Last Updated: August 2023

Author: Office of Oral Health, Vermont Department of Health

Nationwide, tooth decay affects more than half of all children by the third grade. There is a significant link between socioeconomic status (SES) and health. Children from lower-SES families are less likely to access medical and dental care and to have higher rates of dental disease.

The National School Lunch Program (NSLP) is a federally assisted meal program that offers low-cost or free meals to children attending public and nonprofit private schools. Eligibility for NSLP is often used as an indicator of SES status. Children eligible for NSLP are significantly more likely to have decay experience and untreated decay. This suggests that lower-income children are not getting the benefit of early preventive services and are less likely to access a dentist for restorative treatment. To address this problem, Vermont will expand community-based prevention programs, screening and referral services, and restorative dental care programs that target low-income children.

The Basic Screening Survey (BSS) of school children is a statewide standardized survey used to collect observational information on the oral health of children in elementary school. The 2022-2023 BSS was recently completed, and data analysis is in progress. Data for this indicator should be available by the end of 2023.

Although tooth decay (dental caries) is a preventable bacterial disease, it continues to be the most common chronic disease of children in the United States. In fact, it is five times more common than asthma and two times more common than childhood obesity. 

Preventing tooth decay improves a child’s health and keeps them from having costly dental care. Because of this, ending cavities saves money for both the family and society. Annual spending on dental care in the U.S. is well over $100 billion, representing nearly 20% of children’s overall health spending. 

Early dental visits may reduce the need and cost associated with future treatment. There is no better investment in the future of Vermont than supporting the health and well-being of our children

Partners include, but are not limited to:

• The Department of Vermont Health Access
• The Vermont State Dental Society
• Vermont Dental Hygienist's Association
• The Vermont Public Health Association 
• Bi-State Primary Care Association
• The University of Vermont
• The Vermont Health Department’s Local Health Offices

• The Community Preventive Services Task Force (CPSTF) recommends school-based programs to deliver dental sealants and prevent dental caries (tooth decay) among children. 
• Data synthesized from systematic reviews demonstrate that fluoride varnish, sealants, and silver diamine fluoride reduce caries risk by approximately 40%, 80%, and 80%, respectively.
• Cultural competence training for health care professionals shows strong evidence of improving health outcomes. 
• Provision of preventive dental services in primary care practice helps to improve oral health for all populations, especially for underserved.

• Providing quality dental care in nontraditional settings (such as schools) and using teledentistry allows for timely access to oral health prevention, education and dental health care and can help address barriers such as transportation and getting time off from work for dental appointments. Oral health services by school-based or community clinics can involve partnerships with local dental providers. The Vermont Department of Health’s Office of Oral Health coordinates the 802 Smiles Network of School Dental Health Programs.
• Improving the quality of care (e.g. better aligning incentives with evidence-based care) results in positive oral health outcomes and improves oral health equity.
• Providing trainings for health care professionals to enhance their cultural competency skills and their ability to treat people with disabilities improves the quality of care and decreases health disparities. Research shows that “The skills acquired through caring for patients with disabilities are transferrable to other patient care and foster general professionalism.”
• Integrating oral health care and messaging into patient-centered medical homes strengthens primary care systems increases awareness of the importance of oral health and makes oral health preventative care more accessible. This model of care may include co-location of dental services in medical homes and/or inclusion of dental professionals on the medical care team, bidirectional referrals between medical and dental professionals, and integration of oral health messages and services as part of prenatal and pediatric care.

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 representative 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.

1. US Department of Health and Human Services Oral Health Strategic Framework, 2014-2017
2. Collaboration Between Medical Providers and Dental Hygienists in a Pediatric Health Care Setting 
3. Community Preventive Services Task Force Recommendation: Preventing Dental Caries, School-Based Dental Sealant Delivery Programs
4. Addressing Social Determinants of Health and Health Disparities
5. A systematic review of the research evidence for the benefits of teledentistry
6. Advancement of Teledentistry at the University of Rochester’s Eastman Institute for Oral Health
7. Report of the Virtual Dental Home Demonstration: Improving the Oral Health of Vulnerable and Underserved Populations  Using Geographically Distributed Telehealth‐Connected Teams
8. Getting the Incentives Right: Improving Oral Health Equity with Universal School-Based Caries Prevention
9. County Health Rankings & Roadmaps – Cultural competence training for health care professionals  
10. Keep Smiling Vermont – The Oral Health of Vermont’s Children 2016-2017
11. Educating Health Professionals about Disability: A Review of Interventions