Perspective: What Can States Do to Address Poor Oral Health Outcomes for Low-Income Children?

October 08, 2019

Allyson Rogers

Low-income children are five times more likely to suffer from untreated tooth decay compared to children with greater means, leading to suffering in adolescence and long-term health problems that can be easily prevented. And, in addition to health problems, there are also long-term social issues associated with untreated tooth decay – such as social stigmatization and problems finding employment.

All of this has economic implications. Dental procedures resulting from untreated tooth decay may require hospitalization and extensive treatment for children, which incur considerable cost to Medicaid and other health care payers. A 2014 study found the total cost of emergency department visits involving dental conditions during the three-year study period to be $2.7 billion, with 40% of all dental-related visits being made by uninsured patients. Meanwhile, children with dental problems are also more likely to miss school and have a lower grade point average, when compared to children without oral pain.

Clearly, reducing the burden of childhood dental disease is integral to one’s overall health, wellness, and economic opportunity throughout the lifespan. So how do we work together to improve oral health care?

It starts with prevention, in clinical and community settings, that incorporates education, training, and improved care coordination.

  • Provider Education. Quality improvement activities that provide a Plan-Do-Study-Act framework with expert coaches and CME/MOC provider education help medical providers implement preventive oral health services, such as oral health screenings, fluoride varnish applications, and dental home referrals, during well-child visits.
  • Care Coordination. Timely and effective coordination across systems of care, providers, and caregivers makes it easier for medical providers, social workers, and other care professionals to refer children in need of oral care to nearby dentists who accept Medicaid, and to track the care they receive. For example, medically-initiated, electronic dental referrals connect a child to a dentist (that accepts their insurance) at an earlier age, which can achieve impactful results.
  • Community Integration. Training community social service providers (such as WIC clinics, school-based health centers, and Head Start programs) about the importance of children’s oral health so they can share information with their clients and refer them to a dental home increases access to care in both urban and rural settings and helps minimize the potential occurrence of early childhood caries.
  • Evaluation. Expanded and enhanced evaluation and data collection improves integration of oral health care into primary care and social service systems. It also helps improve effective communication and coordination across systems of care, as well as overall promotion and prioritization of oral health.

Primary prevention interventions and activities, like these listed above, notably reduce the rates of dental disease. Implementing these solutions can reduce the number of children needing treatment, alleviate the cost burden on the health care system (currently and in the future), and impact a child’s long-term health and economic potential. It’s time to take action, and Altarum can help states do just that.

Any state working to reduce the burden of childhood dental disease can boost their state’s impact by adopting SmileConnect. SmileConnect is an integrated care model that is proven to increase the number of Medicaid-eligible children receiving preventive oral health services, resources, and dental referrals. Created with funding from the Centers for Medicare & Medicaid Services, SmileConnect combines referral technology, provider education, and community integration for a comprehensive solution that achieves lasting results. Learn more:

Altarum is a nonprofit organization that works with federal and state agencies and foundations to design and implement solutions to improve the health of individuals with fewer financial resources and populations disenfranchised by the health care system. We achieve measurable results by combining our expertise in public health and health care delivery with technology, workforce training and continuing education, applied research, and technical assistance. Our innovative solutions lead to better health for beneficiaries and better value for payers.
What Can States Do to Address Poor Oral Health Outcomes for Low-Income Children?


Allyson Rogers

Allyson Rogers  - MA

SmileConnect Specialist

Areas of Expertise
  • Public health communication
  • Program evaluation
  • Oral health

Allyson leads expansion efforts for SmileConnect, working with states and organizations to determine scalability, feasibility, and pricing. She has been part of the program (formerly known as the Michigan Caries Prevention Program) since its launch in 2014 and has provided expertise in evaluation, marketing, and project management. Allyson holds a master’s degree in Health and Risk Communication.