Low-income children deserve better access to dental care

We don’t take good care of our children’s teeth, and it hurts them at school and later in life.

According to the Centers for Disease Control, tooth decay is one of the most common childhood chronic conditions. One in 5 children between the ages of 5 and 11 and 1 in 7 children between the ages of 12 and 19 have at least one untreated cavity.

These numbers are higher for children from minority and low-income families. African-American and Hispanic children are more likely than white children to have cavities in their primary teeth and are twice as likely as white children to have untreated cavities. The disparity in untreated cavities continues into the teenage years.

A report from the Pew Charitable Trusts states that untreated tooth decay “can cause pain and infection that can lead to difficulty eating, speaking, socializing, and sleeping, as well as poor overall health.” Tooth decay can also contribute to low self-esteem and dental health problems.

Dental problems can also negatively impact both school attendance and performance. A 2000 U.S. Surgeon General report estimated that more than 51 million school hours are lost each year due to dental disease. More recent studies confirm these earlier findings. A 2011 study of schoolchildren in North Carolina published in the American Journal of Public Health found that “children with poor oral health were nearly 3 times more likely … than their counterparts to miss school due to a toothache.”

School absenteeism due to toothache affects learning. A 2012 study from the Herman Ostrow School of Dentistry at the University of Southern California found that “children who reported recent dental pain were four times more likely to have a low grade average — below the median GPA of 2.8 — compared to children without oral pain.” This affects academic performance, job opportunities and earning potential.

Poor dental health also drives up costs for the American taxpayer. The American Dental Association reports that total spending on dental care increased from $50 billion in 1990 to $113 billion in 2014. And during the same period, the share of total dental care in the U.S. funded by public sources rose from 2 percent to 11 percent. A major contributor to this increase is more children receiving dental care from Medicaid and through the Children’s Health Insurance Program.

Tooth decay in children and gum disease can lead to serious health problems in adults. According to the American Dental Association, there are “more than 125 health conditions that can affect oral health, including cardiovascular disease, human papillomavirus (HPV) infection, HIV/AIDS, osteoporosis, obesity, and autoimmune diseases such as rheumatoid arthritis.” And the association reports that people who had tooth decay as a child are more likely to have tooth decay as an adult.

The main culprits that lead to tooth decay are sugar and starch, which are complex sugars. But they are not the direct cause. Decay is caused by the bacteria in everyone’s mouth feasting on the sugars and producing acids that attack the enamel of teeth.

The best advice is what your parents probably told you: limit the sweets and brush your teeth. The more sugar a child eats, the more acid is produced to eat away the teeth. But it is a tough challenge. Sugars and starches are found in a wide variety of foods, including fruits, vegetables, milk and dairy products, bread, candy, cookies, and soft drinks. Processed foods also contain added sugars.

The most obvious way to prevent tooth decay is to get children to brush their teeth at least twice a day. And it’s important to use toothpaste that contains fluoride to help strengthen tooth enamel.

But beyond brushing, there are a number of public health measures we can take to tackle tooth decay in children and adults.

The first is to expand access to fluoridated water. In 1945, communities across the country began adding fluoride to their public water system to fight tooth decay. According to the CDC, “Drinking fluoridated water keeps teeth strong and reduces cavities by about 25% in children and adults.” Today, water fluoridation is widely accepted in the US. About three-quarters of Americans on public water systems — 211 million in all — receive fluoridated water. However, 108 million Americans served by public or private water systems are not.

Here you can find out if your water supply company supplies fluoridated water. And the next time you or your child drinks bottled water, remember that many brands of bottled water do not contain fluoride.

The second is the direct application of materials that reduce cavities. Fluoride varnish or gel can help protect both primary and permanent teeth from cavities. Sealants, a thin plastic coating, bind to the enamel of each tooth and protect the tooth from the acid produced by those sugar-craving bacteria. Sealants are usually applied to permanent teeth, but can also be applied to baby teeth. Many children have sealants applied by their family dentist. School-based kit programs provide the procedure to low-income children in some communities.

How effective are sealants? The CDC reports that “school-aged children without caulk have nearly 3 times more cavities than children with caulk.” It is important that more school systems start using kit programs.

Third is tackling the dental shortages. The Pew Charitable Trusts reports that there are two types of dental shortages in the US. The first is the uneven distribution of dentists. Some areas have an oversupply of dentists and others not enough. In 25 states and the District of Columbia, at least 10 percent of residents do not have adequate access to a dentist, according to an analysis by Pew. The number is highest — 36 percent — in Mississippi. We need to create a better balance by encouraging new dentists to establish their practices in underserved states and communities, and by allowing the use of dental therapists in these areas.

The other shortfall is the relatively small number of dentists accepting Medicaid patients. Medicaid reimbursements for dental care are low, many services are not covered, and there are total benefit ceilings. As a result, many dentists do not participate in the Medicaid program and many low-income families are unable to receive dental care. Efforts should be made to increase reimbursements, cover more dental services, and expand access to dental care for low-income children covered by Medicaid or CHIP.

Finally, the Affordable Care Act has significantly expanded the availability of dental insurance for children. Health law health plans offered through health care exchanges must include this in their coverage. However, it may be offered as a separate plan, increasing costs for participating families. And the range of dental services covered varies from state to state. A report released in September 2016 by the Center for Children and Families at Georgetown University’s Health Policy Institute outlines the shortcomings of the health care law and the changes needed to expand dental care under the law, Medicaid, and CHIP.

Be of good cheer this holiday season. But don’t forget that your children’s dental health is important today and for their future. Let’s resolve to expand access to dental care for all American children.

Low-income children deserve better access to dental care

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