Oral Health

There Is a Serious Unmet Need for Oral Health Services

Many of California’s most vulnerable children and youth are not receiving necessary oral health care.

  • Two out of every ten children and adolescents lack dental insurance coverage. Among children and adolescents living in poverty that number rises to more than three in ten.1
  • 14% of adolescents have not seen a dentist in over a year. Children are more likely to go to the dentist regularly; but, even among children under 12, 7% have not seen a dentist in over a year.2
  • Nationally, more than 16% of children and adolescents ages 5-17 have untreated dental cavities. Among children in poverty, the percentage is much higher: 26% have untreated dental cavities.3

In addition, oral health problems can make it difficult for children and youth to be at school and fully engaged in learning, thereby impeding their educational experience and outcomes.According to the U.S. Surgeon General, American students miss more than 51 million hours of school, each year, as a result of oral health problems.4 According to the American Academy of Pediatric Dentistry, tooth decay is the most prevalent chronic childhood disease: it is far more prevalent than childhood obesity, asthma and diabetes.5  Left untreated, tooth decay leads to pain, tooth abscess, weight loss or nutrition problems, and tooth loss.6

School-Based Health Centers Prevent & Treat Oral Health Problems

In California, by 3rd grade, ⅔ of children have experienced dental cavities. Approximately 7% of California children have missed school because of dental issues that are not maintenance and cleaning. In 2007, there were more than 83,000 ER visits due to preventable dental emergencies. Race-based disparities are also high: non-Hispanic Black people, Hispanics, and Native Americans are most likely to have poor dental health. The greatest disparities are seen in Black children and Mexican-American children. 7

Many children do not have access to affordable dental care because only a quarter of California’s dentists accept Denti-Cal – California’s public dental insurance for low income populations – despite there being over 8 million low-income, disabled and elderly people enrolled. Of those dentists who accept Denti-Cal, only a small percentage of their patients are beneficiaries of Denti-Cal.8 This results in a large disparity in dental health for low-income populations.

School-based health centers (SBHCs) provide high-quality, affordable dental health services, including both preventive and restorative care, thereby improving children’s oral health. Recent research shows that:

  • SBHCs reach children at high risk of oral disease by providing education, prevention, and treatment.9
  • SBHCs can be more effective than community-based dental clinics, across a wide range of indicators, and “provide a natural location [for] preventive and responsive dental care.”10

What Do Oral Health Programs Look Like?

Most programs fall under the umbrella of three categories:

  • Education: Dental health can be managed when kids are taught healthy dental habits and best practices in dental hygiene. When children and their parents are taught prevention methods -such as healthy eating, what kinds of food to avoid – they are equipped to take steps to protect their teeth. Education is also important for mobilizing communities and schools towards establishing better dental health care for children.
  • Screening and Prevention Programs: Screening programs help identify children who have dental issues and connect them with the resources they need. They also help identify children who are most at risk of developing cavities and provide opportunities for early interventions. Prevention programs such as sealant programs and fluoride treatment provide protection against tooth decay. 
  • Restorations and Treatment: Many children from low-income families are unable to find treatment for cavities and tooth decay. SBHCs can provide easy access to restorations and treatment so that these children won’t have to face complications from untreated tooth decay. It also ensures further damage won’t be done.  

All three categories are outlined in the Los Angeles Trust for Children’s Health Oral Health Toolkit.

What SBHCs Can Do to Implement Oral Health Care

Stakeholders and community members need to be educated on the dangers of tooth decay, and be aware of the need for dental health services in schools. One way to do this is to have a dental screening program established in your school in order to see how many children are impacted by tooth decay and cavities. You can then use this information to present to the school board, parents, and other stakeholders in order to underline the need and use supplementary materials to underline importance. The National School-Based Health Alliance hosted a webinar that details the process of starting a school-based dental health center. 

(1) California Health Interview Survey, 2009.
(2) California Health Interview Survey, 2009.
(3) ChildStats: http://www.childstats.gov/americaschildren/tables/hc4c.asp.
(4) Lapin, B. & Smith, A.J.B. School of the 21st Century, Yale University. (2009). Dental Care: The Often Neglected Part of Health Care.
(5) American Academy of Pediatric Dentistry. http://www.mychildrensteeth.org/assets/2/7/ECCstats.pdf
(6) Mayo Clinic https://www.mayoclinic.org/diseases-conditions/cavities/symptoms-causes/syc-20352892
(7) The Center for Disease Control and Prevention https://www.cdc.gov/oralhealth/oral_health_disparities/index.htm
(8) California Healthcare Almanac | Dental Facts and Figures https://www.chcf.org/wp-content/uploads/2017/12/PDF-DentiCalFactsAndFigures2010.pdf
(9) National Maternal and Child Oral Health Resource Center. (2011). Comprehensive Oral Health Services for Improving Children’s and Adolescents’ Oral Health through School-Based Health Centers.
(10) Larsen, C.D., Larsen, M.D., Handwerker, L.B., Kim, M.S., et al. (2009). A Comparison of Urban School- and Community-Based Dental Clinics. Journal of School Health. 79(3): 116-122.