Former U.S. surgeon general advances oral health debate

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When he was surgeon general of the U.S., David Satcher, MD, PhD, issued the first surgeon general's report on oral health in 2000. He has continued to show that oral health matters, as he is now championing the use of dental therapists as a way to reduce the prevalence of caries and provide oral healthcare to underserved populations.

In this exclusive interview with, Dr. Satcher talks about the need to improve the oral health of all Americans, how the first surgeon general's report on oral health came into being, the need for more outcomes research in dentistry, and why it's not about dentists versus dental therapists.

Fluoridation and sealants

Dr. Satcher's interest in the use of preventive measures and community programs is not a new development for him. Long a supporter of community water fluoridation and sealants, he was also one of the first to advocate for increased examinations for common oral and pharyngeal cancers.

David Satcher, MD, PhD, was the first U.S. surgeon general to issue a report on oral health.David Satcher, MD, PhD, was the first U.S. surgeon general to issue a report on oral health.

"This year is the 15th anniversary of the first [oral health] report. It's important to keep the findings of that report in the minds of the public and keep reiterating the implications of that report," he said.

Dental therapists are one part of the solution for Dr. Satcher, but he emphasizes that more study is needed, especially specific outcomes study.

"This is an issue we need to keep studying; we need to keep producing outcomes," he said. "However, it looks pretty clear that even if all [these therapists] do is put on sealants and provide fluoride treatment, the science says they would make a significant difference in reducing dental decay."

He noted that organizations such as the National Dental Association endorse the use of what they term "emerging workforce models," defined as expanded function dental hygienists, expanded function dental assistants, or dental therapists, who would work under "evidence-supported supervision levels."

Dr. Satcher said progress doesn't often come as quickly as public health advocates or he would like.

"We are making progress," he said. "Even though it's sometimes slow, you don't give up. You have to keep pressing and hope it won't take as long as some things have in the past, especially as we have all this new communication technology."

Even 15 years after Dr. Satcher wrote in the surgeon general's report that untreated tooth decay was a public health issue, there is still need to get the message out to the public and legislatures, he noted.

"If you don't have the information getting to the public, it doesn't matter how solid it is in terms of the science," he said. "Someone has to translate it in some way that the public understands it. Rally the public around the issue."

1st report on oral health

When asked how the report on oral health came into being, Dr. Satcher said he was approached by "several people" who told him there was a need for a report on oral health.

"We don't just decide on our own that this is something we are concerned about," he said. "The other key factor is the science. If you are going to call it a surgeon general's report, there should be science available to back up what is in it."

“It is critical to ensure that anyone who is treated has access to the highest level of care they need.”
— David Satcher, MD, PhD

Dr. Satcher was also the first surgeon general to issue a report on mental health, and he continues to be heavily involved in the integration of mental health and primary care. He was asked about a similar process in dentistry and if technologies such as those involved in teledentistry have a role to play in advancing care and reducing the caries rate in underserved areas.

"When we think of telemedicine, we think of utilizing people and making sure patients have access to the support they need -- it may be at a distance," he said. "Physician assistants, nurse practitioners, treating people in prisons -- in all these instances we use telemedicine to connect with the highest levels of consultation; therefore, it ensures you have that access."

"We believe that mental disorders can be treated effectively in primary care settings," he continued. "It reduces costs, it reduces stigma, it enhances quality. We are trying to show that data now."

This also applies to oral healthcare, he said.

"It is critical to ensure that anyone who is treated has access to the highest level of care they need," Dr. Satcher said. "Whoever is providing the care should have access to whatever level of consultation is necessary for any given patient. It may be by telemedicine, phone, or electronic health records."

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