Priority Area: Healthy Mothers, Healthy Babies, Healthy Children - Dental Caries Disease among New York State's Children
Pregnancy and early childhood are critical periods for ensuring good oral health. The consequences of poor oral health are costly yet the problems are preventable. This section focuses on oral health in children, while the link between pregnancy and oral health is discussed in Birth Outcomes .
Among children, the prevalence of tooth decay (dental caries disease) in primary teeth is high. Many children continue to suffer unnecessarily from untreated tooth decay. Nationally, 28% of children ages two to five years have already experienced tooth decay. 1 Despite overall improvements in oral health across age groups, a slight increase in dental caries among children ages two to five years was observed in the last national survey . Surveys also show that disparities are apparent with respect to poverty, race and ethnicity. Those at high risk tend to be minority children, the poor, older people, the chronically ill, and those who are institutionalized. Among 3 rd grade children in NYS, 60% of those in low-income families and 48% in high-income families had tooth decay. 2 In a recent survey of children enrolled in Early Head Start and Head Start Programs in NYS, 41% were found to have early childhood caries with over 7 in 10 still having untreated decay. About 94% of Medicaid-eligible children in NYS under 3 years of age, and 62% of those between 3 and 5 years of age, did not receive any dental care during 2009. In 2008, approximately 4,700 children ages 3-5 years were treated for tooth decay in emergency departments and ambulatory surgery settings in New York State.
In addition to causing needless pain and suffering, dental caries in children, especially if untreated, can predispose them to significant oral and systemic problems as they age. These may include eating difficulties, altered speech, loss of tooth structure or tooth loss, inadequate tooth function, unsightly appearance and poor self-esteem, infection, difficulties concentrating and learning, and missed school days. According to the Surgeon General, children with oral disease miss over 51 million hours of school each year.3
The longer the delay in the treatment of dental disease, the more extensive and costly it becomes. Many children and adults who are Medicaid-eligible are unable to access needed care and treatment. Young children, especially between the ages of 3 and 5 years, might be affected by severe early childhood caries that require hospitalization for treatment. The cost of this treatment is approximately $4,500 per child. The cost of two fluoride varnish applications, a preventive strategy to control early childhood caries, is approximately $60 per year per child under the New York State Medicaid Program. In school-aged children, a preventive and noninvasive sealant application costs $43 per tooth under the Medicaid program, but that same tooth allowed to deteriorate over time might incur restorative treatment in the form of a filling at the cost of $55. Left to decay further, the same tooth may require a crown costing $493 and then perhaps a root canal at a cost of $406 (costs are based on 2003 Medicaid reimbursement fees).
- Centers for Disease Control and Prevention. Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis-United States, 1988-1994 and 1999-2002. MMWR Surveillance Summaries. August 26, 2005; 54(No. SS-3): 1-44.
- New York State Department of Health. Oral Health Status of 3rd Grade Children. 2005
- U.S. Department of Health and Human Services: Oral Health in America: A report of the Surgeon General. Rockville MD: U.S.Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.
By the year 2013, reduce the prevalence of tooth decay in New York 3rd grade children to no more than 42%, consistent with the Healthy People 2010 objective. (Baseline: 54.1%, NYS Oral Health Survey, 2004)
Indicators for Tracking Public Health Priority Areas
- Percent of children with caries experience (history of tooth decay).
- Percent of children with untreated caries.
Data and Statistics
- Oral Health Status of Third Grade Children: New York State Oral Health Surveillance System, 2005.
- The New York State County Health Assessment Indicator (CHAI) Reports consist of a series of oral health indicators by county.
New York State Department of Health Programs
- The Bureau of Dental Health
- The Bureau implements and sponsors a variety of programs aimed at preventing, controlling and reducing dental diseases and other dental conditions; promoting healthy behaviors; and increasing access to quality oral health services. These programs are designed to:
- Assess and monitor the oral health status of children;
- Provide guidance on policy development and planning to support oral health-related community efforts;
- Mobilize community partnerships to design and implement programs directed toward the prevention and control of oral diseases and conditions; and
- Inform and educate the public about oral health, including healthy lifestyles, health plans, and the availability of care.
