dental care and accelerating oral health disparities as more people face increasing barriers to receiving essential care for oral health ( The Lancet 2019 ). If our idea of what oral health should be continues to move toward these newer expectations and trends, then the risk is high for many to remain disenfranchised from the benefits of good oral health as care becomes more unaffordable. This will result in many Americans continuing to live with untreated disease, to have poor access to prevention and care, and to experience a lower quality of life.

Communication and Contagion

As we observe the tremendous impact of population-related and socially driven health disparities that was predicted in 2000, we are acutely aware that patterns of disease must be understood globally as well as nationally. We are not isolated, and in fact, it is not possible for us to be isolated as a country with respect to oral health, any more than to any other aspect of the human condition. The fourth and fifth major influences predicted in the first Surgeon General’s Report on Oral Health—changing patterns of disease, including the emergence and reemergence of infectious diseases, and instant worldwide communication—are even more salient at this particular moment in time.

As this report was in development, our world was unexpectedly gripped by the COVID-19 pandemic, a vivid illustration of universal human vulnerability to a viral disease that does not respect national or social boundaries. We have learned that it does not matter where such a disease originates; we will ultimately experience it as citizens of the world. Furthermore, it will cease to affect us only when and if it no longer infects anyone, anywhere in the world. This was the lesson of smallpox, as well as the efforts to eradicate polio, and we are learning these lessons again today. Although vaccines now provide individual protection from the virus, the emergence of variants of the original COVID-19 coronavirus remind us that the disease will not instantly be eradicated, nor will we have seen the last of such pandemics. We simply cannot exist as an island on this globe, and our health fate is inevitably shared with all the earth’s inhabitants. This is true for oral health as well as for every other aspect of health.

In response to COVID-19, this report’s contributors have attempted to describe in real time the impact of the pandemic on oral health specifically, and on the delivery of oral health care services—from the postponement of dental care during the pandemic to the modification of treatment procedures by eliminating or adapting aerosolizing techniques and adding protective equipment. That effort to understand the impact of the pandemic can be viewed in some way in each of the Sections of this report, yet it also was clear that we were writing only the early chapters of this history, that we were only beginning to imagine the longer-term consequences on oral health of this virus, and perhaps of other infectious diseases in the future. A very cogent lesson of the COVID-19 pandemic is that managing such events will necessitate partnerships among all nations. Just as it is a fact that viral diseases have no boundaries, it is an imperative that science must have no boundaries. In this regard, of course, instant worldwide communication is our best friend.

Of course, there have been other changes in disease patterns as well, and this monograph has described those with respect to oral diseases. We are seeing unprecedented levels of human papillomavirus–related oropharyngeal cancer, and the ongoing epidemic of opioid misuse represents another pattern that was not a part of the picture in 2000. Across the board, we see improvements in our ability to control and to treat the most common oral diseases—but not for all of the people all of the time. Substantial challenges remain for achieving the goal of integrating new technologies, such as EHR and telehealth. Those who live with poverty, those who have medically compromising conditions—including mental illness and substance use disorders—and those who differ by virtue of race or ethnicity, are undeniably bearing the brunt of these new patterns of disease. It is important to acknowledge that these same groups stand to gain the most if we are able to fully apply new science and technology in ways that will be available to them. Again, our challenge is less whether we can prevent or treat a particular disease than it is whether we can do that for everyone.

Reconsidering a Framework for Oral Health

The 2000 report closed its discussion of important influences by identifying two major drivers for the advancement of oral and craniofacial health over the coming years. Those were stated as: (1) the need and demand for dental, oral, and craniofacial health services; and (2) the role, functions, and mix of health professionals. These two themes are certainly salient in the topics covered in this report. Rather than drivers for the future, however, these two themes now appear to represent major facets of the oral health landscape that are, themselves, being driven by the changing patterns described in the report. Based on the work in this volume, the key determinants of the need for services and types of providers are changing population patterns and changing disease patterns. These two factors ultimately will require changes in the services that are needed and also in the roles, functions, and mix of health care professionals who will provide those services. The entry of new kinds of providers—such as dental therapists—and the provision of some oral health services by medical providers are demonstrating the recognition that oral health is inseparable from overall health. Integrated electronic health records and the extension of health services to new settings are additional steps that will extend care options and thereby enhance the capacity to prevent oral disease. The advantages of these strategies ultimately accrue to patients, and especially to the growing number of individuals who have not been well served by traditional approaches to care.

