Tuesday, March 17, 2015

This blog is designed to time with Blog Carnival week hosted by The Children's Dental Health Project Week, March 16-20. For more info, visit cdhp.org or @Teeth_Matter

Kids SmilingBeing a parent or caregiver can be a difficult task, especially when it comes to ensuring your children are healthy, equipped for learning, and achieving their potential. When it comes to taking care of our bodies, oral health isn’t often the first thing that comes to mind. Yet more than 90% of all systemic diseases have early manifestations in the oral cavity.1 Tooth decay that occurs early in life, when left untreated, leads to damage to the permanent teeth, resulting in higher dental costs in adulthood.2 The cost of treating just one decayed permanent molar in an individual across their lifespan can be between $2,187 and $6,105.3,4 Maintaining oral health is one of the most important things parents and caregivers can do—not only for themselves but for their children. Instilling good oral habits in children at a young age is critical to their overall health and well-being, and it’s crucial that parents and caregivers are knowledgeable about how to care for their children’s teeth.

Tooth decay is the most common chronic disease of early childhood—five times more common than asthma.5 Approximately 37% of children ages 2 to 8 years have experienced dental caries, with 14% left untreated. The disparities tend to worsen as children get older, with approximately 50% of children ages 12 to 15 and 67% of children ages 16 to 19 experiencing dental decay.6 Poor dental health has significant adverse effects on a child’s physical and social development. It can impair their ability to eat and speak, often resulting in pain, embarrassment, and reduced self-esteem, among other long-term consequences.7 Increasing awareness of the availability of dental coverage and the importance of the age one dental visit, as recommended by the American Academy of Pediatric Dentistry, is a great starting point for educating parents and caregivers.8

Coverage Is Available

Getting low-income children enrolled in dental coverage continues to be a challenge across the nation. Currently, there are approximately 3.7 million children who are eligible for but not enrolled in Medicaid or the Children’s Health Insurance Program, insurance plans that include dental coverage.9 Fortunately, for children living in Michigan, the Michigan Department of Community Health, in partnership with Delta Dental of Michigan, have been working to address this specific issue for several years by implementing a unique initiative called the Healthy Kids Dental program, created 15 years ago and incrementally implemented in counties throughout the state. Through the Healthy Kids Dental model, dental providers are reimbursed at significantly higher rates than traditional Medicaid, increasing provider participation in Medicaid and resulting in greater access to and utilization of dental care for children in Michigan. Currently, Healthy Kids Dental is providing essential dental care to 550,000 children in 80 of Michigan’s 83 counties. The program may expand within the next year, pending legislative approval, to provide dental coverage to eligible children up to 8 years of age in the remaining three counties (Kent, Oakland, and Wayne). Although the expansion would provide coverage for only a portion of children in those areas, it would mean dental coverage to an additional 210,000 children in Michigan, primarily targeting the state’s youngest children, representing the most critical population.10

Educating Families

To help parents and caregivers understand the importance of caring for their children’s teeth and enrolling them in dental coverage, the Centers for Medicare & Medicaid Services have created “Think Teeth” handouts that are available for free. These handouts can be distributed to families by community organizations and are customizable to further indicate organizational support.

While educating caregivers is one step to changing family oral health behaviors, there is a role for the community to reiterate these common messages to families and create a supportive environment for sustaining behavior change. By encouraging the practice of appropriate oral health behaviors through school communications, youth programs, and community-based events, communities can have a major impact on awareness. Schools and early childhood programs are explicitly affected by dental issues, as approximately 51 million hours of school are missed each year due to dental-related issues.11 Predictably, when children are no longer experiencing dental-related pain, learning improves.12 Thus, it is important for educators to consistently promote proper oral hygiene and have a basic understanding of the signs and symptoms of dental-related issues among children, as they are sometimes unable to verbalize their dental pain.13

Additionally, schools can serve as a great outreach channel for connecting families to appropriate community resources. The “Think Teeth” materials can be utilized by schools and early childhood programs to educate families, and the consistent oral health promotional messaging can be integrated into their school’s social media, website, and newsletter communications. There are also many talented organizations leading the effort to improve family oral health behaviors, developing a creative spectrum of resources for families and schools, including the BRUSH! Curriculum’s classroom lessons for children from birth through age 5, “Sesame Street” Healthy Teeth, Healthy Me videos, Mouth Healthy Kids’ online games for children, and the Ad Council’s parent-focused commercials.

