National Children’s Dental Health Month, marked in February each year, is a good time to celebrate the progress that has been made in children’s oral health and contemplate the work still ahead.
Overall, the prevalence of untreated tooth decay has been decreasing among the nation’s youth, although disparities linked to income, race, and ethnicity persist. The most recent federal statistics show that 13 percent of children ages 2 to 19 had such decay in 2015-16, down from 16 percent in 2011-12.
But the rates remain high among children with family incomes below the federal poverty level. Nearly 19 percent of those children had untreated decay, compared with 7 percent of those with family incomes three times the poverty level.
In terms of race and ethnicity, black children had the highest prevalence of untreated decay (17 percent) compared with Hispanic (14 percent), white (12 percent), and Asian (11 percent) youth. Left untreated, tooth decay can lead to serious consequences, including pain, infection, and school absences.
The numbers also show positive trends in the use of dental sealants. These thin plastic coatings applied to the surface of teeth play a critical role in preventing decay. According to federal data, 43 percent of 6- to 11-year-olds had sealants in 2011-14, up from 31 percent in 1999-2004, but here too, disparities are linked to family income, race, and ethnicity.
Children from low-income families were significantly less likely to have sealants than their higher-income peers (48 percent versus 39 percent). Black youth were least likely to have sealants (32 percent), compared with 46 percent of white and 43 percent of Mexican-American youth.
The share of children without dental insurance also has hit a record low thanks to Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA). As of 2015, nearly 90 percent of children had some form of dental coverage, with almost 39 percent covered by Medicaid or CHIP.
However, the Trump administration issued policy guidance in January that could affect health insurance for children and possibly reduce these numbers. This Medicaid guidance clarifies how states can apply for waivers that allow them to require adults to work as a condition of eligibility. The requirement could jeopardize children’s coverage, because research shows that enrollment of children in Medicaid increases as more parents are covered.
In addition, federal guidance issued in October allows states to modify certain ACA coverage requirements in the private health insurance marketplaces. For example, states can apply for waivers to use state and federal subsidies to support plans that do not cover children’s dental benefits or that offer coverage with lower value than required by the ACA.
Advocates and policymakers at all levels of government can take additional steps to protect and build on advances in children’s oral health and to address the disparities that remain, primarily in access to care. Evidence-based prevention approaches and improvements to delivery systems will help ensure that more children receive critical preventive and restorative dental care.
For example, despite their proven value in preventing decay, sealants are underutilized among low-income children. Oral health experts widely support sealant programs in schools as a strategic way to reach these families. However, in a number of instances, state regulations make it difficult for these programs to be successful. Dental hygienists, who apply the sealants, may be prohibited from working in schools without a dentist present. Lawmakers looking to improve oral health among low-income children should consider proposals that remove these and other barriers.
Greater use of silver diamine fluoride (SDF), a new nonsurgical treatment to prevent and arrest decay, offers another cost-effective way to boost dental health. A liquid solution, SDF can be brushed on a cavity without anesthesia or drills. The American Dental Association recommends this approach as a noninvasive method to treat cavities. New research shows that use of SDF in young children can reduce Medicaid program dental expenditures by avoiding more expensive treatments. It can also prevent stressful restorative procedures and reduce the use of general anesthesia. Public and private insurers should reimburse for this procedure.
Increasing use of dental therapists also can expand access to care. These providers are allowed to practice in some capacity in eight states, typically to help reach low-income children and other underserved populations. They can drill and fill teeth—procedures that could previously be done only by dentists. They also can treat children in settings such as schools and Head Start programs and provide a cost-efficient way to serve more patients on Medicaid. Expanding access to these services could produce significant benefits: 48 percent of children on Medicaid did not receive any dental care in 2017. With 46 million children enrolled in Medicaid/CHIP, more states should consider authorizing dental therapy.
The nation has made significant progress in increasing the availability of dental care, but there is more work to be done. Policymakers should focus on evidence-based solutions and strategies to continue to improve oral health outcomes for all children.
Jane Koppelman is a research manager and Allison Corr is an officer with The Pew Charitable Trusts’ dental campaign.