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Vermonters have good oral health

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% of third graders with dental decay

Current Value

48%

2023

Definition

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Story Behind the Curve

Last Updated: March 21, 2023

Author: Office of Oral Health, Vermont Department of Health

Since 2002-2003, there has not been a significant decline in the prevalence of tooth decay among Vermont’s third grade children. Vermont has not reached the Healthy Vermonters Goal for the percent of children with dental decay (30%).  Although the percentage of third grade children with decay experience in 2016-2017 is lower than in 2002-2003, the difference is not statistically significant. Unless significant improvements are made, this goal of only 30% of third grade children with decay experience will not be met. This suggests that Vermont needs to expand preventive dental care programs. The report for the 2022-2023 Basic Screening Survey of Children's Oral Health is being finalized, and updated data will be used to guide next steps in 2023.
Adequate fluoride intake and access to preventive dental care, including dental sealants, help prevent dental decay in children (CDC, 2022). Vermont has many positive factors that promote adequate fluoride intake and access to preventive dental care for children, such as:
  • Most VT children have comprehensive dental insurance coverage, thanks to Medicaid.
  • All health care insurers reimburse medical care providers for fluoride varnish applications in the medical home.
  • Public health dental hygienists in local health office WIC programs provide oral health education and help connect families enrolled in the WIC program with a dental home. They also work to promote integration of medical and dental health care within their communities.
  • The 802 Smiles Network serves as an umbrella for, and supports all dental health programs in schools across the state.
  • VT’s testing program for fluoride in well water is free for families of children under the age of four (knowing the fluoride concentration in the tap water ensures proper fluoride supplementation, when indicated).
  • In Vermont, dental services for pregnant women insured by Medicaid have no annual dollar cap; this helps to reduce transmission of bacteria that cause tooth decay from mother to child (da Silva Bastos et al., 2015).
Unfortunately, oral health disparities remain among Vermont children. Compared to children not eligible for the free and reduced meals (FARMs) program, children who are eligible for FARMs had significantly higher prevalence of untreated decay and decay experience (Vermont Department of Health, 2017). This highlights the need to support school-based dental health programs (where students can receive preventive dental care such as fluoride applications and sealants at school) through the 802 Smiles Network and to increase the percentage of Vermonters served by adequately fluoridated water systems.

Why Is This Important?

Cavities (also known as caries or tooth decay) are the most common chronic disease of childhood in the United States. Untreated cavities can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. Children who have poor oral health often miss more school and receive lower grades than children who don’t (Centers for Disease Control and Prevention, 2022).

Partners

What Works

Adequate fluoride intake and access to preventive dental care, including dental sealants, are effective interventions to help prevent dental decay in children (Centers for Disease Control and Prevention, 2022).

Strategy

We have chosen to focus our efforts to reduce tooth decay in children by promoting adequate fluoride intake and access to and utilization of preventive dental services, including dental sealants. We will do this by focusing on:
  • Ensuring that children have access to school-based oral health services through the 802 Smiles Network of School Dental Health Programs.
  • Helping to connect families with a dental home where their children can receive comprehensive and ongoing dental health care in a coordinated and family-centered manner
  • Partnering with medical and prenatal care providers to promote the integration of oral health services and messaging as part of prenatal care and well-child visits in the medical home
  • Ensuring that Vermont children have adequate fluoride intake by supporting community water fluoridation and promoting the free (for children under four) Fluoride in Well Water Testing Program.
Since children of lower socioeconomic status (in Vermont and nationwide) experience more cavities and less access to dental health services (Centers for Disease Control and Prevention, 2021 and Vermont Department of Health, 2017), we will focus our efforts towards Vermonters insured by Medicaid and enrolled in WIC and/or Head Start (income-eligible programs). 

Notes on Methodology

Decay (defined here as decay experience) refers to having untreated decay or treated decay including a dental filling, crown, or other type of restorative dental material. Decay experience also includes teeth that were extracted because of tooth decay. Children were screened by a dental hygienist in a sample of Vermont public schools.  The dental screenings by the hygienists were not complete diagnostic dental examinations (they did not include x-rays or more advanced diagnostic tools) so these numbers may underestimate the proportion of children needing dental care.
 
The Basic Screening Survey (BSS) of school children is a statewide standardized survey designed to collect observational information on the oral health of children in elementary school, as well as parent reported data on access to care. The BSS was developed by the Association of State and Territorial Dental Directors (ASTDD) with technical assistance from CDC. The survey is conducted in a sample of elementary schools.  Gross dental or oral lesions are recorded by dental hygienists in accordance with state law. The examiner records presence of untreated cavities and urgency of need for treatment. In addition, caries experience (treated and untreated decay) is recorded. School-age children are also examined for presence of sealants on permanent molars. Training materials and technical assistance are provided by ASTDD on sampling and analysis is available to states undertaking these surveys using the standard protocol. Sample weights were used to produce population estimates based on selection probabilities and indicating the number of children in the sampling interval each screened child represented. 

References

Information included on this page drew from research and the established literature. For more information, please see:

 

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