Preventing Dental Caries with Community Programs

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The Reality

• Although dental caries (tooth decay) is largely preventable, it remains the most common chronic disease of children aged 5 to 17 years—4 times more common than asthma (42% versus 9.5%). 
• Once established, the disease requires treatment. A cavity only grows larger and more expensive to repair the longer it remains untreated. 
• Fewer than 1 in 5 Medicaid-covered children received at least one preventive dental service in a recent year; many states provide only emergency dental services to Medicaid-eligible adults. 
• Poor children have nearly 12 times more restricted-activity days because of dental-related illness than children from higher-income families. Pain and suffering due to untreated tooth decay can lead to problems in eating, speaking, and attending to learning. 
• Many adults also have untreated dental caries (e.g., 27% of those 20 to 39 years, 21% of those 40 to 59 years, and 19% of those 60 years and older). 

Community-Based Strategies Prevent Tooth Decay

Community Water Fluoridation

• CDC has recognized community water fluoridation as one of 10 great public health achievements of the 20th century.
• Community water fluoridation effectively prevents dental caries in communities with varying disease prevalence. Children in communities with water fluoridation experienced 29% fewer cavities. 
• At present, 67% of individuals on public water systems— more than 170 million people—are receiving the benefits of community water fluoridation.

School-Based Sealant Programs

• Children receiving dental sealants in school-based programs have 60% fewer new decayed pit and fissure surfaces in back teeth for up to 2 to 5 years after a single application. Among children, 90% of decay is in pits and fissures. 
• School-based sealant programs provide sealants to children unlikely to receive them otherwise (e.g., children in low-income households). Children of racial and ethnic minority groups have twice as much untreated decay in their permanent teeth, but only receive about half as many dental sealants.
• Although 29 states reported dental sealant programs serving 193,000 children, this number represents only about 3% of poor children who could receive sealants.

Meeting Healthy People 2010 Objectives

*There is no Healthy People 2010 objective for adult caries; 94% of adults who have one or more natural teeth have experienced tooth decay. 
Source: U.S. Department of Health and Human Services. Healthy People 2010, vol II. 2^nd ed. Washington, DC: U.S. Government Printing Office, 2000:21-11 to 21-15.

(A text version of this graphic is also available.)

Community-Based Strategies to Prevent Tooth Decay Save Money 

• Every dollar spent on community water fluoridation saves from $7 to $42 in treatment costs depending on the size of the community. Savings are greatest in large communities. 
• At least 60% of the U.S. population on public water systems has received fluoridated water since 1990, translating to savings in dental treatment costs of over $25.7 billion in the past decade 
• School-based dental sealant programs are cost saving when delivered to populations at high-risk for tooth decay, such as children in low-income households. 

Effective Strategies 

• Community and school partnerships raise awareness of the value of school sealant programs. Healthy Smiles for Wisconsin, a CDC-supported state-wide effort to improve the oral health of Wisconsin children through school and community partnerships, began in October 2000; it helped to establish 40 new community-based sealant programs during the 2000-2001 school year. During that year, more than 4,500 children in 40 counties received dental sealants. 
• Community coalitions are essential for gaining approval for community water fluoridation. During the past decade, broad-based citizen coalitions in several large U.S. cities have educated residents about the benefits of water fluoridation. Water fluoridation was approved in many of these jurisdictions, including Los Angeles and Sacramento, CA; Manchester, NH; Las Vegas, NV; San Antonio, TX; and Salt Lake City and Davis County, UT. 

Hope for the future 

Many Americans now enjoy markedly better oral health than their parents did. However, certain segments of the population (e.g., those who are poor, who are members of racial or ethnic minority groups, or who are elderly) still have severe dental decay, much of which remains untreated. Healthy People 2010 seeks to eliminate these disparities, so that all Americans receive the benefits of good oral health. Community-based programs are a particularly cost-effective way to help achieve this goal. For example, extending fluoridated water to the remaining 34% of the population on public water systems would save over $1.5 billion dollars per year. Increasing the percentage of children at high risk for tooth decay who participate in school sealant programs to 50% would prevent over half of the caries that these children would otherwise have and save public health dollars.

Historical Document
Page last modified: November 21, 2006
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion