• In 2000, United States Surgeon General David Satcher, M.D., Ph.D., published the first Surgeon General's Report on Oral Health in America. According to the report, oral diseases are progressive and cumulative, and become more complex over time. They can affect our ability to eat, the foods we choose, how we look, and the way we communicate. These diseases can affect economic productivity and compromise our ability to work at home, at school, or on the job.

• Dental caries (tooth decay) is the single most common chronic childhood disease--five times more common than asthma. More than 50 percent of five- to nine-year-olds has at least one cavity or filling, and that proportion increases to 78 percent among 17-year-olds. These figures represent improvements in the oral health of children compared to a generation ago.

• In Hawaii tooth decay among children is 100 percent higher than children on the mainland U.S.

• There are striking disparities in dental disease by income: Poor children suffer twice as much dental caries as their more affluent peers, and their disease is more likely to be untreated.

• These poor-nonpoor differences continue into adolescence: One out of four children in America is born into poverty, and children living below the poverty line (annual income of $17,000 for a family of four) have more severe and untreated decay.

• Professional care is necessary for maintaining oral health, yet 25 percent of poor children have not seen a dentist before entering kindergarten. Nearly one in five children in Hawaii below age nine has never been to a dentist.

• Medical insurance is a strong predictor of access to dental care. Uninsured children are 2.5 times less likely than insured children to receive dental care. Children from families without dental insurance are three times more likely to have dental needs than children with either public or private insurance. For each child without medical insurance, there are at least 2.6 children without dental insurance.

• As of 1997, as many as 41 percent of the uninsured population in Hawaii was children, compared to 25 percent for the United States as a whole.

• Medicaid has not been able to fill the gap in providing dental care to poor children. Less than one in five Medicaid-covered children received a single dental visit in a recent year-long study period. Although new programs such as the State Children's Health Insurance Program (SCHIP) may increase the number of insured children, many will still be left without effective dental coverage.

• The social impact of oral diseases in children is substantial. More than 51 million school hours are lost each year to dental-related illness. Poor children suffer nearly 12 times more restricted-activity days than children from higher-income families. Pain and suffering due to untreated diseases can lead to problems in eating, speaking, and attending to learning.

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The need for continuous dental health education in Hawaii, especially among children, is essential. These statistics are real and startling:

Tooth decay is nearly 100% higher among Hawaii children as compared with children on the U.S. mainland.

Hawaii children ages five through nine have an average of four decayed teeth, while the average mainland child has two decayed teeth.

Nearly one in five Hawaii children below the age of nine has never been to a dentist.

In 1999, 50.5% of Hawaii schoolchildren below the age of 12 had not visited a dentist or a dental clinic in the past year.

The Hawaii Health Performance Plan (HHPP) states:
15.85% of Hawaii five-year-olds have Baby Bottle Tooth Decay, as compared with 5% of U.S. mainland five-year-olds. Native Hawaiians have a rate of 20.79%, Filipinos 32.19%, and Molokai children 32.67%.
18.54% of Hawaii six-year-olds bear cavity-free permanent teeth, while 94.4% of their mainland counterparts can claim the same.
72.7% of six- to eight-year-olds in Hawaii had one or more cavities as compared with the national average of 35% for the same population.
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