CHILDREN’S ORAL HEALTH: STATES FILLING THE NEED

Volume 28, Issue 498 September 4, 2007

Megan Foreman

Statistics about children’s dental disease are staggering.

Nine million children lack health insurance, but more than twice that number lack access to oral health services.
More than one-quarter of children have tooth decay in baby teeth before they enter kindergarten. By age 19, 68 percent of youth have decayed permanent teeth.
Disparities are rampant. The rate of untreated dental cavities in children from families with incomes below the poverty level is double that of non-poor children.

However, states have a variety of tools at their disposal to improve children’s oral health.

Medicaid and SCHIP. Federal law requires that all states include dental benefits for children in their Medicaid programs. All states provide some level of dental benefits through their State Children’s Health Insurance Programs (SCHIP), although coverage varies from state to state. Federal SCHIP provisions allow states to implement cost sharing or waiting period policies, which can make access more difficult for SCHIP enrollees than it is for their Medicaid counterparts. Both programs wrestle with low dentist participation rates. Dentists complain about low reimbursement rates and heavy administrative burdens.

Allied Professionals. Dental hygienists and other professionals offer preventive services when
dentists are in extremely short supply. Arizona allows hygienists to form "affiliated practices" with dentists to provide care in underserved counties without a dentist's direct supervision. The state also increased the number of dental hygienists by funding a community college program. Pennsylvania created a program to train dental assistants to perform additional services with oversight from dentists. Rhode Island involves community health centers, school-based health clinics and hospital dental centers in its network to reach additional low-income children.

Simplification. Virginia’s Smiles for Children program, which enrolls children in Medicaid and SCHIP, increased its reimbursement rates for dentists by 30 percent and streamlined the administrative processes. In its first year of operation the number of enrolled children who received oral health services increased by 24 percent. A single dental program administered by a single vendor simplifies the system for providers and patients.

School-Based Outreach and Prevention. Dental sealants—plastic coatings on vulnerable posterior teeth—help prevent decay. As of 2005, 40 state or local health departments had developed community- and school-based sealant programs, typically in poor or underserved areas where children were unlikely to receive private oral health care. Programs vary, but often use school-based clinics or mobile vans to apply sealants or link schools to private dental practices where children can receive these services. A CDC review shows that school-based dental sealant programs effectively prevent and decrease decay for children and adolescents by 60 percent.

School Mandates. According to the American Academy of Pediatric Dentistry, four states and the District of Columbia require children to have a dental exam before they start school. The newest of these mandates passed in Iowa in 2007; HF 906 requires schools to verify that children have had a dental exam between the ages of 3 and 6 and requires proof of an exam again in high school.

Water Fluoridation. According to the Centers for Disease Control and Prevention
(CDC), water fluoridation to prevent tooth decay is one of the 10 greatest public health achievements of the 20th century. The CDC estimates that each $1 invested in fluoridation saves $38 in avoided dental treatment costs. Census data show that 67 percent of the nation’s population is served by fluoridated water systems. Eleven states, the District of Columbia and Puerto Rico mandate territory-wide water fluoridation.

Adapted from an NCSL LegisBrief.
For more information on children’s oral health, contact:
Megan Foreman, NCSL, (303) 364-7700, ext. 1401
megan.foreman@ncsl.org