Majority of States Fail to Ensure Proper Dental Health & Access to Care for Children

An estimated one in five children in America go without dental care each year and two thirds of states do not have effective policies in place to ensure proper dental health and access to care, according to a report by the Pew Center on the States.

The Cost of Delay: State Dental Policies Fail One in Five Children, released with support from the W.K. Kellogg Foundation and the DentaQuest Foundation, grades each state's policy responses to the urgent challenges in dental health among America's low-income children. February is National Children's Dental Health Month.

"Millions of children go without dental care each year but the good news is, it's fixable," said Shelly Gehshan, director of the Pew Children's Dental Campaign. "By enacting a handful of effective policies, states can help eliminate the long-term health and economic consequences of untreated dental problems among kids. Several states are leading the way—but all states can and must do more to ensure access to dental care for the 17 million children left out of the system."

Pew scored all 50 states and the District of Columbia, using an A-F scale, on whether and how well they are employing eight proven policy solutions to ensure dental health and access to care for children. These policies fall into four categories: cost-effective ways to help prevent problems from occurring in the first place; Medicaid improvements that enable and motivate more dentists to treat disadvantaged children; new workforce models that expand the number of qualified dental providers; and gathering data to gauge progress and improve performance.

Only six states merited "A" grades: Connecticut, Iowa, Maryland, New Mexico, Rhode Island and South Carolina. These states met at least six of the eight policy benchmarks and had policies in place that met or exceeded the national performance standards. These high grades do not mean that all people in the state have access to quality dental care services. Severe access problems still exist in states that received "A" grades, but these states have policies in place needed to improve dental care.

Nine states received a grade of "B": Alaska, Colorado, Idaho, Illinois, Maine, New Hampshire, Ohio, Texas and Washington. Twenty states received a grade of "C" because they met four or fewer of the eight policy benchmarks. Six states and the District of Columbia earned a "D" grade: Alabama, Indiana, Mississippi, Montana, Nevada and Utah. Nine states earned an "F," meeting only one or two policy benchmarks: Arkansas, Delaware, Florida, New Jersey, Hawaii, Louisiana, Pennsylvania, West Virginia and Wyoming. No state met all eight targets. New Jersey ranked lowest in the nation, meeting only one benchmark.


There are many solutions that can be achieved at relatively little cost and the return on investment for children and taxpayers will be significant. Americans are expected to spend $106 billion on dental care in 2010. This includes many expensive restorative treatments – from fillings to root canals – that could have been mitigated or avoided altogether with earlier, easier and less expensive ways of ensuring adequate dental care when they were children.

The Pew report highlights four proven solutions that can improve both the dental health of children and their access to care:

• Sealants: Protective coatings applied to the teeth by a dentist or hygienist cost one third as much as filling a cavity and have been shown to prevent 60 percent of cavities. School-based programs are the most cost-effective strategy for providing sealants to disadvantaged children, yet this strategy is vastly underutilized.

• Community water fluoridation: Identified by the Centers for Disease Control and Prevention (CDC) as one of 10 great public health achievements of the 20th Century, fluoridated water counteracts tooth decay and strengthens teeth. Fluoride occurs naturally in water, but the level varies within states and across the country. In addition to being the most far-reaching preventive measure states can enact, fluoridation also offers an unmatched return on investment, saving $38 in dental treatment costs for every dollar spent. About 30 percent of the population on community water systems does not yet receive fluoridated water.

• Medicaid improvements: Making minor changes to this federal program can enable and motivate more dentists to treat low-income children. Only 38 percent of Medicaid-eligible children received dental care in 2007, largely because too few dentists are willing to treat them. The number of children receiving dental services more than doubled over just four years in several states that have increased Medicaid reimbursement rates.


• More dental providers: New professionals, similar to nurse practitioners in the medical field, can expand the number of qualified dental providers who can fill the unmet needs of children. A growing number of states are exploring new models that increase the involvement of physicians, hygienists, and new types of dental professionals.



DentaQuest Foundation
The DentaQuest Foundation is committed to optimal oral health for all Americans through its support of prevention and access to affordable oral health care, and through partnerships with philanthropies, policy makers and community leaders.