Snapshot Meeting Children Where They Are: State Strategies to Increase Preventive Oral Health

Differences in Access and Outcomes Exist. The American Academy of Pediatric Dentistry reports that children in rural communities are more likely to report unmet dental needs and less likely to have visited a dentist in the past year. According to KFF, half of children covered by Medicaid or CHIP do not receive necessary dental services. Seventeen percent of children from low-income households have untreated cavities and severe tooth decay in their primary teeth—over three times the rate of children from higher-income households.  

Oral Health Affects Education. Poor oral health can negatively impact a child’s school performance. The Centers for Disease Control and Prevention (CDC) estimates that 34 million school hours are lost each year due to unplanned (emergency) dental care. 

School-Based Dental Care Expands Access. Some students receive dental cleanings, diagnostic services and preventive care—such as fluoride treatment and dental sealants—through school-based dental programs. Studies suggest that such services offered through school-based care can reduce tooth decay among children who lack regular access to oral health care and may also contribute to improved school attendance.  

Early Prevention Can Reduce Costs. States that have expanded early prevention services through sealants and topical fluoride have seen cost-savings for children enrolled in Medicaid. CDC projects that providing sealants to low-income children in schools could save up to $300 million in dental treatment costs.  

Pediatricians Play a Key Role in Oral Health. Pediatric offices can be an important access point for introducing oral health education to children and families. Children who attend regular well-child visits are more likely to receive preventive dental care. The American Academy of Pediatrics recommends pediatricians apply fluoride varnish during routine well-child visits to help prevent cavities.

Expanding Scope of Practice: States are modifying the roles of oral health professions to increase access to services in schools and public health settings.  

• Hawaii allows dental assistants to operate under general supervision in public health settings, including schools. 
• Iowa permits registered dental assistants who complete specialized training to place dental sealants on children’s teeth. 

Implementing School-Based Services: Schools serve as important access points for preventive dental care including oral health screenings and sealants to students. 

• Colorado is piloting a school-based dental program to provide oral health screenings for kindergarten and third-grade students while assessing the cost effectiveness of screenings, and programmatic best practices.  
• Kansas operates a statewide school oral health screening initiative, reaching over 100,000 school-age children each year. The initiative also requires outcome data collection to inform program improvements.  

Enhancing Education and Awareness: Some states integrate oral health education in school curricula or public health programs. 

• Oregon requires oral health instruction as part of the health education curriculum for students in public schools.  
• Iowa’s I-Smile program places dental hygienists in clinics run by the federal supplemental nutritional program for women, infants and children known as WIC, Head Start centers, preschools and childcare sites to provide education and connect children and pregnant women to care.  

Expanding Telehealth and Mobile Dental Services: States are leveraging teledentistry and mobile dental services to provide oral health care to children.  

• Ohio permits mobile dental facilities to operate in schools. 
• Nevada has a pilot program allowing children enrolled in Medicaid to receive virtual dental checkups, at-home fluoride kits and caregiver education on fluoride application. 

Integrating Oral Health into Primary Care: Some states are embedding dental services into pediatric primary care settings. 

• Virginia permits medical assistants to administer topical fluoride varnish. 
• Texas allows physicians, physician assistants and advanced practice registered nurses to apply fluoride varnish during Texas Health Steps checkups and bill for the service, while also referring children to a dental home.