Executive Summary

In the face of major budget shortfalls, 22 states were able to raise their 2010 grades, proving that dental health policies can be improved at a relatively low cost.

Pew graded the states based on eight benchmarks (PDF) that are a roadmap for policymakers looking to improve and expand access to children's dental health. The grades reflect changes that have occurred since Pew's initial assessment in 2010. Read the state facts sheets.

While many states have made significant strides in improving oral health policies, too may children go without proper dental care, mainly because of a shortage of dentists willing to serve Medicaid-enrolled patients.

Pew graded all 50 states and the District of Columbia on their dental health policies.

Key Findings

 The report card, produced with support from the W.K. Kellogg and the DentaQuest Foundations found that: 

  • 27 states earned grades of an A or B, while 23 states and the District of Columbia received a C or lower grade.
  • 22 states raised their grades and six of them have improved by at least two letter grades: Arkansas, Delaware, Massachusetts, Minnesota, Utah and West Virginia.
  • Seven states received an A grade, and five earned an F.  Three of those five states—Florida, Hawaii and New Jersey—got an F for the second consecutive year.
  • States that raised their grades made progress primarily by reimbursing physicians for preventative dental services, expanding water fluoridation and increasing the percentage of Medicaid-enrolled children who receive care.
  • Six states received lower grades mainly because Medicaid reimbursement rates have not kept pace with the growth in dentists' fees.

Tooth decay is the most common disease of childhood— five times more common than asthma. For every child without medical insurance, there are nearly three children without dental insurance.

Dental health has a major affect on children's health, education and well being. Research shows that kids who do not receive dental care miss a significant number of school days, use expensive emergency room services more often and face worsened job prospects as adults, compared with their peers who do receive care.

The State of Children's Dental Health: Making Coverage Matter graded states' ability to serve insured and soon-to-be insured children. In the face of major budget shortfalls, 22 states were able to raise their 2010 grades, proving that dental health policies can be improved at a relatively low cost.

Report Contents

Maryland Top Performer in Dental Health

Maryland is the top-performing state for 2011 by meeting seven of Pew's eight policy benchmarks. Many of the state's successful efforts to strengthen oral health were spurred by a 12-year-old boy's tragic death, which garnered headlines in 2007. An $80 tooth extraction could have saved the life of Deamonte Driver, but his mother did not have private dental insurance and the family's Medicaid coverage had lapsed.

Maryland achieved six policy benchmarks in the 2010 Pew report, and it now meets a seventh benchmark—reaching a threshold for the percentage of its low-income children who see a dentist. The most recent data show that 42 percent of Maryland's Medicaid-enrolled children received some kind of dental service over the course of a year.

The Driver tragedy galvanized state policy makers, who worked through the Dental Action Committee, a non-legislative body that created a plan for reducing barriers to dental care. The committee's roadmap led to an increase in the state's Medicaid reimbursement rates for dentists, encouraging more of them to treat low-income patients.  Pew's 2011 report shows that Maryland's Medicaid rate is one of the five best in the nation. 

The committee also launched or supported other efforts to improve access to care. The Deamonte Driver Dental Project is using a mobile van and other means to provide dental services to underserved children in one Maryland's high-need counties. The project is a partnership among the state's General Assembly, the governor's office and the Department of Health and Mental Hygiene.

Gov. Martin O'Malley said his state has relied on better coordination to improve access to dental care. “We've made sure that government works with our partners in the private sector and with our teaching hospitals so that dental care and oral health education is available in every jurisdiction statewide,” Gov. O'Malley said.

In addition to striving to expand access to care, Maryland continues to invest in proven preventive strategies, giving more of its residents (98.8 percent) access to fluoridated water than any other state. Only the District of Columbia provides fluoridated water to all of its citizens whose homes are connected to public water systems.

Maryland officials are not content with the progress their state has made. “Our oral health agenda in 2011 is focused on the fact that we can accomplish even more,” said Joshua M. Sharfstein, M.D., secretary of the state's Department of Health and Mental Hygiene.

"I am so happy that Maryland's commitment to dental health, particularly in the lives of our children, has been recognized," said U.S. Rep. Elijah Cummings (D-Md.).  “However, we cannot be happy with this plateau.  We must never stop in our pursuit of better health for our children."  Cummings and Rep. Mike Simpson (R-Idaho) co-chair the Congressional Oral Health Caucus.

Arkansas Makes Strides in Dental Health

Arkansas Raises Grade from "F" to "C"

When Arkansas received an F from Pew's report card in 2010, policy makers seized on the failing grade as an opportunity to reinvigorate the state's oral health coalition and pursue needed policy changes.  “I looked at Arkansas' grade and I immediately thought, ‘We can do better than this,'” said state Senator David Johnson, who helped lead the state's efforts.  One year later, Arkansas' grade is a C.

The state improved its grade because of progress in two areas.  First, Arkansas increased the share of its Medicaid-enrolled children who receive actual dental care.  In fact, 57 percent of these kids obtained a dental service of some kind, making Arkansas one of the top-ranking states.

Second, the state has changed a law that created a hurdle for dental hygienists to place sealants on children's teeth.  Sealants are clear plastic coatings that are applied to molars—the most cavity-prone teeth.  Research shows that sealants prevent 60 percent of decay at one-third the cost of filling a cavity.

With the state's budget under tremendous pressure, Sen. Johnson said it helped greatly that there were cost-effective strategies he could propose for strengthening children's oral health.

“Usually, whether it's education or health care, you've got to spend a lot of money to get a positive result,” he said. “The best part of this was realizing we could raise our grade without having to spend a whole lot of money.  We were able to do something positive for public health and do it in an efficient way.”

Arkansas is poised to make additional progress because of other laws that its legislature enacted in 2011.  One of these laws allows pediatricians and other medical personnel to get Medicaid reimbursement for providing preventive dental services to children.  Another law will expand water fluoridation to many more communities, extending this cavity protection to an estimated 640,000 additional Arkansans.

State Senator Jason Rapert explained his support for expanding fluoridation by sharing a personal story.  He informed fellow legislators that the condition of his daughters' teeth deteriorated after the family moved from a fluoridated city to a non-fluoridated community.

“There is a lot of misinformation out there on the topic of fluoridation,” Sen. Rapert said. “When I looked at the data and talked to dentists and other people who have studied this issue, I came away feeling that passing this bill was the appropriate thing to do.”

“Policy change is often a test of persistence, and patience is still a virtue,” said Dr. Lynn Mouden, director of the state's Office of Oral Health.  “The passage of the fluoridation bill in Arkansas was the culmination of 11 years of work, with the dentists, hygienists, advocates and the state oral health coalition all partnering with our office.”

Pew funded a public opinion survey on fluoridation, revealing that Arkansans supported this preventive strategy by a nearly three-to-one margin.

Media Contact

Mary McNamara

Manager, Communications