Pew Children's Dental Campaign Q&A

Feb 23, 2010

The Pew Children’s Dental Campaign is a national effort to help states increase access to dental care for low-income children. Shelly Gehshan, director of the campaign, discusses the crisis in children’s dental health and policy solutions within states’ reach.

You can also watch video of Shelly Gehshan briefing members of Congress and their staff on the campaign’s February 2010 report, “The Cost of Delay: State Dental Policies Fail One in Five Children.” 

What are the goals of the Pew Children’s Dental Campaign?

The Pew Children’s Dental Campaign is a national effort to help states increase access to dental care--particularly for low-income children who face significant challenges. We use research to bring critical issues to policy makers’ attention and advocate in a number of states to advance fiscally-sound policies and provide return on investment to taxpayers. Pew operates three campaigns aimed at ensuring children are healthy and ready to learn: working to ensure more children receive dental care,  advocating for  high-quality, voluntary pre-k for all, and promoting smart state and federal investments in quality, voluntary home visiting programs for new and expectant families. 

Why are there urgent challenges in children’s dental health?

There are three main reasons children aren’t getting the care they need.  First, many don’t have access to sealants and fluoridated water, proven preventive measures. Second, not enough dentists are willing to treat children, in part because of low Medicaid reimbursement rates that don’t cover their expenses. Finally, in some urban and rural areas, there simply aren’t enough dentists available, and new types of providers are needed.

Isn’t a child’s dental health the responsibility of his or her parents?  

Parental guidance, good hygiene and a proper diet are critical to caring for kids’ teeth. But the national problem of poor dental health and limited access to care among disadvantaged children cannot be attributed principally to parental inattention, too much candy or soda, or too few fruits and vegetables. Broader, systemic factors have played a significant role, and three in particular are at work: 1) too few disadvantaged children have access to proven preventive measures, including sealants and fluoridation; 2) too few dentists are willing to treat Medicaid-enrolled children; and 3) in some communities, there are simply not enough dentists to provide care.

What are the long-term costs of poor dental health to society?

The total costs of dental care are not insignificant. Between 2009 and 2018, annual spending for all dental services in the United States is expected to increase 58 percent. Approximately one-third of the money spent on dental services goes to services for children.

While dental care represents a small fraction of overall health spending, improving the dental health of children has lifetime effects. When children with severe dental problems grow up to be adults with severe dental problems, their ability to work productively can be impaired.

Consider the military. A 2000 study of the armed forces found that 42 percent of incoming Army recruits had at least one dental condition that needed to be treated before they could be deployed. More than 15 percent of recruits had four or more teeth in urgent need of repair.

Decayed and missing teeth can pose major obstacles to gainful employment, particularly for people with low incomes who often work in the service sector without sick leave, An estimated 164 million work hours each year are lost because of dental disease.

How well are states doing at addressing the crisis in children’s dental health? 

In The Cost of Delay: State Dental Policies Fail One in Five Children, Pew scored all 50 states and the District of Columbia, using an A-F scale, on whether and how well they are employing eight proven policy solutions to ensure dental health and access to care for children.

Only six states merited “A” grades: Connecticut, Iowa, Maryland, New Mexico, Rhode Island and South Carolina. We awarded 33 states and the District of Columbia a grade of “C” or below. Nine earned an “F,” meeting only one or two policy benchmarks: Arkansas, Delaware, Florida, New Jersey, Hawaii, Louisiana, Pennsylvania, West Virginia and Wyoming. 

What are the solutions within states’ reach?

Our new report highlights four proven solutions that can improve both the dental health of children and their access to care:

  • Sealants—protective coatings applied to the teeth by a dentist or hygienist—cost one-third as much as filling a cavity and have been shown to prevent 60 percent of cavities. School-based programs are the most cost-effective strategy for providing sealants to children who most need them, yet this strategy is vastly underutilized. 
  • Water fluoridation counteracts tooth decay and strengthens teeth. It occurs naturally in water, but the level varies within states and across the country. In addition to being the most far-reaching preventive measure states can enact, fluoridation also offers an unmatched return on investment, saving $38 in dental treatment costs for every dollar spent. 
  • Medicaid improvements could enable and motivate more dentists to treat low-income children.  Pew’s analysis found that Medicaid reimburses dentists at a national average of 60.5 percent of their usual fees, with 26 states falling below this level. But raising rates alone often is not enough— streamlining the administrative burdens for participating dentists and working collaboratively with providers are also important.
  • New workforce models can expand the number of qualified dental providers who can fill the unmet needs of children.  A growing number of states are exploring new models that increase the involvement of physicians, hygienists and new types of dental professionals.

 Read more about Pew's report on children's dental health at www.pewcenteronthestates/costofdelay.

Learn more about the Children's Dental Health Campaign at



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