New report: Simple school-based program could solve a big health problem for poor and rural kids

While tooth decay is sometimes perceived as a childhood rite of passage, elementary school-aged children missing school and causing parents to miss work due to painful toothaches are no laughing matter. Parents of children with poor oral health miss twice as much work as their counterparts, due to preventable, unnecessary tooth pain.

A new report from NC Child entitled “School-Based Sealant Programs: An Innovative Approach to Improve Children’s Oral Health,” shows that dental decay is not spread evenly across the state; children from poor, rural counties tend to have the highest rates of decay. Dentists are also spread unevenly across the state. In three counties–Camden, Hyde, and Tyrrell–there are no dentists. In Sampson and Duplin counties there are just 1.7 dentists per 10,000 people, far below the national average of 6.1 dentists per 10,000. Wake County, by contrast, has 7.9 dentists per 10,000 people.

Tooth decay is a preventable chronic disease that has far-reaching health and social consequences. School-based sealant programs are a proven approach that the state should expand to prevent dental caries. North Carolina can follow models established in other states to save money and eradicate this unnecessary, painful condition for children in our state.

According to the report, school-based sealant programs offer a powerful solution to address dental decay. Sealants cut cavities by 80 percent for up to two years, and 50 percent for up to four years. Because dental hygienists provide sealants in school-based programs, children in areas without an accessible dentist can receive much-needed preventive care.

States like Kansas, Ohio, and Oregon have achieved impressive declines in expensive, painful dental decay with school-based sealant programs. North Carolina could follow suit — but current regulations are getting in the way. This is from the report:

“North Carolina is uniquely positioned to benefit from SBSPs. The majority of dentists in North Carolina practice in 20 primarily urban and suburban counties, leaving 80 percent of the state primarily rural areas) with reduced access to dental professionals. Although North Carolina’s dentist-to-population ratio has improved over the past several years, 72 percent of growth has occurred in urban and suburban counties, leaving geographic disparities unaddressed. In addition, the American Dental Association reports that only 30.7 percent of NC dentists participated in children’s public insurance programs in 2015….

Across the board, children of color are more likely to arrive at Kindergarten with untreated decay than non-Hispanic white children. Where a child grows up also impacts his or her oral health. Children in rural North Carolina are more likely to experience untreated decay than their counterparts in urban and suburban counties. These geographic disparities are mirrored by dentist-to-population ratios: the largely rural regions of the state that have persistent shortages of dentists also have higher numbers of children entering school with untreated decay.

Over the past decade, North Carolina has made enormous strides in improving early childhood access to preventive care, but the state has significant room to improve sealant access. In 2015, the Pew Charitable Trusts released a 50-state report in which North Carolina received a “D” grade for sealants, in part due to its inability to fully implement SBSPs.”

Unfortunately, the interpretation of current policy prevents dental hygienists from providing preventive care, including sealants, without a prior dental exam. This restriction makes the wide-scale adoption of SBSPs challenging, since so many of the children in need don’t have access to dental services.

The report includes the following recommendations to improve children’s oral health and academic outcomes:

1. Reduce oral health disparities and target all children at high risk for tooth decay by promoting and expanding dental sealant placements in school-based settings.
2. Staff school-based sealant/prevention programs with dental hygienists operating under the direction of public or private dentists.
3. Increase children’s access to sealants by eliminating unnecessary rules that limit the use of appropriately-trained and licensed dental hygienists in placing sealants.

Ready for Kindergarten means a new backpack, a box of crayons, pencils, and a bright smile. Too many children show up on the first day of school with painful, untreated tooth decay that will mean missed school days and missed opportunities to learn on track with their peers. It’s time to fix this totally preventable, painful problem with a common-sense solution that is already saving money and alleviating children’s suffering in other states.

Sarah Vidrine is the Oral Health Policy Analyst at the advocacy group NC Child. She co-authored the report with MSW Intern Abby Hamrick.