- Preventive Dentistry Program
- This program addresses the problem of dental disease in underserved areas. A program of dental screening, referral and other preventive services in schools, Head Start centers and other congregate sites significantly improves the oral health of children.
- Community Water Fluoridation
- The Bureau of Dental Health in collaboration with the Bureau of Water Supply Protection monitors the quality of fluoridation services statewide. In addition, technical assistance is provided to communities interested in implementing water fluoridation.
- School-Based Supplemental Fluoride Program
- The Fluoride Supplement Program consists of the school-based Fluoride Mouth Rinse Program that serves elementary school children, and the Preschool Fluoride Tablet Program that serves three to five year-olds in Head Start centers and migrant childcare centers in fluoride-deficient areas.
- Physically Handicapped Children’s Program – Dental Rehabilitation Program
- The Dental Rehabilitation Program provides financial assistance to needy children under the age of 21 who have severe handicapping conditions such as cleft lip, cleft palate and malocclusions.
- Dental Public Health Residency Program
- The Dental Public Health Residency Program is designed for dentists planning careers in dental public health. It prepares residents via didactic instruction and practical experience in dental public health practice.
- Oral Health Initiative
- The Bureau of Dental Health is building linkages with stakeholders to improve the oral health of New Yorkers through activities including surveillance, state oral health plan development, support for program management and a statewide oral health coalition, and dissemination of information.
- School-based Dental Health Centers
- A school-based dental health center is a delivery system of primary and preventive health located in a school and provided by an Article 28 hospital, diagnostic and treatment center, or community health center. Providers implementing preventive services or primary care services in schools are required to obtain authorization from the NYSDOH. The Department provides technical assistance with the implementation of program activities, coordination with partner organizations, training, and site visits.
Strategies – The Evidence Base for Effective Interventions
- Preventing Dental Caries: Community Water Flouridation
- The Task Force on Community Preventive Services recommends community water fluoridation based on strong evidence of effectiveness in reducing tooth decay. Community water fluoridation involves adding fluoride to community water sources, then adjusting and monitoring the amount of fluoride to ensure that it stays at the desired level.
- Preventing Dental Caries: School-based or -linked Sealant Delivery Programs
- The Task Force on Community Preventive Services recommends school-based and school-linked dental sealant delivery programs are based on strong evidence of effectiveness in preventing or reducing tooth decay among children. These programs provide direct delivery of dental sealants to children in school-based or school-linked (clinic or private practice) settings.
- Proven and Promising Best Practices for State and Community Oral Health Programs.
- The Association of State and Territorial Dental Directors website provides reports and examples of best practices related to surveillance systems, state plans, state coalitions, state mandates, water flouridation, school flouride programs, school sealant programs, workforce development, and special health care needs.
Reports and Resources
- Clinical Practice Guidelines during Pregnancy and Early Childhood, New York State Department of Health.
- To improve the oral health of pregnant women and young children and reinforce the recommendations of professional associations, the NYSDOH's expert panel of health care professionals published a report with evidence-based recommendations for prenatal, oral health and child health professionals.
- Oral Health for Infants, Children, Adolescents, and Pregnant Women: Knowledge Path
- Published in January 2009 by the National Maternal and Child Oral Health Resource Center, the report has recommendations for professionals and consumers on specific aspects of oral health.
- National Institute of Dental and Craniofacial Research Educational Resources
- The website features a variety of educational resources such as curricula that can be used by teachers, handouts that can be copied by health care providers, brochures for consumers, and an online tutorial on "Genetics, Disease and Dentistry" for dental students and faculty.
- Improving the Oral Health of Young Children: Fluoride Varnish Training Materials and Oral Health Information for Child Health Care Providers
- The New York State Department of Health has created a webpage to provide resources on available training materials for improving the oral health of young children.
- Healthy People 2010 Oral Health Toolkit
- The toolkit is designed to assist states, tribes, territories, and communities to develop programs that will help eliminate oral health disparities and achieve the nation’s Healthy People 2010 oral health objectives.
- Centers for Disease Control and Prevention, Division of Oral Health, Success Stories Workbook
- The Impact and Value: Telling Your Program’s Story workbook provides guidance on how to develop success stories and highlight program achievements. Samples of success stories include the Arkansas Preventing Tooth Decay by Strengthening the Community Water Fluoridation Program and Alaska’s surveillance efforts to provide information for program focus and decision making.
