Dental health of school children - Oregon, 1991-92

Morbidity and Mortality Weekly Report, Nov 26, 1993

Oregon remains among the states and territories with the smallest proportion of its population receiving fluoridated water at optimal levels (8). Although water fluoridation for larger water systems is particularly cost-effective (9), only 11 of 39 Oregon cities or census-defined places with populations [greater than or equal to] 10,000 and only one of three cities with [greater than or equal to] 100,000 persons (1990 census) are fluoridated.

Several factors may contribute to the observed urban/rural differences in treatment needs. Community- and school-based programs may not exist in many rural areas, thus limiting access to primary preventive measures such as fluoridated water, fluoride mouthrinse, or dental sealant. In addition, access to care may be restricted in rural areas because most dentists practicing in these areas may not be "active"(*) Medicaid providers.

Reaching preschool children before dental caries occurs will require the cooperation of other health professionals. During well-child appointments, primary-care providers (e.g., pediatricians and nurse practitioners) should screen and refer young children for oral health prevention services (10).

Although the sample in Oregon was selected to ensure representation of all racial/ethnic groups and to allow comparison of their dental caries rates, anecdotal reports suggest that the participation level (40%) was adversely affected by sending informed consent forms home with children; by parents' perception that children who receive regular dental care need not participate in the survey; and by concerns about transmission of human immunodeficiency virus in clinical dental settings.

A dental survey requires trained examiners and substantial travel. Because such surveys are costly, they are conducted infrequently. Current data are essential for planning programs that use resources most effectively; therefore, alternate methods for routine assessment of oral health status (e.g., telephone interview data and respondent-assessed measures) must be developed and validated.

References

(1.)National Institute of Dental Research. Oral health of United States children, the national survey of dental caries in U.S. school children, 1986-87--national and regional findings. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1989; DHHS publication no. (NIH)89-2247.

(2.)Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991:349-64; DHHS publication no. (PHS)91-50212.

(3.)Division of Dental Health, North Carolina Department of Environment, Health, and Natural Resources. The North Carolina 1986-87 School Oral Health Survey. Raleigh, North Carolina: North Carolina Department of Environment, Health, and Natural Resources, October 1991.

(4.)Kumar J, Green E, Wallace W, Bustard R. Changes in dental caries prevalence in upstate New York schoolchildren. J Public Health Dent 1991; 51:158-63.