Vermonters have lifelong opportunities for oral health

% of adults aged 45-64 with disabilities who have lost at least one tooth due to tooth decay or gum disease


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Story Behind the Curve

Author: Oral Health Program, Department of Health
Updated: March, 2019

Adults with a disability in Vermont are more likely to have six or more teeth removed due to tooth decay or gum disease than adults with no disability. Even with risk factors like diabetes or cigarette use, adults without a disability are still less likely to have had any teeth extracted due to tooth decay or gum disease compared to adults with a disability. To address this problem, we have identified adults with disabilities as a target population for our state health improvement plan (SHIP) strategies. By involving adult Vermonters with disabilities in the development of strategies and work plans in the SHIP, we will increase the likelihood of reducing the oral health disparities that exist between adult Vermonters with and without disabilities. 

What Works

The Association of State and Territorial Dental Directors’ Best Practice Approach: Individuals with Special Health Care Needs (SHCN) and Their Oral Health Needs, 2011 outlines a number of strategies that can be employed to address the oral health care needs of people with disabilities. 


At the Vermont Department of Health, we will explore multiple strategies to promote oral health for Vermonters with disabilties. Examples include: 

  • Empower adults with disabilities and their families/caregivers and advocate for their oral health. 
  • Support, educate and train the dental workforce to serve adults with disabilities.
  • Extend coverage of oral health services in Medicaid for adults.
  • Enhance partnerships to support an oral health program of outreach, case management, preventive services and dental care for adults with disabilities.
Why Is This Important?

One in four Vermont adults has a disability. Adults with disabilities access dental care less and experience more tooth loss due to tooth decay or gum disease than adults who do not have a disability. This is important not only because of the role oral health plays on overall health, but also because oral health is related to a person’s ability to learn, work, sleep, and general quality of life. 

Individuals with disabilities face a number of behavioral, cognitive, and physical challenges that can adversely affect their health; oral health is no exception. In some cases, dental health care providers may not feel comfortable treating patients with disabilities. Additionally, lack of adequate insurance coverage may also be deterrent because it may not compensate for the additional time involved for the provider (Journal of Multi-Disciplinary Care, 2016) Addressing oral health disparities for Vermonters with disabilities is a State Health Improvement Plan. 

Notes on Methodology

This question about the number of permanent teeth removed because of tooth decay or gum disease is asked every other year. The Behavioral Risk Factor Surveillance System (BRFSS) asks several questions to determine an individual’s disability status. Disabilities identified by the BRFSS include mobility, cognitive, visual, hearing, self-care and independent living. The BRFSS does not include people living in institutions and group homes, who may be more likely to have a disability, and therefore may underestimate the prevalence of disability.

Vermont tracks risk behaviors using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS). Since 1990, Vermont, along with the 49 other states, Washington D.C. and U.S. territories, has participated in the BRFSS with the Centers for Disease Control and Prevention. Several thousand Vermonters are randomly and anonymously selected and called annually. An adult (18 or older) in the household is asked a uniform set of questions. The results are weighted to represent the adult population of the state. The results are used to plan, support, and evaluate health promotion and disease prevention programs. 
Due to BRFSS weighting methodology changes beginning in 2011, comparisons between data collected in 2011 and later and that from 2010 and earlier should be made with caution. Differences between data from 2011 forward and earlier years may be due to methodological changes, rather than changes in opinion or behavior.

The CDC provides the Vermont Department of Health with funding each year to carry out the survey. Currently, ICF Macro with an office in Burlington, Vermont, is the interviewing contractor for the Vermont BRFSS.

Beginning in 2009, Vermont started interviewing adult residents on cellular telephones as well as landline telephones. This change ensures the survey is conducted among a representative sample of Vermont adults and was made due to changing telephone patterns with more households using primarily cellular telephones.

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