Improving children’s oral health in Colorado - Part I

By: Amy Cotton

Earlier this year, the Colorado Department of Public Health and Environment (CDPHE) released a report showing impressive statewide improvements in children’s oral health over the past decade. The Children’s Dental Health Project (CDHP) asked agency staff to walk through some of the data and share some strategies they believe helped to achieve progress. CDHP’s Amy Cotton posed several questions to Natalie Thomas, the child and school oral health coordinator within CDPHE.

The following Q&A is the first of a two-part blog:

1. What are some key markers of the state’s recent progress in children’s oral health?

Fewer Colorado children entering kindergarten today have experienced tooth decay than 10 years ago. Our data shows 31% of kindergarteners experienced caries – the disease that causes tooth decay - in the 2016-2017 school year. That’s down from over 45% (a more than 14 percentage point decline) from the 2006-2007 year:

Additionally, more kids’ treatment needs are being met. While 23% of kindergarten-age kids had untreated dental disease in 2006-2007, we have reduced that to less than 18% of kindergarten children today. Expanding access to treatment that can address dental disease is one element of our recent success, while we are also focused on preventing early childhood caries.

Another indicator of our state’s success is seen in older children. Among students in third grade, the percent of children who have dental sealants has improved:

Sealants are thin coatings painted on the chewing surfaces of teeth to help avoid dental disease. Between 2006-2007 and 2016-2017, the percent of third graders with sealants increased from 37 to 57 percent. This is good news, as sealants are highly effective in preventing decay and make the most of our fiscal resources.

2. Improvements in kids’ oral health have been attributed, in part, to programs like Cavity Free at Three. What does the program do and how has it helped boost children’s oral health over the past decade?

Cavity Free at Three helps improve the health of Colorado’s children and pregnant women by training medical and dental professionals to provide their patients with preventive oral health services. With shortages in our dental workforce, other health care professionals are essential to fill in the gaps. Medical providers can help address oral health very early in a child’s life and connect families to a “dental home.” The program helps establish a dental home for children before age one. Providers can also remind pregnant women that it is safe and important to go to the dentist, for their health and their child’s health. Our program offers patient education resources for both parents and pregnant women in nine different languages.

One effective strategy this program uses is promoting fluoride varnish and risk assessment in both medical and dental settings. Research demonstrates that children who receive four fluoride varnish applications by age three have lower rates of tooth decay. Cavity Free at Three helps providers incorporate oral health screenings, placement of varnish, and billing for those services. One of our regional oral health specialists, Julie Nutter, relayed how it’s clear our program is making a real difference. She told us that a provider who does oral health screenings in Salida said he saw much less decay at the Early Childhood Center last year than in previous years. He attributed it to the Cavity Free at Three clinics she provides twice per year.

Success in reaching children who need these services is partly because of Colorado’s provider payment policies. The state adequately reimburses health providers for delivering oral health services in medical settings. Cavity Free at Three offers ongoing assistance to support organizations with that key administrative aspect of the system.

3. National-level data released earlier this year pointed to persistent challenges in oral health disparities. What gaps in oral health equity among Colorado families did your report reveal? And what may be behind them?

Colorado children are much more likely to have received sealants on permanent teeth regardless of their race or family income compared to children across the U.S., on average. But we still see concerning economic and racial disparities. For example:

  • In schools where a majority of students are in low-wage families, nearly half (44%) of all kindergarteners had at least one cavity in 2016-2017. By contrast, this was the experience for only 15 percent of kindergarteners in more economically secure families.
  • Just over four in 10 Latino kindergarteners experienced dental disease, nearly double the percentage of their white peers (nearly 41 percent versus about 23 percent, respectively).
  • Among third graders, one in four black children (25%) had untreated tooth decay as compared to just over one in 10 (13%) among their white peers.

Overall, the system is not organized to meet the needs of historically marginalized communities, who face higher barriers to good oral health.

We also are aware of geographic disparities. In rural areas, children with Medicaid coverage often face challenges finding dental care. In seven of Colorado’s 64 counties, families do not have local access to any dental services. This means they must often drive substantial distances or face long waiting lists to access oral health care. Overall, the system is not organized to meet the needs of historically marginalized communities, who face higher barriers to good oral health. Several local and federal policies have created an environment where many Coloradans, across generations, are limited in their access to healthy food, clean water, low-cost transportation, and the ability to live in safe neighborhoods. These social determinants of health need our attention. We can do more to support communities of color and low-wage families, wherever they live, in achieving optimal oral health.

Stay tuned for additional insights on Colorado children’s oral health gains in the second post of this two-part article, coming soon.

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Did you know?

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Children with poor oral health were nearly 3x more likely to miss school due to dental pain.
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