A new report by Surgeon General Vivek Murthy and the Department of Health and Human Services makes clear that the United States is still in the grip of a decades-long epidemic, albeit one that many Americans scarcely know exists. What this and previous reports do not make clear, however, is that the epidemic continues to cause lasting harm to millions of men, women and children in part because of the influence of a very powerful special interest.
To a large extent, this epidemic is as “silent” as when one of Murthy’s predecessors, Dr. David Satcher, brought it to the nation’s attention 16 years ago. In “Oral Health in America: A Report of the Surgeon General,” Dr. Satcher wrote that:

‘In spite of the safe and effective means of maintaining oral health that have benefited the majority of Americans over the past half century, many among us still experience needless pain and suffering, complications that devastate overall health and well-being, and financial and social costs that diminish the quality of life and burden American society. What amounts to a “silent epidemic” of oral diseases is affecting our most vulnerable citizens — poor children, the elderly, and many members of racial and ethnic minority groups.’

Dr. Satcher’s report, which received widespread media attention, called for the development of a “National Oral Health Plan to improve quality of life and eliminate health disparities.” It was the first call to action to address the crisis. Unfortunately, despite the initial publicity, it didn’t result in all that much action. Three years later, Dr. Satcher’s successor, Richard H. Carmona, released his own “National Call to Action to Promote Oral Health.” It, too, decried the many disparities related to oral health and called on health care professionals, researchers, policy makers and community leaders to collaborate on ways to reduce them.
But ten years after Satcher’s report — and seven years after Carmona’s — President Obama’s first Surgeon General, Regina Benjamin was still referring to America’s oral health care crisis as a silent epidemic. Her own report, published in the March/April 2010 edition of the relatively obscure Public Health Reports, the official journal of the U.S. Public Health Service, was titled “Oral Health: The Silent Epidemic.” Like her predecessors, Benjamin cited the consequences of inadequate dental care. “If left untreated,” she wrote, “(dental caries and periodontal disease) may cause pain, dysfunction, poor appearance, loss of self-esteem, absence from school or work, and difficulty concentrating on daily tasks.”
Fast-forward to 2016. Surgeon General Murthy’s report, like Benjamin’s, was published in Public Health Reports. Like his predecessors, he cited progress on a few fronts since 2000 (more kids are receiving dental sealants that prevent cavities, fewer teens have tooth decay and more adults are retaining their natural teeth), but not nearly enough progress in reducing disparities. Murthy wrote that:

‘Poor oral health continues to disproportionately affect low-income individuals, the frail and vulnerable, and the traditionally underserved. One-quarter of preschool-aged children living in households below the federal poverty level have untreated tooth decay, compared with about one in 10 children living above the poverty level. As of 2012, more than 29% of non-Hispanic black adults aged 65 years and older had complete tooth loss compared with fewer than 19% of the overall U.S. population of the same age.’