On kidsdata.org, measures of dental care include the percentage of children who have dental insurance and the percentage of children who recently visited a dentist.
Tooth decay is the most common chronic disease among children ages 6-18 (1). Untreated dental problems, such as cavities and gum disease, can affect a child’s health and quality of life by leading to pain, nutritional and sleep problems, impaired concentration, and increased school absences, as well as lost work hours for parents (2, 3, 4). If dental disease is not treated early, it can result in the need for more serious and expensive intervention later on (2).
Tooth decay and other oral diseases disproportionately affect low-income children, children of color, and the uninsured (1, 5). Those children, compared to their peers, are less likely to receive routine dental check-ups, which are critical for preventing tooth decay. For this reason, the federal government has set a public health goal focused on improving access to preventive dental services for low-income children (6).
For more information about dental health see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Paradise, J. (2012). Children and oral health: Assessing needs, coverage, and access. Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured. Retrieved from: http://www.kff.org/medicaid/upload/7681-04.pdf
2. Children Now. (2010). Strong dental benefits for children: Cost-effective and critical to overall health and success. Retrieved from: http://www.childrennow.org/uploads/documents/oral_health_factsheet_05052010.pdf
3. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011). Oral health: Preventing cavities, gum disease, tooth loss, and oral cancers at a glance 2011. Retrieved from: http://www.cdc.gov/chronicdisease/resources/publications/AAG/doh.htm#aag
4. Savage, M. F., et al. (2004). Early preventive dental visits: Effects on subsequent utilization and costs. Pediatrics, 114(4), e418-e423. Retrieved from: http://pediatrics.aappublications.org/content/114/4/e418.full.
5. Dye, B. A., et al. (2012). Oral health disparities as determined by selected Healthy People 2020 oral health objectives for the United States, 2009–2010. NCHS Data Brief, 104. Retrieved from: http://www.cdc.gov/nchs/data/databriefs/db104.pdf.
6. U.S. Department of Health and Human Services. (2012). Healthy People 2020 topics and objectives: Oral health. Retrieved from: http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=32
All children need access to high quality, affordable dental care. Among low-income families, finding dentists who accept public insurance can be a particular challenge. Even for higher-income families, dental care may be financially out of reach if they do not have dental coverage. Disparities are persistent among African American/Black and Latino children compared to other children, and must be addressed (1). California law requires an oral health assessment before starting school, which can help ensure early dental care. However, budget pressures led California to suspend the Children’s Dental Disease Prevention Program, the only statewide public program to provide school-based, oral health services to children. Fluoridated water has been successful in reducing cavities among children (6), but it is not available everywhere in California.
According to research and subject experts, policy options that could influence children’s dental care include:
- Increasing reimbursement rates for dental providers under public insurance programs, to create incentives for them to treat low-income children (1, 2); this is most effective when combined with improved administration of Medicaid-funded dental coverage and improved Medicaid partnerships with dental societies (3)
- Protecting children’s dental coverage in public health insurance programs, and incentivizing that coverage in the private insurance market (2)
- Increasing outreach to families enrolled in public insurance programs about the availability of dental care (1, 4)
- Ensuring that schools have adequate funding to fully implement all aspects of the kindergarten dental checkup requirement (5) and reinstating state support for children’s dental disease prevention (2)
- Ensuring that all communities have fluoridated drinking water (6)
- Expanding the dental workforce to help improve access to
care for underserved children; for example, the scope of practice of dental hygienists could be expanded to provide basic preventive and restorative care for children in various settings such as schools, public health clinics, and offices of physicians (7)
- Promoting collaboration across medical and dental disciplines to ensure consistent, evidence-based oral health education for child health care providers, including screening, parent education, and topical fluoride application (8)
For more policy ideas and research on this topic, see kidsdata.org’s Research & Links section, or visit the California Dental Association, Children Now, the American Academy of Pediatric Dentistry and the American Academy of Pediatrics Oral Health Initiative.
Sources for this narrative:
1. Pourat, N., & Finocchio, L. (2010). Racial and ethnic disparities in dental care for publicly insured children. Health Affairs, 29(7), 1356-1363.
2. Children Now. (2010). Strong dental benefits for children: Cost-effective and critical to overall health and success. Retrieved from: http://www.childrennow.org/uploads/documents/oral_health_factsheet_05052010.pdf
3. Borchgrevink, A., et al. (2008). Increasing access to dental care in Medicaid: Does raising provider rates work? California HealthCare Foundation. Retrieved from: http://www.chcf.org/publications/2008/03/increasing-access-to-dental-care-in-medicaid-does-raising-provider-rates-work
4. Hughes, D. (2007). Access, use, and costs of dental services in the Healthy Kids Program. Urban Institute. Retrieved from: http://www.urban.org/UploadedPDF/411528_dental_service_kids.pdf
5. California Dental Association. (2011). Kindergarten oral health requirement. Retrieved from: http://www.cda.org/public-resources/kindergarten-oral-health-requirement
6. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (1999). Achievements in public health, 1900-1999: Fluoridation of drinking water to prevent dental caries. Morbidity and Mortality Weekly Report, 48(41), 933-940. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm
7. Nash, D. A. (2009). Adding dental therapists to the health care team to improve access to oral health care for children. Academic Pediatrics, 9(6), 446-451. http://www.academicpedsjnl.net/article/S1876-2859%2809%2900249-6/fulltext
8. Douglass, A. B., et al. (2009). Educating pediatricians and family physicians in children's oral health. Academic Pediatrics, 9(6), 452-456. Retrieved from: http://www.academicpedsjnl.net/article/S1876-2859%2809%2900250-2/fulltext
In California, 80.0% of children had dental insurance in 2007, but that percentage ranged widely among counties, from 91.0% in Solano County to 65.0% in Nevada County. In 2007, 62.3% of California children had a dental visit in the past 6 months, up from 55.6% in 2001. However, 12.9% of children ages 2-17 had never visited a dentist in 2007.