Preventing Dental Caries with Community Programs

The Reality

Although dental caries (tooth decay) is largely preventable, it remains the most common chronic disease of children aged 6 to 11 years (25%), and adolescents aged 12 to 19 years (59%). Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15%).

Once established, the disease requires treatment. A cavity only grows larger and more expensive to repair the longer it remains untreated.

Less than 1 of 3 children enrolled in Medicaid received at least one preventive dental service in a recent year. Many states provide only emergency dental services to Medicaid-eligible adults.

Many adults also have untreated tooth decay (e.g., 28% of those 35 to 44 years and 18% of those 65 and older).

Community-based Strategies Prevent Tooth Decay

Community Water Fluoridation

CDC recognizes community water fluoridation as 1 of 10 great public health achievements of the 20th century.

Community water fluoridation still prevents tooth decay even though people now also get fluoride from other sources such as toothpaste, rinses, and other topical applications at the dental office.

At present, 69% of individuals on public water systems— more than 184 million people—are receiving the benefits of community water fluoridation.

School-based Sealant Programs

Children receiving dental sealants in school-based programs have 60% fewer new decay in the pit and fissure surfaces of back teeth. (90% of decay is in pits and fissures).

School-based sealant programs provide sealants to children unlikely to receive them otherwise (e.g., children in low-income households). Children of racial and ethnic minority groups have twice as much untreated decay in their permanent teeth, but only receive about half as many dental sealants.

Thirty-six states reported dental sealant programs serving 258,000 children. This number, however, represents only about 8% of lower income children who could receive sealants.

Meeting Healthy People 2010 Objectives

	Ages 2–4 (%)	Ages 6–8 (%)	Age 15 (%)	Ages 35–44 (%)
*Baseline caries experience 1988–1994**	18	52	61
Update: 1999–2004	24	53	56
Healthy People 2010 Target: Baseline caries	11	42	51	**
Baseline untreated decay: 1988–1994*	16	29	20	27
Update: 1999–2004	19	29	18	28
Healthy People 2010 Target: Baseline untreated decay	9	21	15	15

*One or more teeth with untreated or filled carious lesions (dental decay).
**There is no Healthy People 2010 objective for adult caries; 95% of adults (aged 20 to 64 years) who have one or more natural teeth have experienced tooth decay.
Source: U.S. Department of Health and Human Services. Healthy People 2010. Washington, DC: U.S. Government Printing Office, 2000:21–11 to 21–15.
***One or more teeth with untreated carious lesions (dental decay).

Community-based Strategies to Save Money

Every dollar spent for community water fluoridation saves from $8 to $49 in treatment costs depending on the size of the community. Savings are greatest in large communities.

Fluoridated water saves more than $4.6 billion annually in dental costs in the United States.

School-based dental sealant programs are cost saving when delivered to populations at high-risk for tooth decay, such as children in low-income households.

Effective Strategies

Community and school partnerships raise awareness of the value of school sealant programs. Healthy Smiles for Wisconsin, a CDC-supported statewide effort to improve the oral health of Wisconsin children through school and community partnerships, began in October 2000. This program helped to establish new community-based sealant programs, and in 2007–2008 these programs provided sealants to 9,202 children in 19 counties.

Community coalitions are essential for gaining approval for community water fluoridation. During the past decade, broad-based citizen coalitions in several large U.S. cities have educated residents about the benefits of water fluoridation. Water fluoridation was approved in many of these jurisdictions, including Los Angeles and Sacramento, CA; Manchester, NH; Las Vegas, NV; San Antonio, TX; and Salt Lake City, UT.

Hope for the future

Many Americans now enjoy markedly better oral health than did their parents. However, certain segments of the population (e.g., those who are poor, who are members of racial or ethnic minority groups, or who are elderly) still have severe dental decay, much of which remains untreated. Healthy People 2010 objectives seek to eliminate these disparities, so that all Americans receive the benefits of good oral health. Community-based programs such as community water fluoridation and school-based dental sealant programs are a particularly effective and cost-savings way to help achieve this goal. For example, increasing the percentage of children at high risk for tooth decay who participate in school sealant programs to 50 % would prevent more than half of the caries that these children would otherwise have and save public health dollars.

State Programs in Action: Ohio

State outline of Ohio School-based sealant programs in Ohio began in 1984 with a single demonstration program in one city. By 2000, 34 of Ohio’s 88 counties had programs. These programs target children who are at high risk for tooth decay and least likely to receive dental care.

Photo of a man and his two school-aged children As the program has expanded, the percentage of 8-year-olds statewide who have dental sealants has increased steadily, from 11% in 1987–1988 to 30% in 1998–1999 to 43% in 2007. Although this percentage still falls short of the Healthy People 2010 objective of 50%, children from all demographic groups in schools with sealant programs have achieved or exceeded the objective.

The Ohio program has met only a portion of the need for dental sealants, but has already shown that school-based programs can reach children at high risk for tooth decay and could potentially reduce or eliminate racial and economic disparities in the prevalence of this effective preventive measure.