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.4 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.
Bright Futures Pocket Guide
Bright Futures is a national disease prevention and health promotion initiative funded by the Maternal and Child Health Bureau. This pocket guide provides health professionals with an overview of preventative oral health supervision for infants, children and adolescents, and includes information about risk assessment.
California Mobile Dental Provider Guidelines
This information kit, jointly developed by a group of oral health and education professionals, is designed to assist schools and school districts that are approached by mobile or portable dental providers. The information kit includes a one-page overview of issues to consider, a more detailed set of guidelines, and a sample memorandum of understanding. This information kit is not intended to lead schools/districts to a particular decision; rather, it is intended to give decision-makers some tools and ideas to help make the best choice for a particular situation.
The L.A. Trust Oral Health Toolkit
This toolkit, developed by the Los Angeles Trust for Children’s Health Oral Health Initiative, showcases best practices in dental health and provides an extensive background on different kinds of oral health programs and the best ways to implement them. The information provided is a great way to gain a start on your oral health program.
National School-Based Health Alliance Oral Health Resources
The National School-Based Health Alliance has a hub for oral health resources, including a playbook, which is a comprehensive guide to school oral health programming, and two white papers, “School Oral Health: An Organizational Framework to Improve Outcomes for Children and Adolescents” and “Confronting the Consent Conundrum: Lessons from a School Oral Health Learning Community.”
Rural Oral Health Toolkit
This information kit, developed by the Rural Health Information Hub, outlines considerations for rural school-based oral health programs. This toolkit touches on implementation considerations and provides resources for programming, especially sealant programs.
Clinical Guideline on Fluoride Therapy
The American Academy of Pediatric Dentistry provides fluoride guidelines to help practitioners and parents/caregivers make decisions about the appropriate use of fluoride as part of the comprehensive oral health care of infants, children, adolescents, and persons with special health care needs.
Center for Oral Health Program: WIC Early Entry into Dental Care
The purpose of the WIC: Early Entry into Dental Care is to increase the number of at-risk young children who receive preventive dental services and access early dental care, and to ensure that families have information about diet and proper brushing practices. The program, run by the Center for Oral Health, uses WIC centers as the service delivery point. (WIC provides food and nutrition education to low-income pregnant and parenting woman and their children.)
Health Professional’s Curriculum to Oral Health
The Smile for Life: A National Oral Health Curriculum is one of the nation’s most comprehensive and widely used oral health curriculum’s for primary care clinicians.
Oral Health Study Module for Health and Early Childhood Professionals
Open Wide: Oral Health Training for Health Professionals is a series of four online modules designed to help health and early childhood professionals working in community settings promote oral health. Topics include tooth decay, risk factors for tooth decay, and prevention of tooth decay; oral health risk assessment and oral health screening; and anticipatory guidance for parents. The modules were prepared by the National Maternal and Child Oral Health Resource Center and the Center for the Advancement of Distance Education at the University of Illinois at Chicago.
The Oral Health Resource Bulletin
The Oral Health Resource Bulletin, which is updated periodically, is designed for health professionals, program administrators, and policymakers working to improve the oral health of infants, children, adolescents, and families.
(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.