Although dental caries (tooth decay) is largely preventable, it remains
the most common chronic disease of children aged 6 to 11 years (25%), and
adolescents aged 12 to 19 years (59%). Tooth decay is four times more common
than asthma among adolescents aged 14 to 17 years (15%).
Once established, the disease requires treatment. A cavity only grows
larger and more expensive to repair the longer it remains untreated.
Fewer than 1 of 3 children enrolled in Medicaid received at least one
preventive dental service in a recent year. Many states provide only
emergency dental services to Medicaid-eligible adults.
Many adults also have untreated tooth decay (e.g., 28% of those 35 to 44
years and 18% of those 65 and older).
Community-based Strategies Prevent Tooth Decay
Community Water Fluoridation
CDC recognizes community water fluoridation as one of 10 great public
health achievements of the 20th century.
Community water fluoridation still prevents tooth decay even though
people now also get fluoride from other sources such as toothpaste, rinses,
and other topical applications at the dental office.
As of 2010, 73.9%—204.3 million Americans—are receiving the benefits of
community water fluoridation.
School-based Sealant Programs
Children receiving dental sealants in school-based programs have 60%
fewer new decay in the pit and fissure surfaces of back teeth (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.
36 states reported dental sealant programs serving 258,000 children.
This number, however, represents only about 8% of lower income children who
could receive sealants.
Table I. Meeting Healthy People 2010 Objectives (Source: Healthy People 2010)
Baseline caries experience
Having one or more teeth with untreated or
filled carious lesions (dental decay).
Healthy People 2010 Target
(There is no Healthy People 2010 objective for adult caries; 95% of
adults [aged 20 to 64 years] who have one or more natural teeth have
experienced tooth decay.)
Baseline untreated decay
(Having one or more teeth with untreated carious lesions [dental decay])
Health People 2010 Target:
Baseline untreated decay
Source: Health People 2010
Community-based Strategies to Save Money
Every dollar spent for community water fluoridation saves from $8 to $49
in treatment costs depending on the size of the community. Savings are
greatest in large communities.
Fluoridated water saves more than $4.6 billion annually in dental costs
in the United States.
School-based dental sealant programs are cost saving when delivered to
populations at high-risk for tooth decay, such as children in low-income
Community and school partnerships raise awareness of the value of school
sealant programs. Healthy Smiles for Wisconsin, a CDC-supported statewide
effort to improve the oral health of Wisconsin children through school and
community partnerships, began in October 2000. This program helped to
establish new community-based sealant programs, and in 2007–2008 these
programs provided sealants to 9,202 children in 19 counties.
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 community 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, 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, and who are elderly) still have
severe tooth decay, much of which remains untreated. Healthy People 2010
objectives seek to eliminate these disparities so that all Americans receive the
benefits of good oral health. Community-based programs, such as community water
fluoridation and school-based dental sealant programs, are an effective and
cost-saving way to help achieve this goal. For example, increasing the
percentage of children at high risk for tooth decay who participate in school
sealant programs to 50% would prevent more than half of the caries that these
children would otherwise have and save public health dollars.
Programs in Action: Ohio
School-based sealant programs in Ohio began in 1984 with a single
demonstration program in one city. By 2000, 34 of Ohio’s 88 counties
had programs. These programs target children who are at high risk
for tooth decay and least likely to receive dental care.
the program has expanded, the percentage of 8-year-olds statewide
who have dental sealants has increased steadily, from 11% in
1987–1988 to 30% in 1998–1999 to 43% in 2007. Although this
percentage still falls short of the Healthy People 2010 objective of
50%, children from all demographic groups in schools with sealant
programs have achieved or exceeded the objective.
The Ohio program has met only a portion of the need for dental
sealants, but has already shown that school-based programs can reach
children at high risk for tooth decay and could potentially reduce
or eliminate racial and economic disparities in the prevalence of
this effective preventive measure.