Oral health begins at home — regular brushing with fluoride toothpaste, choosing water over sugary drinks, and eating a healthy diet. Engaging families and encouraging these habits are crucial to improve children's oral health. But we have a lot of work to do. The most recent federal data show that 1 in 6 children has experienced tooth decay before kindergarten. Among kids and teens (2-19 age group), 52% of Hispanic children have had at least one cavity, while the share is lower for African American kids (44%) and white children (39%).

Nearly all cavities can be prevented, and doing so could reduce health care spending. Issue briefs from the Children’s Dental Health Project and the Centers on Medicare and Medicaid identify a variety of state options to help publicly insured kids get the early preventive services or individualized care they need.

Policymakers should draw on on such reports, clinical research, pilot programs, and findings from other chronic disease strategies. A Coordinated System to End Cavities (at right) is an infographic describing an oral health system that can reduce disease, improve lives and ultimately save tax dollars. This family-centered system has many parts. Click on the infographic to learn more.

The system to End Cavities begins with people who work directly with parents. Scroll through or click below to see the other parts of a coordinated system that can help us end cavities.

Obstetricians-Gynecologists | Medical professionals | Dental professionals |
Allied family support professionals | Policymakers, advocates and Medicaid officials |
Fluoridated municipal water | Academic researchers

A woman's teeth and gums may not seem like a priority during pregnancy, but oral infections can have significant consequences for her overall health, her pregnancy and her child. Research finds that four in 10 of all pregnant women have tooth decay or gum disease, and that a mother's oral health strongly predicts her child's oral health status.

The American Congress of Obstetricians and Gynecologists encourages medical providers to counsel women about oral health and "the safety and importance of oral health care during pregnancy." The American Academy of Pediatric Dentistry, the American Academy of Periodontology & the European Federation of Periodontology and other professional health organizations have also issued statements on the importance of dental care during pregnancy. Unfortunately, while more than 70% of women covered by Medicaid are in their childbearing years, and nearly 50% of U.S. births are covered by Medicaid, states are not required to offer dental benefits to adult pregnant women or mothers of young children. (See Medicaid Officials below.)

Primary prevention of tooth decay begins before age 3, yet fewer than 1 in 6 Medicaid-enrolled children ages 1-2 receive any preventive dental services (CDHP analysis). In fact, a 2016 report reveals the gaps between coverage and care. Because nearly 80% of these children visit the pediatrician, primary providers have an unmatched opportunity to support the oral health of young children.

The American Academy of Pediatrics encourages pediatricians and medical staff to assess children’s risk for dental disease, provide preventive services like counseling and fluoride varnish, and refer families to a dentist as necessary. In nearly all states, these services are within the providers’ scope of practice and reimbursable by Medicaid or private insurance. The Affordable Care Act also emphasizes these providers’ role in preventing tooth decay and managing the disease that causes it.

This white paper by the National Interprofessional Initiative on Oral Health explores ways to develop and test "an actionable pathway for delivering preventive oral health care in the primary care setting."

Dental professionals (dentists, hygienists and a range of other providers) are well positioned to provide individualized care, reflecting American Academy of Pediatric Dentistry guidelines and current science. This approach goes beyond a twice-a-year dental visit and may not be well supported by state Medicaid policies.

Further, dental professionals are not traditionally trained to treat Early Childhood Caries (ECC) as a chronic medical condition that can be addressed by low-cost strategies as opposed to an acute surgical problem requiring high-cost dental repair. (Learn more in this blog post.) An updated, multi-faceted approach to care can provide a better experience for families, keep kids healthy and reduce state expenditures.

The Children's Dental Health Project and partners modeled outcomes from various strategies to reduce ECC among children in New York State’s Medicaid/CHIP, and identified opportunities for significant cost savings. Published in the Journal of the American Dental Association, the analysis showed that significant improvements can be generated in children’s oral health with impressive Medicaid savings. 

