Preventing Dental Caries

The Reality

• Although dental caries (tooth decay) is largely preventable, it remains the most common chronic disease of children aged 5 to 17 years—5 times more common than asthma (59% versus 11%).
• Once established, the disease requires treatment. A cavity only grows larger and more expensive to repair the longer it remains untreated.
• Fewer than 1 in 5 Medicaid-covered children received at least one preventive dental service in a recent year; many states provide only emergency dental services to Medicaid-eligible adults.
• Poor children have nearly 12 times more restricted-activity days because of dental-related illness than children from higher-income families. Pain and suffering due to untreated tooth decay can lead to problems in eating, speaking, and attending to learning.
• Many adults also have untreated dental caries (e.g., 27% of those 35 to 44 years old and 30% of those 65 years and older).

Community-Based Strategies Prevent Tooth Decay

Community Water Fluoridation

• Community water fluoridation has been ranked one of 10 great public health achievements in the 20th century.
• Community water fluoridation effectively prevents dental caries in communities with varying disease prevalence. Children in communities with water fluoridation experienced 29% fewer cavities.
• At present, 66% of individuals on public water systems— over 162 million people—are receiving the benefits of community water fluoridation.

• Children receiving dental sealants in school-based programs have 60% fewer new decayed pit and fissure surfaces in back teeth for up to 2 to 5 years after a single application. Among children, 90% of decay is in pits and fissures.
• School-based sealant programs provide sealants to children unlikely to receive them otherwise (e.g., children in low-income households). Children of racial and ethnic minority groups have about three times more untreated decay and teeth missing due to caries but are about one-third as likely to receive sealants.
• Although 29 states reported dental sealant programs serving 193,000 children, this number represents only about 3% of poor children who could receive sealants.

Community-Based Strategies to Prevent Tooth Decay Saves Money

• Every dollar spent on community water fluoridation saves from $7 to $42 in treatment costs depending on the size of the community. Savings are greatest in large communities.
• At least 60% of the U.S. population on public water systems has received fluoridated water since 1990, translating to savings in dental treatment costs of over $25.7 billion in the past decade
• School-based dental sealant programs are cost saving when delivered to populations at high-risk for tooth decay, such as children in low-income households.

Effective Strategies

• Community and school partnerships raise awareness of the value of school sealant programs. Healthy Smiles for Wisconsin, a CDC-supported state-wide effort to improve the oral health of Wisconsin children through school and community partnerships, began in October 2000; it helped to establish 40 new community-based sealant programs during the 2000-2001 school year. During that year, more than 4,500 children in 40 counties received dental sealants.
• Community coalitions are essential for gaining approval for community water fluoridation. During the past decade, broad-based citizen coalitions in several large U.S. cities have educated residents about the benefits of water fluoridation. Water fluoridation was approved in many of these jurisdictions, including Los Angeles and Sacramento, CA; Manchester, NH; Las Vegas, NV; San Antonio, TX; and Salt Lake City, UT.

Hope for the future