Science and Surveillance
Changes in the Oral Health of US Children
and Adolescents and Dental Public Health
Infrastructure Since the Release of the Healthy
People 2010 Objectives
Scott L. Tomar, DMD, DrPH; Anne F. Reeves, MPH, DDS
We examined progress in US children’s oral health and dental
public health infrastructure since the Healthy People 2010 Oral
Health Objectives were issued. We summarize trends in the prev-
alence of dental caries and dental sealants on the basis of national
and state-specific data. Trends in state oral health program activ-
ities, funding, and staffing were derived from annual surveys.
The prevalence of dental caries in primary teeth of children aged
2–4 years increased from 18% in 1988–1994 to 24% in 1999–
2004. Racial disparities persisted in that age group, with caries
significantly more prevalent among non-Hispanic black and
dren. Caries prevalence in primary teeth of non-Hispanic white
children aged 6–8 years remained unchanged, but increased
among non-Hispanic black and Mexican American children.
State-specific prevalence of caries among third-graders ranged
from 40.6% to 72.2%. Caries in permanent teeth declined among
children and adolescents, while the prevalence of dental sealants
increased significantly. State oral health programs’ funding and
ture by acids produced by dental plaque bacteria.2
Untreated dental caries can result in pain, infection,
impaired oral function, and other personal and population
Dental caries prevention in children and adolescents
involves a range of population- and individual-level strate-
gies that may include oral health education, community
water fluoridation, topical fluorides such as fluoride
varnish, dental sealants, antibacterial rinses, and dietary
interventions. Other than community water fluoridation,3
the community-based prevention strategies best supported
staffing remained modest, although the proportion of states with
sealant programs increased 75% in 2000 to 85% in 2007 and
the proportion with fluoride varnish programs increased from
13% to 53%.
Progress toward improving the oral health of America during the
past decade has been mixed. Greater attention to the oral health of
young children is clearly needed, and child health professionals
can be valuable partners in the effort. With continued high prev-
alence of a largely preventable disease, ongoing problems with
access to basic oral health services, and increased national atten-
governments to make serious and sustained investments in dental
sealants; public health dentistry
Academic Pediatrics 2009;9:388–95
ental caries is, by far, the most common chronic
disease affecting children and adolescents in the
United States.1It is a multifactorial, transmissible
by evidence and feasibility are dental sealants and fluoride
varnish application. A dental sealant is an effective method
for preventing dental caries in which plasticlike coatings
molars, the sites most susceptible to dental caries.4–6
Dental sealant programs typically target children in grade
typically erupt, and grade 7, when the second permanent
molars have typically erupted. Fluoride varnish involves
professional application of a topical agent that involves
painting a small amount of high-concentration fluoride
(22 600 ppm fluoride, compared with 1100 ppm fluoride
in most toothpastes and 1 ppm fluoride in fluoridated
community drinking water). Although fluoride varnish
may be used among children of almost any age, it is partic-
ularly well suited for young children at high risk for dental
caries.7Fluoridevarnish is far less technique sensitive than
dental sealant application, although there is limited infor-
mation on direct comparisons between the 2 interventions
on prevention effectiveness.8
A dental public health infrastructure is essential for any
jurisdiction to carry out the core dental public health func-
tions of assessment, policy development, and assurance.
That is, there must be an adequate workforce, a sufficient
From the University of Florida College of Dentistry, Department of
Community Dentistry and Behavioral Science, Gainesville, Fla (Dr
Tomar); and University of Washington, Department of Pediatric
Dentistry, Seattle, Wash.
Address correspondence to Scott L. Tomar, DMD, DrPH, University of
Florida College of Dentistry, Department of Community Dentistry and
Behavioral Science, 1329 SW 16th St, Suite 5180, PO Box 103628, Gain-
esville, Florida 32610-3628 (e-mail: email@example.com).
Received for publication July 9, 2009; accepted September 20, 2009.
Copyright ? 2009 by Academic Pediatric Association
Volume 9, Number 6
November–December 2009 388
incorporating public health approaches to addressing the
oral health needs of populations.
Inconclusion,progress towardimprovingthe oralhealth
of America during the past decade has been mixed. Greater
attention to the oral health of young children is clearly
ners in the effort. With continued high prevalence of
a largely preventable disease, ongoing problems with
access to basic oral health services, and increased national
attention to health care reform, there is a clear need and
opportunity forgovernments tomake serious and sustained
investments in dental public health.
We thank Drs William Maas and Wendy E. Mouradian for their helpful
suggestions. We also thank Dr Kathy Phipps for her input on state
infrastructure and surveillance activities.
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