"Look Mom, no cavities!"
Unfortunately, that line from an old toothpaste commercial is not what many Washington State school children can say. A 1994 survey of third-grade students conducted by UW researchers showed that a third of the children in the state had unmet dental needs. About 20% of these children experienced 84% of the cavities. The study revealed that 64% of the students were free of cavities, or caries, in the permanent teeth.
These findings and others were the foundation for expanding access to dental care for children in the region. In large part, they led to the legislative action that increased Medicaid dental funding in the State of Washington.
The study was undertaken at least in part because national studies of children's oral health have had limited sampling rates within any one state. Indications from community and professional sources had suggested that many children in Washington experience high caries rates.
The goal of this study was to obtain information about children's dental health at the county level—the smallest political unit for policy-making that would be useful for state legislators, and the level at which services are organized and delivered. In the study, dental exams were performed on 2921 children in 84 public schools covering all 39 counties in Washington. Incidence of caries, the presence of sealants, and the prevalence of fluorosis (chalky, white spotting of the permanent teeth) were documented.
The work was carried out with funding from the Washington Dental Service Foundation by a team of researchers, led by UW professor Peter Domoto, involving the UW School of Dentistry, the Washington State Dental Association, the State Department of Health, and the Superintendent of Public Instruction, among other organizations.
UW dental students and faculty were trained in study procedures and went out to counties around the state. Seventy-five students and 15 faculty members worked with 33 local dentists who served as county coordinators in the selected schools.
The researchers found that the average number of decayed and filled surfaces per child in Washington ranged from 2.4 to 7.4, with a state-wide average of 4.7, including an average of 1.2 active cavities. On average, 33% of children studied had at least one decayed surface. Overall, mild fluorosis was found in 7.6% of the children, and 34% had sealants on one or more permanent molars.
The survey results show there is a great deal of variability between counties in dental disease rates and in the numbers of children with unmet treatment needs. Higher disease rates were associated with lower economic level.
In addition, the study found a large variability between counties in the use of pit and fissure sealants. "We believe this reflects the varying degrees of access to dental care in general, found in the different regions of the state," says Domoto. The researchers found that about 1 of 7 children in the state are covered by Medicaid funding; and the uninsured rate among children in some parts of Washington approaches 25%. The findings resulted in legislative action which allocated increased funding for these economically disadvantaged children.