Oral Health Care
Key Questions (by Eric Anderson and Theresa Poulos)
Public health’s most effective approach to reducing the prevalence of dental caries lies in local water fluoridation. The ASTHO’s Guide to Community Preventive Services Fact Sheet: Oral Health highlights the findings of 21 studies that compared optimally fluoridated communities with those that were not, to demonstrate that appropriate levels of fluoridation can reduce the incidence of dental caries on a community-wide level. The CDC’s Preventing Dental Caries fact sheet reinforces these findings and translates them into community cost-savings, noting that fluoridated water has saved the US over $25.7 billion in the past decade.
For a national view of the percentage of communities in each state that have appropriately fluoridated water, refer to the CDC’s US map showing results from the 2002 Annual Fluoridation report. This data can be viewed in Tables in the original 2002 Annual Fluoridation Report itself. For more detailed state- and county-level data on water fluoride levels, refer to the CDC’s data resource, My Water’s Fluoride.
However, over-exposure to water fluoride during childhood can result in enamel fluorosis. So while water fluoridation has been proven reduce caries prevalence, at very high levels of fluoridation, the benefits of caries prevention begin to wane due to the increasing prevalence of dental fluorosis. More information on dental fluorosis can be found at the CDC’s webpages on Water Fluoridation and Dental Fluorosis, which are subsections of its Oral Health Resources page.
The Center for Disease Control provides a summary in a fact sheet on the importance of early prevention and dental sealants, both of which are preventive strategies implemented during childhood, but which have influence as children grow up. A Yahoo! Health news release emphasizes the importance of childhood diet in caries prevention, focusing on limiting sugars in childhood diets. For more detailed policy analysis, a Health Technology Assessment provides a comprehensive cost/benefit analysis of increasing childhood dental visits.
For more information, the best organization to contact is the American Academy of Pediatric Dentistry. This organization of over 6000 pediatric dental specialists is a leader in childhood oral health policy and guidelines.
Two issue briefs addressing access barriers to oral health come from the National Rural Health Association and the Center on Aging Society. The former addresses barriers of geography and economics that prevent access to rural populations, while the latter provides a broad overview of insurance coverage issues that many Americans face. A Kaisernet article on Miami-Dade county explains that many dentists who work under Medicaid are dissatisfied with the Florida Medicaid system, citing need for improvement. A second Kaisernet report focuses on geographic barriers in Massachusetts, explaining that many dental patients would have to travel more than 20 miles to visit a dentist, which many low-income patients would find difficult or impossible to drive.
For more comprehensive policy analysis, Oral Health America analyzes the current state of dental access and suggests policy that could improve access for the future. A California Policy Research Center paper focuses on access problems in Hispanic immigrant communities, claiming that the Spanish language barrier and low-income patients are the two biggest problems Hispanic communities face.
- National Institute of Dental and Craniofacial Research (NIDCR). The mission of NIDCR is to improve oral, dental and craniofacial health through research, research training, and the dissemination of health information.
- Naval Dental Research Institute
- American Dental Association