and limitations in educational, career, and marital opportunities
as well as in other social relations.1–3
Although oral health status has improved for most Americans
and Europeans over the last two decades, there are still
reasons for concern. In theUnited States, one-fourth of adults
aged 65 and older have lost all of their teeth, while approximately
18% have untreated tooth decay in permanent teeth.
Among dentate adults 20–64 years of age, the mean number
of decayed, missing, and filled permanent teeth is 10.33.4 In
Europe, only a minority of Europeans (41%) report that they
still have all their teeth, 31% wear a removable denture and
29% of them have worn their denture for at least 10 years.5
In England in particular, 30% of dentate adults have carious
teeth, 54% have bleeding in the mouth, and 84% have
one or more fillings.6 Proper oral hygiene practices are not