Prevention

 

 

Is tooth decay preventable?  

Yes, dental caries (tooth decay), a chronic infectious disease caused by bacteria, is largely preventable. Once established, though, it requires treatment. Both community-based and individual strategies (including disease management) target prevention of tooth decay.

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Community-based strategy: Community Water Fluoridation in Florida

Fluoride reduces the ability of bacteria to produce acid and promotes the remineralization of enamel, thereby preventing a cavity from continuing to form. Community water fluoridation is a proven cost-effective intervention that optimizes fluoride content in public water systems to promote oral health. Florida’s Department of Health supports Community Water Fluoridation. A national public health target (Healthy People 2010) of 75% is set for each state. Currently 76.7% of people served by community water systems receive optimally fluoridated water, reaching 69.5% of Florida's population. Florida’s higher-than-national average may, however, be affected by local decision making to discontinue fluoridation.

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Community-based strategy: School-based sealant programs(S-BSPs) in Florida  

A sealant is a plastic material applied to the chewing surfaces of the posterior teeth. The sealant acts as a barrier, protecting enamel from plaque and acids. Disparities exist in both the knowledge and prevalence of sealants by race or ethnicity and income. S-BSPs address disparities as follows:

  • Ohio data show that targeting S-BSPs by “family income-based school-level criteria was effective in reaching higher risk children.”
  • School-based dental sealant programs are cost saving when delivered to populations at high risk for tooth decay, such as low-income households.
  • See the CDC's page on Preventing Dental Caries with Community Programs  

Florida does not collect Basic Screening Survey data statewide, but available surveillance data of 2009 indicated that for the school years 2002-2003, only 8.9% of 2nd and 7th graders received sealants through S-BSPs. A 2010 Pew report indicates that the share of high-risk schools with sealant programs was still less than 25%, as of 2009.

Sealant program success requires attention to regulatory compliance, clinical materials and methods, eligibility and consent, Medicaid billing and other issues. The level of dentist engagement is a component of organization of a dental sealant program. In Florida, hygienists are not permitted to place sealants without a dentist’s prior examination. Florida is among 21 states that allow general supervision with a dentist’s exam.

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Are medical providers in Florida reimbursed for preventive dental health care?  

Yes, Florida’s Medicaid Fee-for-Service policy allows for the application of fluoride varnish in a medical office any time a child is in the provider’s office and due for treatment. In addition, Medicaid health maintenance organizations (HMOs) are contractually required to provide the same services as the Medicaid Fee-for-Service program.

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What individual interventions can be accomplished during pregnancy?  

Bacteria that causes dental caries are transmissible 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.

Florida has not customized either the NY or California Perinatal Guidelines, which are available as guidance for professional care during this period.

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What individual interventions can be accomplished in early childhood?  

Identifying high-risk children and developing disease management plans for children are a component of prevention. A dental home should be established by age 1. Fluoride varnish, for example, is offered for children of all ages, including infants.

Florida has examples of fluoride varnish programs and other preventive programs.

  • A WIC-Dental Partnership for Prevention Pilot Program in Palm Beach County targeted infants ages 6-18 months for oral hygiene fluoride treatment and referrals, as required
  • A Florida Public Health Institute (FPHI) pilot program utilized RDH’s in a pediatric practice to increase preventive oral health services (including fluoride varnish)

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What individual interventions can be accomplished during childhood?   

  • Palm Beach County Health Department uses portable equipment to screen 2nd graders utilizing Medicaid (with reimbursement for non-Medicaid through the Quantum Foundation)
  • Duval County Health Department uses a mobile unit to screen 2nd and 7th graders, with referrals
  • Monroe County has a pilot project to provide sealants to 2nd and 6th graders at a school in the county with no Medicaid providers.
  • "Seals on Wheels” provides mobile preventive care in Miami-Date
  • Fluoride varnish may replace school fluoride mouthrinse programs, for example.

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What individual interventions are recommended during adolescence?  

The Florida “Healthy District Self-Assessment Tool” for school districts includes a question requiring documentation demonstrating a community referral process for dental issues and whether the district offers preventive dental health services.

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Does Florida have state legislation mandating school and adolescent oral health programs or services?  

No, according to Florida’s State and Adolescent Oral Health Profile (2007)

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What are other states doing that is innovative?  

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. See ZOE.

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How can federal health reform help with prevention in Florida?  

The 2010 federal health care reform law (ACA) requires a national public education campaign on oral health. An HHS 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. 

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