- Centers for Disease Control and Prevention, Division of Oral Health, Adult Oral Health
- This website features a wide variety of resources and materials on adult oral health including fact sheets, articles in professional journals, and links to additional resources on adult oral health.
- Oral Health America
- This website has a variety of resources including a comprehensive report on the oral health of older Americans and an overview of state oral health programs.
- Integrating Oral Health into the Prevention Agenda
- This Powerpoint presentation about promoting oral health as part of a community's effort to address Prevention Agenda goals was developed by Bridget Walsh, senior policy associate at the Schuyler Center for Analysis and Advocacy.
Return on Investment
- Cost Savings of Community Water Fluoridation
- Two published studies conducted by the Centers for Disease Control and Prevention reaffirm the benefits of community water fluoridation. The studies continue to show that widespread community water fluoridation prevents cavities and saves money, both for families and the health care system. The economic analysis found that for communities of more than 20,000 people, where it costs about 50 cents per person to fluoridate the water, every $1 invested in this preventive measure yields approximately $38 savings in dental treatment costs.
- Kumar JV, Adekugbe O, Melnik T. Geographic variation in Medicaid claims for dental procedures in New York State: role of fluoridation under contemporary conditions. Public Health Reports 2010;125 (Sept-Oct):647-654.
- The authors conducted an evaluation to determine if the number of claims reimbursed for caries-related procedures for children in the New York State Medicaid program varied by county fluoridation coverage. Compared with the predominantly fluoridated counties, the mean number of restorative, endodontic, and extraction procedures per recipient was 33.4% higher in less fluoridated counties. The mean number of claims per child for caries-related services was inversely correlated with the extent of fluoridation in a county (Spearman's correlation coefficient-.54, p < 0.0001), but claims for non-caries related services were not. These findings, when added to the already existing weight of evidence, have implications for promoting policies at the federal and state levels to strengthen the fluoridation program.
- Kallestal C et al. Economic evaluation of dental caries prevention: a systematic review. Acta Odontol Scand 2003;61:341-346.
- This review published of economic on cost evaluation studies of caries prevention showed that all preventive measures, except flouride gels, resulted in lower costs compared to fillings, and that water flouridation was the most cost-effective preventive measure. However, the systematic review that included 17 original studies from 154 references concluded that the scarcity of well-conducted studies, as well as contradictory evidence, made it difficult to conclusively judge the health-economic effects of caries prevention methods.
- Cost-effectiveness analysis of a school-based dental sealant program for low-socioeconomic-status children: a practice-based report. J Health Care for the Poor and Underserved. 2002;13(1):38-48.
- The cost of maintaining a healthy tooth surface (where healthy was defined as surfaces neither filled nor decayed) was $27. The cost of maintaining a healthy tooth surface (defined as that without any current decay) was $39. The results of the sensitivity analyses showed a net saving for the sealant group of $2,890 when decayed teeth were filled and missing teeth were left untreated, and of $11,120 when decayed teeth were filled and missing teeth were replaced.
- Dasanayake AP, Li Y, Kirk K, Bronstein J, Childers NK. Restorative cost savings related to dental sealants in Alabama Medicaid children. Pediatric Dentistry 2003; 25(6):572-576.
This retrospective cohort study was carried out in multiple centers. Data were extracted from the Alabama Medicaid administrative data. The reimbursed cost per patient was $55.50 ($20.03 for sealant and $35.47 for restorative care) in the sealant group and $71.90 (all for restorative care) in the non-sealant group. Thus, the use of sealants led to about $17 per child (unadjusted for inflation) cost-savings to Medicaid in subsequent restorative costs. The statistical analysis showed that the costs were lower in the sealant group after controlling for baseline factors. Race, gender and age at entry also had independent effects on the cost of subsequent restorative care.
- Area Health Education Centers
- Association of Perinatal Networks of New York
- Clinical Directors Network
- Dental Hygienists' Association of the State of New York State
- New York State Academic Dental Centers
- New York State Association for Rural Health
- New York State Dental Association
- New York State Dental Foundation
- New York State Oral Health Coalition
More InformationBureau of Dental Health
Corning Tower, Room 542
Empire State Plaza
Albany, NY 12237