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Although the nation's oral health is believed to be the best it has ever been, oral diseases remain common in the United States. In May 2000, the first report on oral health from the US Surgeon General, Oral Health in America: A Report of the Surgeon General, called attention to a largely overlooked epidemic of oral diseases that is disproportionately shared by Americans: This epidemic strikes in particular the poor, young, and elderly. The report stated that although there are safe and effective measures for preventing oral diseases, these measures are underused. The report called for improved education about oral health, for a renewed understanding of the relationship between oral health and overall health, and for an interdisciplinary approach to oral health that would involve primary care providers.

In utero, the 20 primary teeth evolve from the expansion and development of ectodermal and mesodermal tissue at approximately 6 weeks of gestation. The ectoderm forms the dental enamel and the mesoderm forms the pulp and dentin. As the tooth bud evolves, each unit develops a dental lamina that is responsible for the development of the future permanent tooth. The adult dentition is composed of 32 permanent teeth. Figure 45-1 shows the anatomy of the tooth and supporting structures. Table 45-1 outlines the eruption pattern of the teeth.

Table 45–1. Eruption Pattern of Teeth.
Figure 45-1.

Anatomy of the tooth and supporting structures.

General Considerations

Dental caries (tooth decay) is the single most common chronic childhood disease, five times more common than asthma and seven times more common than hayfever among children 5-7 years of age. Minority and low-income children are disproportionately affected. According to the Centers for Disease Control and Prevention (CDC), among children aged 2-11 years, 21% have had untreated tooth decay in primary teeth, and of these, 32% are Mexican American, 27% are African American, and 18% are white. In addition, one-third of persons of all ages have ...

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