This monograph has provided numerous examples of ways in which consumers/patients, health care providers, and health policy makers can engage to improve oral health and strengthen an oral health framework that benefits all Americans. For parents, encouraging twice-a-day toothbrushing, providing a healthy diet, and ensuring regular dental care—including seeing a dentist by a child’s first birthday—are behaviors that will set children on the right course for sustained oral health. Pregnant women are learning that it is both safe and smart to receive preventive dental care and seek treatment for dental problems. Safe and effective measures to prevent oral diseases are available for everyone, regardless of age. Smoking is a major risk factor for gum diseases and oral-related cancers, and early research on e-cigarette use shows that it may have harmful effects in the mouth and throat that are similar to those of other tobacco use. State and national quitlines are a valuable resource for users of tobacco products who want to quit. Dental providers as well as physicians are increasingly taking the initiative in offering these and other resources.

Dental care has been moving away from extensive treatment and restorative procedures to the use of minimally invasive techniques—for example, with nonsurgical approaches to dental caries management. The effective use of this approach requires a documented assessment of risk and the ability to track small changes in demineralization and other surface conditions. Dental practice has become increasingly reliant on advanced applied technology, such as digital imaging, dental implants, and materials used to prevent, arrest, and restore disease-affected orofacial areas. The effective management of orofacial pain is an essential part of dental practice, and the profession has been active in promulgating improved practices for more judicious prescription of controlled substances and more effective strategies for the appropriate use of nonprescription analgesics.

Interprofessional education and care are changing the way dental services are provided, and there is a growing emphasis on collaborative health care, especially for those with special health needs and those with limitations due to functional dependency. The integration of dental services with medical care is occurring in both directions, with physicians increasingly engaging in oral health prevention activities; dentists now providing diabetic screenings, counseling for tobacco cessation and HPV prevention, or substance use screening. Several states have authorized vaccinations as a part of dentists’ health services as well. Although more Americans than ever are receiving dental care away from a conventional dental office, more are also receiving some primary health care services from oral health professionals.

This monograph also has highlighted society’s structural influences on oral health. Although actions taken by individuals and providers are essential for good oral health, ensuring better oral health for all requires actions at the level of public policy. Only through policy can access to oral health services be assured for all. Unfortunately, that access to care is the most persistent challenge to the goal of oral health for all. It is not enough to articulate that oral health is important, or that it is clearly related to general health. Access to oral health care must be declared an essential health benefit—one to which all Americans have a right, regardless of age or any other characteristic of our lives. From a simple declaration such as this, it could be expected that many other structural changes would flow—from addressing the scope of practice or improving educational competencies, to expanding dental insurance coverage, among others. If America is to make a significant step toward improved oral health for all, it is clear that individuals, providers, and policy makers will all have important roles to play.

Creating Optimal Oral Health for All

This report, Oral Health in America: Advances and Challenges , reflects the interconnectedness among a wide variety of factors and determinants that influence oral health and overall health. Although the report has been presented in six broad sections that appear at first glance to be more independent than related, a closer inspection will prove otherwise. The six sections can be conceptualized as a complex cluster of puzzle pieces (see Introduction , Figure 1 ) that, when assembled, can bring our nation much closer to optimal oral health for all. For example, in the figure, three puzzle pieces (reflecting Sections 1 , 4 , and 5 ) are shown as unconnected to the assembled puzzle, suggesting that connecting them in position will improve oral health in America. These pieces focus on several major issues that influence access to care, such as the workforce, care integration, financing care, and health systems. Other equally important issues from these three sections include inequities and disparities, pain management, substance misuse, and behavioral health issues. In considering the meaning of this puzzle, it also needs to be understood that the three pieces that are shown as connected within the assembled puzzle should not be perceived as representing completed work. For example, from implementing effective strategies to address adolescent oral health to identifying interventions that provide proper oral health services for older adults, many tasks have not yet been addressed.

The current report is far-ranging and describes the many ways in which the major social or cultural influences foreseen by the 2000 report have buoyed new discoveries and encouraged creative approaches in oral health care. Unfortunately, those same influences also have limited our progress. We have the problems of too much data and not enough applicable information, producing a paradox that affects our health care system and challenges our decision-making efforts. New knowledge and novel technology create enormous potential and also raise additional questions about what is feasible financially, operationally, or culturally. New opportunities for pain management create the potential for misuse of the same medications that can solve a problem. Better understanding of the behaviors that support oral health create demands for greater understanding of the educational, social, cultural, and financial obstacles to achieving those behaviors. Better health care means longer lives, and longer lives inevitably result in additional health care challenges, including those of oral diseases and disorders.

