ADA Gives America a 'D' in Oral Health Awareness

Laird Harrison

July 09, 2012

July 9, 2012 — Americans have a poor grasp of basic information about oral health, the American Dental Association (ADA) has announced, according to an Internet survey released in June.

Only a third of those responding knew that "natural" sugar cause as much harm as refined sugar, for example. Half thought they only needed to floss twice a week, and only a quarter knew that children should see dentists before their first birthdays.

"Some of these results are surprising," ADA spokesperson Alice Boghosian, DDS, told Medscape Medical News. "I'm not sure everybody knows how important it is to take care of your mouth."

The ADA conducted the survey in May with a nationally representative sample of almost 1500 adults. The margin of error was ±2.6 points.

Among the other findings:

  • 90% of respondents thought they should brush after every meal; the ADA recommends only twice a day

  • 81% thought that sugar causes cavities; the ADA classified this as a wrong answer because sugar acts indirectly through acid-producing bacteria to demineralize tooth structure

  • 59% did not know that these bacteria are communicable

  • 55% did not know they should use toothbrushes with soft bristles

The survey highlights an important problem, Frank Catalanotto, DMD, a professor of community dentistry and behavioral sciences at the University of Florida in Gainesville, told Medscape Medical News. Dr. Catalanotto was not involved in the survey.

"I agree that a key factor in reducing oral diseases, or maintaining oral health, is education of the public about oral health issues and needs," said Dr. Catalanotto in an email. "I think the basic value of the ADA survey results is to show that the public does not know what they need to do to promote their own oral health."

The survey showed no progress from a larger survey the ADA conducted in conjunction with Roper and Procter & Gamble in 2008.

The 2 surveys may not be directly comparable, as the 2008 survey was conducted by telephone. The 2008 telephone survey involved a sample of 1000 Americans and had a margin of error of ±3 percentage points.

A comparison of results from the 2 surveys suggests that little has changed in Americans' knowledge of oral health.

For example, in the 2008 survey, 29% said that gingival bleeding from brushing is normal. In the 2012 survey, 34% said it was normal.

In 2008, the mean response to the question, "How often do you think you should replace your toothbrush (or brush head)?" was 4 months. In 2012, 65% thought they should only replace their toothbrush twice a year. The ADA recommends replacing a toothbrush every 3 months.

Fewer People Happy With Their Smiles

Dr. Boghosian said she was struck by an apparent deterioration in Americans' perceptions of their own teeth. In 2008, 37% said they were happy with their smile, and in 2012 that percentage had dropped to 23%.

"You have to ask yourself if this is the societal norm," said Dr. Boghosian, who also serves as a private practice dentist in Niles, Illinois.

Dr. Boghosian said she thought most dentists are doing an adequate job of educating their patients about oral health.

"I think dentists are discussing these things," she said. However, "I think they are discussing them with the small population of people who already know about them."

She speculated that the survey picked up responses from people who do not get dental care and who are also less informed about oral health. Individual dentists cannot do much to reach these folks, said Dr. Boghosian.

"Overall I think dentists do a fine job," she said. "I think you need the help of a larger organization like the ADA to spread the word."

To that end, the ADA has launched a new Web site, which offers oral health information for lay users, she pointed out. "I'm telling my patients to go to the Web site and play with it," she said.

The healthcare overhaul law, upheld by the US Supreme Court on Thursday, calls on the US Centers for Disease Control and Prevention to launch a new public education campaign about oral health, but Congress has not appropriated money for this program.

Dr. Catalanotto and Dr. Boghosian have disclosed no relevant financial relationships.

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