To support a common message to children and families, engaging alternative channels of communication, such as afterschool programs, school nutrition programs, and community-based activities and events, can be beneficial to reinforcing and supporting the appropriate behaviors and positive attitudes about oral health. Oral health is integral to systemic health, and the best way to ensure children have a foundation of good health to grow from begins with prevention.

Michigan Caries Prevention Program

In an effort to address the burden of children’s dental disease in Michigan, Altarum, in partnership with Delta Dental of Michigan, University of Michigan School of Dentistry, and the Michigan Department of Community Health, is developing a statewide initiative called the Michigan Caries Prevention Program. The initiative is a multipronged approach that engages providers, schools, and early childhood programs to educate children and families about the importance of oral health, and promotes dental coverage options across the state through the project’s partners. The program’s website, MITeeth.org, launched in February, during National Children’s Dental Health Month. The website provides additional information on the state of oral health in Michigan and a review of the strategies that the Michigan Caries Prevention Program has planned in order to transform the current system of children’s oral health.

Bottom line: It is important to “think teeth”—promote oral health, assist families in obtaining dental coverage for their children, and encourage children to learn proper oral hygiene skills early in life to ensure a caries free adulthood.

CMS Disclaimer: This project described was supported by Grant Number 1C1CMS331321 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.


  1. Academy of General Dentistry. (2012). Importance of oral health to overall health. Retrieved from http://www.knowyourteeth.com/print/printpreview.asp?content=article&abc=i&iid=320&aid=1289.
  2. Michigan Department of Community Health, Oral Health Program. (2010, March). Michigan oral health plan. Retrieved from http://www.michigan.gov/documents/mdch/Michigan_State_Oral_Health_Plan_FINAL_2_326169_7.pdf.
  3. Delta Dental Data & Analysis Center. (2004). Estimating lifetime costs of a cavity. Retrieved from https://www.cdhp.org/resources/298-lifetime-costs-of-a-cavity-by-delta-dental.
  4. Delta Dental of California. (2012, January–June). Data of commercially insured patients. Retrieved from http://www.ilikemyteeth.org/wp-content/uploads/2013/06/Infographic-on-Fluoridation-June-2013.pdf.
  5. Pew Charitable Trusts. (2012, February). A costly dental destination. Retrieved from http://www.pewtrusts.org/~/media/Assets/2012/01/16/A-Costly-Dental-Destination.pdf.
  6. Dye, B.A., Thornton-Evans, G., Li, X., Iafolla, T.J. (2015). Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012. NCHS data brief, no 191. Hyattsville, MD: National Center for Health Statistics.
  7. Jurgensen, N., & Petersen, P. (2009). Oral health and the impact of sociobehavioural factors in a cross sectional survey of 12-year-old school children in Laos. BMC Oral Health, 9, 29.
  8. American Academy of Pediatric Dentistry. (2014). Fast facts. Retrieved from http://www.aapd.org/assets/1/7/FastFacts.pdf.
  9. Harrington, M., Kenney, G. M., Smith, K., Clemans-Cope, L., Trenholm, C., Hill, I., Anderson, N. (2014, August 1). CHIPRA mandated evaluation of the Children’s Health Insurance Program: Final findings. Ann Arbor, MI: Mathematica Policy Research.
  10. Czelada, L. (2015, February 27). Healthy Kids Dental, now for all Michigan kids. The Detroit News. Retrieved from http://www.detroitnews.com/story/opinion/2015/02/27/czelada-michigan-healthy-kids-dental/24077017/.
  11. Gift, H. C. (1997). Oral health outcomes research: Challenges and opportunities. In G. D. Slade (Ed.), Measuring oral health and quality of life (pp. 25–46). Chapel Hill, NC: Department of Dental Ecology, University of North Carolina.
  12. Reisine, S. T. (1985). Dental health and public policy: The social impact of dental disease. American Journal of Public Health, 75(1), 27–30.
  13. Ramage, S. (2000). The impact of dental disease on school performance: The view of the school nurse. Journal of the Southeastern Society of Pediatric Dentistry, 6(2), 26.

All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions or policy positions.