Health Policy Brief

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TO: Melinda Katz, Queens Borough President

FROM: Lingyi Mei

DATE: 1/19/2018

Re: Reducing Early Childhood Tooth Decay in Queens, NY


Statement of Issue:

Tooth Decay is largely preventable, yet it still remains the most common chronic illness for children. Untreated tooth decay can cause pain and infections that may lead to missed school days, poor appearance, decreased self-esteem and even death. Nearly half of all children entering kindergarten have had at least one cavity and three-quarters have untreated cavities. In the U.S, 9 million children lack health insurance, and more than twice that number lack access to oral health services. The percentage of children with untreated tooth decay is twice as high for those from low-income families compared with children from higher-income families. This is implying that the current oral health care system is not adequately addressing the needs of children with the highest risk for poor oral health.


States often use periodicity schedules that do not align with updated professional guidelines. This will limit the frequency of dental visits and preventive services, despite a child’s level of risk. Periodicity schedules may imply limits for patients and providers.


Socioeconomic forces that place these children at risk of untreated dental decay. Children living in poverty do not visit the dentist as regularly. Besides health insurance coverage, barriers such as provider office location and whether a practice accepts Medicaid insurance could impact utilization.


Connection between nutrition and oral health condition. Food insecure families tend to have less control over food selection. The nutritional scale in lower income communities is leading towards more cariogenic food.


Poor oral health status lead to problems with learning and other medical conditions. Children were 3 times more likely than their peers to miss school as a result of dental pains. Health issues that are caused by poor oral health include cardiovascular disease, respiratory infections, renal disease, diabetes, etc.


Policy Options:

  • State dental periodicity schedules should serve as the minimum recommended frequency for preventive oral health visits, rather than the maximum allowable frequency of preventive oral health visits. States should also consult with professional dental organizations in developing their dental periodicity schedules.
  • Advantages: This will allow the building in the flexibility for providers to follow clinical guidelines, which will be directed at providing evidence-based approaches to prevention. Adherence to professionally recommended best oral health practices will meet the medical and dental needs of the children. Children’s access of dental health care will not be limited by the dental periodicity schedule.
  • Disadvantages: expanding the frequency of preventive care will increase the cost for preventive care.


  • Explore opportunities to invest in fluoride tooth brushing programs through early childhood education programs. Asking the Centers for Medicare and Medicaid Services to allow the use of Medicaid administrative dollars to support investment in community water fluoridation efforts.
  • Advantages: Fluoride combats tooth decay and prevents the acid produced by the bacteria in plaque from dissolving, or demineralizing tooth enamel.  It can reverse low levels of tooth decay and thus prevent new cavities from forming.  Children with at least 4 fluoride varnish application between ages 6 months and 35 months experienced the least decay.
  • Disadvantages: People have raised questions about the safety and effectiveness of water fluoridation.  Some researches have shown a small link between fluoride consumption and osteosarcoma, a rare form of bone cancer.
  • State should reimburse medical providers for performing oral health risk assessments, providing anticipatory guidance, and applying preventive fluoride varnish to children. Also offering primary care physicians access to a network of referring dentist.
  • Advantages: To reduce the incidence of caries and improve children’s access to preventive oral health care. Medical providers will be more willing to perform oral health assessment on children when there is an effective referral structure to ensure patient access on follow up dental care.  Dental preventive care is less expensive than inpatient dental care for caries-related conditions.
  • Disadvantages: Will be relying on other health care providers to perform oral screenings in children, rather than dentists.


Policy Recommendations:

Dental disease can impact all aspects of children’s lives, from their nutrition to their educational performance and self-esteem.  States have an important role to play in the adoption and implementation of strategies to promote the use of oral health care among children enrolled in Medicaid. Improving state Medicaid program performance through policy changes will lead to enhanced oral health care access and utilization for children.  The goal of the new policies will be focused on increasing dental preventive care and avoiding expensive inpatient dental care for caries-related conditions in the future.