In 2000, the Surgeon General’s Report on Oral Health in America demonstrated that oral health is integral to overall health. Twenty years later, this report has both reaffirmed those findings and provided a greater understanding of that relationship. The true value of this report, however, will be in the extent to which it provides a plan for securing the same benefits of good oral health for every individual. Given the multiple and often complex influences on oral health, we have attempted to identify some key findings of the current report that reflect these forces ( Box ). Just as each section of this report has identified a call to action, we will close this report with three more calls to action that suggest promising directions for achieving better oral health for all: (1) policy changes are needed to reduce or eliminate social, economic, and other systemic inequities that affect oral health behaviors and access to care to significantly improve the nation’s oral health; (2) dental and other health care professionals must work together to provide integrated oral, medical, and behavioral health care in schools, community health centers, nursing homes, and medical care settings, as well as dental clinics to improve oral health for more people; and (3) we need to diversify the composition of the nation’s oral health professionals, address the costs of educating and training the next generation, and ensure a strong research enterprise dedicated to improving oral health to strengthen the oral health workforce.

These calls to action are not simple decisions that can be made and implemented easily. Each requires the development of a still stronger scientific evidence base, a commitment to recruiting and sustaining human resources to accomplish the task, and a focus on implementation and evaluation—all within the context of our changing demographics. We must test both the new models that we envision and our approaches to disseminating those models, and we must prove their results, both in terms of economic and social impact as well as the health impact for individuals. The charge is daunting, but we are better positioned than ever to undertake work that will create the opportunity for optimal oral health and ensure oral health equity across all communities and for every individual within those communities.

Box Key summary messages for Oral Health in America: Advances and Challenges

• Good oral health is important for the overall health and well-being of individuals of all ages, their families, communities, and the nation.
• Through research and policy changes over the past 20 years, we have made substantial advances in the understanding and treatment of oral diseases and conditions, yet many people of all ages and demographic backgrounds still have chronic oral health problems and lack access to care.
• Healthy behaviors can improve and maintain individuals’ oral health; these behaviors are shaped by social and economic conditions in which people are born, grow, work, and live.
• Oral and medical conditions often share common risk factors, and just as medical conditions and their treatments can influence oral health, so can oral conditions and their treatments affect other health issues.
• Substance misuse and mental health conditions negatively affect the oral health of many, and oral health providers are an integral part of the interprofessional team caring for these individuals. Professional schools have been challenged in preparing dental providers with the knowledge and skills needed for these new roles.
• Oral health services are evolving rapidly towards interprofessional models of delivery that integrate services across the health professions and expand access to care through new practice settings and new professional roles.
• The COVID-19 public health crisis has challenged the nation’s health care system, including oral health care providers as never before, and with those challenges came new ways of ensuring safety during provision of dental care, of treating disease, and recognizing that oral health cannot be separated from overall health.
• To significantly improve the nation’s oral health, policy changes are needed to reduce or eliminate social, economic, and other systemic inequities that affect oral health behaviors and access to care.
• To improve oral health for more people, dental and other health care professionals must work together to provide integrated oral, medical, and behavioral health care in schools, community health centers, nursing homes, and medical care settings, as well as dental clinics.
• To strengthen the oral health workforce, we need to diversify the composition of the nation’s oral health professionals, address the costs of educating and training the next generation, and ensure a strong research enterprise dedicated to improving oral health.
• The Lancet. Editorial: Oral health at a tipping point. The Lancet . 2019;394(10194): 188. [ PubMed : 31327351 ]
• U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General . Rockville, MD: USDHHS, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. https://www ​.nidcr.nih ​.gov/sites/default/files ​/2017-10/hck1ocv ​.%40www.surgeon.fullrpt.pdf .
• Cite this Page Oral Health in America: Advances and Challenges [Internet]. Bethesda (MD): National Institute of Dental and Craniofacial Research(US); 2021 Dec. Conclusion.
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Oral Health Topics

The Oral Health Topics section on ADA.org is intended to provide dentists with clinically relevant, evidence-based science behind the issues that may affect their patients and their practice. Refer to the Oral Health Topics for current scientific reviews of subjects that relate to oral health, from amalgam separators and antibiotic prophylaxis to xerostomia and X-rays.

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