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Why This Topic Is Important
Oral health affects overall health and is essential for healthy development (1, 2). Tooth decay is the most common chronic disease and the greatest unmet health need among children in California and the U.S. (1, 3, 4). Untreated dental problems such as cavities and gum disease can affect a child's health and quality of life by causing pain, loss of teeth, impaired growth, sleep and speech issues, self-confidence problems, poor school performance, and increased school absences, among other issues (1, 2, 3). Nationwide, children miss more than 51 million hours of school each year due to dental problems (3).

Tooth decay is an infectious disease that can be transmitted from mothers to their infants, making oral health for pregnant women a critical public health issue (1, 4). Problems with oral health and access to dental care disproportionately affect people of color, low-income families, those with public or no insurance, and those in rural areas (2, 3, 5). For example, children in these groups—especially young children—are less likely to receive routine dental checkups, which are critical for preventing tooth decay (1, 2). In California, the disparity in oral health between lower- and higher-income children is among the worst in the nation (4). In addition, California children with public insurance are more likely to have oral health problems not only when compared with those with private insurance but also when compared with those who are uninsured; this may be due to the state's low reimbursement rates for providers, along with other barriers to accessing care (4).
For more information about children's dental health, see kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  Mariani, M., et al. (2016). Healthy mouth, healthy start: Improving oral health for young children and families through early childhood home visiting. Children's Partnership. Retrieved from: https://www.childrenspartnership.org/research/healthy-mouth-healthy-start-improving-oral-health-young-children-families-early-childhood-home-visiting

2.  Hummel, J., et al. (2015). Oral health: An essential component of primary care. Qualis Health. Retrieved from: https://www.safetynetmedicalhome.org/resources-tools/white-papers

3.  U.S. Preventive Services Task Force. (2021). Screening and interventions to prevent dental caries in children younger than 5 years: U.S. Preventive Services Task Force recommendation statement. JAMA, 326(21), 2172-2178. Retrieved from: https://jamanetwork.com/journals/jama/fullarticle/2786823

4.  Schor, E. (2014). Dental care access for children in California: Institutionalized inequality. Lucile Packard Foundation for Children's Health. Retrieved from:
https://www.lpfch.org/publication/dental-care-access-children-california-institutionalized-inequality

5.  Mandal, M., et al. (2013). Changes in children's oral health status and receipt of preventive dental visits, United States, 2003–2011/2012. Preventing Chronic Disease, 10, 130187. Retrieved from: https://www.cdc.gov/pcd/issues/2013/13_0187.htm
Policy Implications
All children need access to high quality, affordable dental care. Increasing attention now focuses, too, on the importance of good oral health for expectant mothers, as tooth decay is infectious and can spread to infants (1, 2). California ranks among the worst in the nation on measures of children's oral health and access to dental care, with the highest rates of dental disease and greatest barriers to care consistently experienced by very young children, children of color, and those with low family incomes (1, 2, 3).

The federal Affordable Care Act (ACA) includes dental health care for children among the essential health benefits that must be covered by all qualified health insurance plans, a major step forward in ensuring access to oral health care for children (4). California also has restored funding for the Children's Dental Disease Prevention Program, which provides school-based oral health education and services to low-income children, and developed a statewide oral health plan aimed at informing and educating the public, improving dental care access and utilization, and addressing oral health disparities (5). While these and other changes represent significant progress, continued efforts are needed to ensure that all children and pregnant women have access to high quality, affordable dental care.

Policy and program options that could influence child and maternal dental health include:
  • Improving public education, especially for families enrolled in public insurance programs, about the availability and value of preventive dental care and the importance of good oral health; these efforts should be culturally and linguistically appropriate, and reach families through schools, community partners, or other avenues that are already used and trusted by families (2, 4)
  • Continuing to identify and apply best practices for increasing children's access to high-quality dental care; for example, ensuring that California's Dental Transformation Initiative is leveraged effectively to achieve long-term improvements in access to preventive care for children (4, 5)
  • Supporting existing efforts to increase reimbursement rates for dental care providers under public insurance programs (2)
  • Increasing the number of dentists serving children and expectant mothers where Medi-Cal patients live, including providers who are linguistically and culturally responsive to communities of color (1, 2, 4)
  • Maintaining and expanding evidence-based strategies that bring dental care to underserved communities, such as telehealth and school-based services; also, expanding strategies to reach very young children and expectant mothers in need, e.g., through home-visiting programs (1, 2, 4, 6)
  • Ensuring that all communities have fluoridated drinking water (2, 5)
  • Promoting collaboration across medical and dental disciplines to ensure consistent, accurate oral health education—covering screening, parent education, and topical fluoride application—for child health care providers (2, 3, 5)
  • Supporting efforts to integrate dental care into primary care for expectant mothers (2, 3, 5)
For more policy ideas and research on this topic, see kidsdata.org’s Research & Links section or visit California's Office of Oral Health, California Dental Association, American Academy of Pediatric Dentistry, and American Academy of Pediatrics.

Sources for this narrative:

1.  Mariani, M., et al. (2016). Healthy mouth, healthy start: Improving oral health for young children and families through early childhood home visiting. Children's Partnership. Retrieved from: https://www.childrenspartnership.org/research/healthy-mouth-healthy-start-improving-oral-health-young-children-families-early-childhood-home-visiting

2.  Schor, E. (2014). Dental care access for children in California: Institutionalized inequality. Lucile Packard Foundation for Children's Health. Retrieved from:
https://www.lpfch.org/publication/dental-care-access-children-california-institutionalized-inequality

3.  Hummel, J., et al. (2015). Oral health: An essential component of primary care. Qualis Health. Retrieved from: https://www.safetynetmedicalhome.org/resources-tools/white-papers

4.  Schneider, L., et al. (2016). The Affordable Care Act and children's coverage in California: Our progress and our future. Children's Partnership. Retrieved from: https://www.childrenspartnership.org/research/the-affordable-care-act-and-childrens-coverage-in-california-our-progress-and-our-future

5.  California Department of Public Health, Oral Health Program. (2018). California oral health plan 2018–2028. Retrieved from: https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDCB/CDPH%20Document%20Library/Oral%20Health%20Program/FINAL%20REDESIGNED%20COHP-Oral-Health-Plan-ADA.pdf

6.  Glassman, P. (2019). Expanding oral health: Teledentistry. CareQuest Institute for Oral Health. Retrieved from: https://www.carequest.org/resource-library/expanding-oral-health-teledentistry
How Children Are Faring
According to 2017-2018 estimates, 80% of California children ages 2-11 had visited a dentist, hygienist, or orthodontist in the previous six months, up from 70% in 2009. The estimate for adolescents ages 12-17 was 78% in 2017-2018, similar to previous years.

In 2017-2018, fewer than 1 in 16 children ages 2-11 (6%) and fewer than 1 in 60 adolescents ages 12-17 (1.5%) had never had a dental visit. Across regions with data, the estimated percentage of children ages 2-11 who had never had a dental visit ranged from 4.5% to 9%.