Report: Despite progress in oral health, Washington kids still get tooth decay

Problem has wide-reaching effects, especially for low-income children

Imagine trying to concentrate in school with pain. Thousands of children in our state do it every day due to tooth decay, which causes discomfort and infection. Dental problems also affect children’s self-esteem, ability to communicate and jaw development.

Washington has made progress in tackling youth oral health problems through a wide range of policies and programs, such as the Access to Baby and Child Dentistry program, school-based dental sealant programs and preventive oral health care delivered in primary pediatric-care settings. Our state’s rate of dental sealant placement on permanent molars is much higher than the national rate.

However, significant work remains. Tooth decay is still a concern for many Washington kids, according to the recently released Smile Survey 2015–2016: The Oral Health of Washington’s Children.

The Washington state Department of Health’s Smile Survey tracks the oral health of children in the state. (Stock photo)

This Department of Health survey included more than 13,000 kindergarten, second- and third-grade children in 76 public elementary schools and more than 1,400 preschool children from 47 Head Start and Early Childhood Education and Assistance Programs across the state. (First-grade students were not included in the study.)

The survey found that 53 percent of third graders, 50 percent of second graders, 38 percent of kindergartners and 45 percent of Head Start and ECEAP preschoolers had experienced tooth decay. Among the preschoolers, 21 percent had seven or more teeth with decay.

Tooth decay — also called cavities — results from the oral disease known as dental caries, which occurs due to a combination of certain germs and sugary or acidic foods and drinks that affect the teeth over time. Parents with tooth decay pass oral germs to their babies, who then have higher risk for dental caries. But preventive and treatment services that reach children early in life can help.

In addition to revealing how extensive tooth decay is among youngsters, the Smile Survey highlights disparities in oral health.

Children of color in second and third grades had significantly higher rates of tooth decay than white children. In addition, third-grade children who spoke languages other than English at home were found to need dental treatment at a 60 percent higher rate than English-only speakers. Third-grade children from lower-income households had a 66 percent higher rate of tooth decay than their higher-income peers.

Lower-income families may live in substandard housing or share housing, lack access to transportation, have community water systems that aren’t fluoridated, have trouble affording nutritious foods and may have language barriers — all which make it harder to get care and maintain good oral hygiene habits.

Dr. Mark Koday, chief dental officer at the Yakima Valley Farm Workers Clinic (Contributed photo)

“We need a serious change in our approach to preventing tooth decay because the current efforts to control this chronic disease are costly and will continue to fail the kids and families in our state who need the most help,” said Dr. Mark Koday, chief dental officer at the Yakima Valley Farm Workers Clinic.

There are resources for low-income families, and state health leaders continually work on ways to improve them. The state Medicaid program covers families with low incomes and pays for child dental visits. The Healthier Washington initiative is working to transform the way people pay for health care, putting the focus on quality.

“The Washington state Medicaid program is exploring new payment approaches to better incentivize quality and improve access,” state Medicaid Director MaryAnne Lindeblad said. “In addition, the Medicaid Transformation Demonstration Project just launched by the Health Care Authority creates opportunities for communities to pursue options to improve the delivery of child dental services.”

Koday has more recommendations for how to tackle this issue, including embedding dental hygienists in medical practices, where children may be seen more frequently than in dental offices. He also suggests exploring a system that rewards high-quality care and a lower rate of disease, and a payment structure that includes front-end prevention, starting with pregnant moms.

Barriers to good oral health in children include substandard housing, lack of transportation, non-fluoridated drinking water, and limited access to nutritious foods. (Stock photo)

One solution to preventing tooth decay — fluoridation — has major potential to improve children’s oral health.

“Children should not have more cavities simply because they live in Olympia, Spokane or Bellingham — communities where the water does not have adequate fluoride to help prevent tooth decay,” said Diane Oakes, president of the Washington Dental Service Foundation. “Nationally, 75 percent of people have access to community water fluoridation. In Washington, it’s just over 50 percent. The Smile Survey shows that there is a huge opportunity to dramatically improve health with this one cost-effective solution.”

The Smile Survey project is a collaborative effort between DOH’s Oral Health Program in the Community-Based Prevention Section and the Surveillance and Evaluation Section in the Office of Healthy Communities. For your daily dose of healthy information, check out the Department of Health website. You can find DOH on Facebook and Twitter.