Research shows that a mother’s health strongly predicts her young child’s risk of tooth decay, and that parents may lack essential information about good oral hygiene, even how to brush their children’s teeth.

Community health workers, promotores, Head Start staff and WIC and others who offer case-management support to low-income families are important members of the team helping parents make oral health a priority. The Centers for Medicare and Medicaid also offer parent education materials to encourage parents to “Think Teeth,” and locate a dentist.

A Coordinated System to End Cavities (infographic) envisions that all health professionals working with families coordinate services to individual children through accessible electronic health records. In this blog post and video, Dr. Anu Tate, a pediatric dentist at the National Children’s Medical Center in Washington, D.C., explains why medical and dental records should be integrated.

Dental coverage for children

Recent years have brought tremendous growth in dental coverage for children, and dental visits by children covered by public plans (see chart below). States should review their Medicaid and Children’s Health Insurance Program (CHIP) policies related to children’s oral health care, including payment policies. For example, states should reimburse pediatricians and family physicians for administering an oral health risk assessment for children enrolled in Medicaid or CHIP, and high-risk children should be referred for dental care.

Medicaid and CHIP require dental services for children that at a minimum relieve pain and infection, restore teeth, maintain dental health, and provide all medically necessary care.  Federal officials recommend improving dental program performance for children through policy changes that would result from revisiting periodicity schedules, integrating oral with general health supervision, enhancing reporting, and updating payment approaches.

Dental coverage for pregnant women and caregivers

Although more than 70% of Medicaid-enrolled women are of childbearing age, and nearly half of U.S. births are covered by Medicaid, states are not required to offer dental benefits to Medicaid-eligible adult pregnant women. Additionally, some women may not recognize that it's both important and safe to receive dental care during pregnancy.

Many states have taken steps to improve the oral health of pregnant women. For example, 11 states are members of the Perinatal and Infant Oral Health Quality Improvement National Learning Network, which the Children’s Dental Health Project leads in a cooperative agreement with the Health Resources and Services Administration and partners AMCHP, ASTDD, NIPN and NASHP. 

Opportunities in Medicaid and CHIP

Nearly all cavities can be prevented, and doing so could reduce Medicaid spending. Issue briefs from the Children’s Dental Health Project and the Centers on Medicare and Medicaid identify a variety of state options to help publicly insured kids get the early preventive services or individualized care they need.

Of course, access to affordable dental coverage is pivotal for families to put their children on a path of good oral health.

Fluoride is a mineral that exists naturally in water supplies, but usually at a level too low to prevent tooth decay. For more than 70 years, communities have added fluoride to tap water to give all families access to this proven form of cavity prevention. The Centers for Disease Control and Prevention (CDC) reports that fluoridated water and fluoride toothpaste “provide important and complementary benefits” to oral health. In fact, the CDC named fluoridation one of the 10 "great public health achievements of the 20th century." And the National Governor’s Association has cited fluoridated water as one of three “health investments that pay off” by reducing cavities and saving tax dollars.

Local officials should also consider whether their schools and other public facilities have working water fountains, so children have an healthy alternative to sugar-sweetened beverages.

From clinical research, to pilot programs, to data analysis, academic researchers play a crucial role in advancing clinical care and reporting the status of our nation’s oral health. The Early Childhood Caries Resource Center is an invaluable resource for finding the latest in caries research and clinical innovation.

The availability of timely and relevant data, collected through national and state surveillance and survey mechanisms, is crucial to informing strategies to improve Americans’ oral health, and to advancing health equity. There is evidence that the oral health measurement "system" – which includes national and state-level definitions, reporting requirements, human resource capacities and funding sources – can be difficult to navigate and summarize. This creates a barrier to telling a succinct and clear story of the status of our nation's oral health, and of the effectiveness of publicly financed interventions or efforts to prevent or reverse disease among those most affected.

More information on oral health policies and trends is available on the Children’s Dental Health Project’s website.

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