Author Affiliations: Departments of Pediatrics, Pediatric Dentistry, Medical History and Ethics, and Health Services, University of Washington, and Children's Hospital and Regional Medical Center, Seattle (Dr Mouradian); Center for Health Services Research and Policy, George Washington University School of Public Health and Health Services, Washington, DC (Ms Wehr); and Department of Pediatric Dentistry, University of Connecticut Health Center, Storrs-Mansfield (Dr Crall).
Dental caries can be prevented by a combination of community, professional,
and individual measures including water fluoridation, professionally applied
topical fluorides and dental sealants, and use of fluoride toothpastes. Yet,
tooth decay is the most common chronic disease of childhood. Dental care is
the most prevalent unmet health need in US children with wide disparities
existing in oral health and access to care. Only 1 in 5 children covered by
Medicaid received preventive oral care for which they are eligible. Children
from low income and minority families have poorer oral health outcomes, fewer
dental visits, and fewer protective sealants. Water fluoridation is the most
effective measure in preventing caries, but only 62% of water supplies are
fluoridated, and lack of fluoridation may disproportionately affect poor and
Childhood oral disease has significant medical and financial consequences
that may not be appreciated because of the separation of medicine and dentistry.
The infectious nature of dental caries, its early onset, and the potential
of early interventions require an emphasis on preventive oral care in primary
pediatric care to complement existing dental services. However, many pediatricians
lack critical knowledge to promote oral health. We recommend financial incentives
for prioritizing Medicaid Early and Periodic Screening, Diagnostic, and Treatment
dental services; managed care accountability; integration of medical and dental
professional training, clinical care, and research; and national leadership.
Mouradian WE, Wehr E, Crall JJ. Disparities in Children's Oral Health and Access to Dental Care. JAMA. 2000;284(20):2625-2631. doi:10.1001/jama.284.20.2625