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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
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.
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. |
Page last reviewed: November 14, 2008
Page last modified: November 14, 2008
Content source:
Division of Oral Health,
National Center for Chronic Disease Prevention and
Health Promotion |
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