Interdisciplinary Approaches to Promote Adolescents’ Oral Health and Reduce Disparities

Oral Health Disparities Program, Center for Clinical Research

Division of Extramural Research

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The goal of this initiative is to encourage interdisciplinary research to improve the oral health of adolescents in the United States and reduce observed disparities by: exploring approaches that integrate oral health promotion into overall health promotion, and addressing knowledge gaps in the causal factors and management of dental, oral, and craniofacial (DOC) diseases in adolescents.

To stimulate scientific advances, research supported by this initiative is strongly encouraged to involve interdisciplinary, multi-PI collaborations between researchers focused on adolescent health and development, and researchers focused on DOC health and disparities.

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Despite being largely preventable, dental caries remains the most common chronic disease in children and adolescents in the United States. Beyond the impact on oral health, dental caries can impact children’s and adolescents’ quality of life and well-being during important developmental stages, as they can lead to: tooth abscesses, broken teeth, difficulties in speaking and chewing, and missed school days.  Disparities in dental caries have persisted for decades, with underserved low income and racial/ethnic minority children and adolescents experiencing a higher prevalence of disease than their counterparts from higher-income and non-minority families.

Recent epidemiological data on dental caries in primary teeth of preschool-aged children (aged 2-5) is promising.  A comparison of National Health and Nutrition Examination Survey (NHANES) data from 1999-2004 with data from 2011-2014 showed declines in both the overall prevalence of caries experience (28% vs 24%) and untreated caries (20% vs 11%) in the primary teeth of pre-school aged children.    

NHANES data for the same time periods also showed that the prevalence of dental caries experience and untreated dental caries in the permanent teeth of adolescents (age 12-19) remained largely unchanged in the most recent decade.  Furthermore, as with Early Childhood Caries, disparities in dental caries prevalence were found to persist by race/ethnicity and income level, particularly in untreated dental caries. 

Adolescents display a higher prevalence of oral disease than younger children.  NHANES data from 2011-2014 indicated that for adolescents aged 12-19, the prevalence of caries experience was approximately 58% and the prevalence of untreated caries was approximately 19%.  Additionally, the prevalence of periodontitis is higher in adolescents compared to younger children, and adolescent populations around the age of puberty are at an increased risk for periodontitis. 

Adolescence (commonly defined as the period between the ages of 10 and 18), has been described as a critical stage in the life-course during which future patterns of adult health are established.  In addition to a higher prevalence of oral disease, adolescents also have a higher prevalence of other chronic diseases, such as obesity, and increased health risk behaviors such as tobacco use when compared to younger children.

Adolescents possess common risk factors for both oral health and overall health conditions.  They often strive for greater independence from parents and the role of peers become more important in their lives, which can influence health behaviors.  Poor diet and nutrition, high sugar intake, use of tobacco and other nicotine products (including E-cigarettes), alcohol use, trauma from injuries due to sports, and lack of receipt of recommended vaccinations (such are the HPV vaccination) are examples of common risk factors that can impact both oral health and overall health conditions in adolescents.  Furthermore, because of the impact of various determinants of health, underserved low income and racial/ethnic minority groups are at increased risk for oral diseases and general health diseases, resulting in health disparities.

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Gaps & Opportunities

Gaps and opportunities include:

  • Developing collaborative partnerships to conduct interdisciplinary research to promote adolescent oral health and reduce disparities;
  • Understanding unique causal factors and multi-level determinants of adolescent oral health and disparities to guide development of future interventions;
  • Understanding the efficacy and effectiveness of interventions that integrate oral health promotion into overall health promotion across settings that serve adolescents; and
  • Understanding mechanisms of action of oral health behavior change interventions in adolescents.
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Specific Areas of Interest

Examples of research to be supported by this initiative could include, but are not limited to:

  • Interventions that integrate oral health promotion into general health promotion by targeting common risk factors for both DOC disease and general disease, such as diet/nutrition and tobacco (including E-cigarette) use;
  • Interventions in a variety of settings that serve adolescents (particularly those vulnerable and undeserved adolescents), including primary healthcare settings, schools, or community-based settings;
  • Multi-level interventions to reduce oral health disparities and improve oral health in vulnerable and underserved adolescent populations;
  • Research that explores the role of family and peers in influencing adolescent health behaviors and risk factors that affect oral health;
  • Research that explores mechanisms of action of oral health behavior change interventions in adolescents, including novel interventions that are technology-based; and
  • Research that assesses the feasibility, acceptability, and provision of general adolescent health promotion in the dental office, such as HPV vaccination promotion and referral, obesity screening and referral, diet/nutrition counseling, or tobacco/alcohol screening and cessation counseling.
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Centers for Disease Control and Prevention.  Hygiene-related diseases.  Available at:

Dye BA, Mitnik GL, Iafolla TJ, Vargas CM. Trends in dental caries in children and adolescents according to poverty status in the United States from 1999 through 2004 and from 2011 through 2014. J Am Dent Assoc. 2017 Aug;148(8):550-565.e7.

Silk H, Kwok A. Addressing Adolescent Oral Health: A Review. Pediatr Rev. 2017 Feb;38(2):61-68.

American Academy of Pediatric Dentistry Clinical Affairs Committee. Guideline on adolescent oral health care. American Academy of Pediatric Dentistry. 2015. Available at:

Smetana JG, Campione-Barr N, Metzger A. Adolescent development in interpersonal and societal contexts. Annu Rev Psychol. 2006;57:255-84.

U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016. Available at:

Zylke JW, Bauchner H. Preventing Obesity in Children: A Glimmer of Hope. JAMA. 2018 Aug 7;320(5):443-444.

Fisher-Owens SA, Gansky SA, Platt LJ, Weintraub JA, Soobader MJ, Bramlett MD, Newacheck PW. Influences on children's oral health: a conceptual model. Pediatrics. 2007 Sep;120(3):e510-20.

Baer TE, Gottlieb L, Sandel M. Addressing social determinants of health in the adolescent medical home. Curr Opin Pediatr. 2013 Aug;25(4):447-53.

G Caton J, Armitage G, Berglundh T,et al. A new classification scheme for periodontal and peri-implant diseases and conditions. Introduction and key changes from the 1999 classification. J Periodontol. 2018 Jun;89 Suppl 1:S1-S8. 

Califano JV, Research, Science and Therapy Committee American Academy of Periodontology. Position paper: periodontal diseases of children and adolescents. J Periodontol. 2003;74(11):1696–704.

Sheiham A, Watt RG. The Common Risk-Factor Approach: a rational means of promoting oral health. Community Dent Oral Epidemiol 2000; 28: 399-406.



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