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can determine oral health status — education level, age, language barriers, cultural factors, oral health literacy, ability to perform daily oral health care, insurance status and geography all come into play, often in combination with one another. Unhealthy behaviors such as neglecting to brush and floss, using tobacco and alcohol, and eating poorly also can adversely affect dental health. Medical conditions also play a role. There are more than 125 health conditions that may affect or be affected by oral health, including cardiovascular disease, human papillomavirus (HPV) infection, HIV/AIDS, osteoporosis, obesity, and autoimmune disorders like rheumatoid arthritis. According to the CDC, adults with diabetes are almost twice as likely to have gum disease as non-diabetic patients of equivalent ages. People with developmental disabilities suffer from a high occurrence of tooth decay and gum disease for a number of reasons, ranging from physical conditions like an inability to hold a toothbrush to a simple lack of understanding of how to practice basic personal oral hygiene. These types of disabilities can make people more susceptible to disease and at the same time, make it more difficult for them to obtain treatment. Copyright ©2013 American Dental Association 4 Action for Dental Health: Bringing Disease Prevention into Communities Prevention Pays Preventive measures in dental treatment are intended to defend against the onset of disease, such as using sealants to prevent cavities. These examples of national average costs for common preventive and restorative procedures show that stopping disease before it starts can yield savings. This is why the ADA believes that insurers should not impose cost-sharing measures such as deductibles or copays on patients for preventive oral health services. The Affordable Care Act, in fact, forbids the imposition of copayments for preventive care for new health care policies created after March 23, 2010, including oral health risk assessments for children. Teeth with cavities can usually be restored with fillings or crowns. But, each time a tooth is filled, the restoration becomes larger and more of the natural tooth structure is removed. In that sense, the disease is not “cured,” and the affected tooth is at increased risk for future disease that will require additional treatment. When combined with services provided by dental professionals, basic self-administered measures such as brushing with fluoride toothpaste, flossing, drinking optimally fluoridated water, sticking to a healthy diet, avoiding tobacco and excessive alcohol use, can all but eliminate decay. Maintaining Dental Health through Prevention Extracting teeth, filling cavities, or performing root canal therapy are comparatively costly approaches to treating dental disease, when compared with preventive measures. And while emergency and restorative interventions like fillings and root canal therapy can stop disease, they cannot restore the natural tooth and gum tissue lost because of it. The most cost-effective way to ensure optimal dental National Average Costs of Common Preventive Services • Topical fluoride application: $31.70 (child), $32.59 (adult) • Periodic examination by a general dentist: $44.10 • Prophylaxis (cleaning): $61.14 (child), $82.08 (adult) • Sealant application, per tooth: $44.12 National Average Costs of Common Restorative Services • Amalgam filling, two-surface, in a permanent tooth: $146.61. • Resin-based composite filling, rear tooth: $197.09 • Root canal on a molar (excluding final crown): $918.88 • Porcelain crown: $1,026.30 • Extraction of an erupted tooth or root visible above the gumline: $147.32 A Statement from the American Dental Association 5 Action for Dental Health: Bringing Disease Prevention into Communities health in both children and adults is through prevention, education and behavioral modifications. Community water fluoridation is a proven, effective prevention strategy. The estimated average cost for a community to fluoridate its water ranges from approximately 50 cents a year per person in large communities to approximately $3 a year per person in small communities. By one estimate, the cost of providing fluoridated water throughout someone’s life is less than the cost of a single filling. While community water fluoridation has been one of the great public health successes of the past 100 years, state oral health officials know that more is needed, particularly in delivering care to mostly poorer, underserved populations. State oral health programs wisely direct a large percentage of their limited funds toward prevention, rather than treating disease that should have been prevented. In addition to state budget allocations, funding for these programs also comes from other sources. The private DentaQuest