Perspectives on Innovations in Oral Health Care.

A downward trend in dental caries in permanent teeth of children that began in the 1970s has leveled out at historic lows. Severe periodontal disease affects a small percentage of people, and tooth loss has plummeted so that complete tooth loss, once a common occurrence, now is almost non-existent in upper socioeconomic groups. But not all people have benefited equally from these positive trends. Dental problems continue to affect the disadvantaged in society at unacceptable rates, and their disease burden is likely to increase because of trends in social determinants of oral diseases.Personal dental care alone usually is unable to provide a sufficient buffer against these risks to maintain adequate oral health. Extensive disease in young children too often requires treatment in the hospital with a high chance of relapse. A national health goal is to "achieve health equity, eliminate disparities, and improve the health of all groups." Achieving this goal in oral health requires that things be done differently.This issue of the North Carolina Medical Journal highlights several approaches being tried here in North Carolina and elsewhere to address oral health problems. Initiatives fall into 4 categories: advocacy, workforce policies, integration of oral health and primary care, and the medical management of caries.