Local Commentary

Senator Whipple

The death of a child in the District of Columbia some months ago from complications of untreated tooth decay reminded us of the importance of children’s oral health.

Recently I received a Legisbrief from the National Conference of State Legislatures on the topic and was pleased to see that Virginia was cited as a success story.

The article explained that dental disease is the most common chronic illness for children in the United States. It said that more than one-quarter of children have tooth decay in their baby teeth before the enter kindergarten and that by age 19, 68 percent have decayed permanent teeth.

Dental disease is preventable, yet dental care is the most common unmet health treatment need in children, and the problem disproportionately affects children in low-income families.

How can states address this issue?

Eleven states have mandated statewide water fluoridation. According to the Center of Disease Control and Prevention, water fluoridation to prevent tooth decay is one of the 10 greatest public health achievements of the 20th century.

Medicaid and the State Children’s Health Insurance Programs (SCHIP) are mandated by Federal law to include dental benefits, although SCHIP benefits vary from state to state. Nationwide, however, these programs have problems with dentist participation because of low reimbursement rates and heavy administrative burdens.

Here’s where the Virginia success story comes in and this is what the Legisbrief had to say about it:

”Virginia’s Smiles for Children program, which enrolls children in Medicaid and SCHIP, saw a 24 percent increase in the number of children receiving oral health care in its first year of operation. Dentist participation increased significantly, thanks to a 30 percent increase in reimbursement rates and a streamlined administrative process. A year after it began, one-quarter of dentists in Virginia participate. A single dental program administered by a single vendor simplifies the system for providers and parents.”

Other states are using systems of school-based outreach and prevention. About 40 state or local health departments are providing dental sealant programs in poor or underserved areas where children are less likely to have private oral health care.

Four states and the District of Columbia require children to have a dental exam before they start school. The most recent bill passed this year in Iowa.

Another approach is to train dental hygienists and other professionals to offer preventive services when dentists are scarce. Arizona, for example, allows hygienists to provide services in underserved areas if they are affiliated with a dentist, and the state is also trying to increase the supply of hygienists by funding community college programs.

The NCSL Legisbriefs, one of which I have quoted from liberally, are two-page issue papers. Each gives background material about an issue, gives examples of state actions, and lists resources and contacts for further information. As Chairman of the Health Care subcommittee of the Senate Education and Health Committee, I always pay particular attention to any health-related issue papers.