Yes, dental caries (tooth decay), a chronic infectious disease caused by oral bacteria’s interaction with sugars, is largely preventable. Once established, though, it requires treatment to stop the decay process and repair the cavities that result. Both community-based and individual strategies (including disease management) target prevention of tooth decay.
Community water fluoridation is the adjustment of the fluoride concentration in the community water supply to a level beneficial to reduce tooth decay and promote good oral health. Fluoride reduces the ability of bacteria to produce acid and promotes the remineralization (self-repair) of tooth enamel, thereby stopping the decay process and preventing a cavity from continuing to form. The U.S. Centers for Disease Control and Prevention (CDC) encourages community water fluoridation as a proven cost-effective intervention that optimizes fluoride content in public water systems to promote oral health. A national public health target (Healthy People 2020) of 79.6% is set for each state. As of 2008, 72.4% of U.S. residents on community water systems have optimally fluoridated water.
A sealant is a plastic coating applied to the chewing surfaces of the posterior teeth (molars). The sealant acts as a barrier, protecting enamel from bacterial plaque and acids. Disparities exist in both the knowledge and prevalence of sealants by race or ethnicity and income. CDC has demonstrated that S-BSPs reduce oral health disparities in children. Ohio has demonstrated that targeting S-BSPs by “family income-based school-level criteria was effective in reaching higher risk children.” CDC has also demonstrated the cost effectiveness of S-BSPs with data indicating that “if 50 percent of children at high risk participated in school sealant programs, over half of their tooth decay would be prevented and money would be saved on their treatment costs.” Most states collect Basic Screening Survey data that includes statewide statistics on sealant prevalence. The national public health target (Healthy People 2020) for sealant placement on molar teeth of children aged 6 to 9 years is 28.1%. The nationwide prevalence of sealant application from 1999-2004 for this age group is 25.5%.
Successful sealant programs attend to regulatory compliance, clinical materials and methods, eligibility and consent, dental community support, Medicaid billing and other administrative issues.
It varies by state. As of 2011, two thirds of states reimburse primary care medical providers for application of fluoride varnish.
Bacteria that cause dental caries are transmitted early in life from caretakers, particularly mothers, to children. Educating pregnant women and other caregivers about the importance of oral health and how to prevent disease transmission is critical. New York State developed Perinatal Guidelines (later adapted by California) to provide guidance for professional care during this period.
Key components of prevention and disease management are risk assessment early in life; parent counseling, goal setting, and action planning; proper use of fluorides; and disease management. A dental home should be established by age 1. Fluoride varnish, for example, is offered for children of all ages, including infants.
Preventive services include screening, sealants, fluoride varnish, healthy diets, and other interventions – all supported by oral health education and promotion.
Shifting responsibility for oral health and dental care from family to the teenager is critical for adolescents to assume adult responsibilities. Public school settings can be a locus for preventive and educations services, including process for community referral.
No, ASTDD State and Adolescent Oral Health Profiles (see link below) show variation among states.
Among the many state initiatives, North Carolina’s Into the Mouths of Babes (IMB) program is a Medicaid program that reimburses physicians for providing preventive dental services to children 0-3 years of age. Carolina Dental Home links medical and dental offices so that physicians can more easily refer children in need of treatment. Zero Out all Early (ZOE) childhood tooth decay reaches children enrolled in Early Head Start (EHS) programs in North Carolina.
The ACA (health reform) authorizes a national public education campaign on oral health. A Department of Health and Human Services public education campaign augments a requirement in the CHIPRA law that health education materials be provided to new parents of CHIP enrollees about the risks for and prevention of early childhood caries.
ACA also authorizes early child caries management demonstration projects and expanded support for S-BSPs through federal grants.
Federal Government links:
Analysis from the Children’s Dental Health Project (CDHP) and other groups: