Oral Health

The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures for the 2015-2017 grant cycle. Performance Measure 13 is (a) the percent of women who had a dental visit during pregnancy and (b) the percent of infants and children ages 1 to 17 with a past-year preventive dental visit. This evidence brief points to a selection of resources for state MCH programs about oral health, with emphasis on evidence-based information.

Significance

The Title V Maternal and Child Health Services Block Grant to States Program guidance¹ defines the significance of this goal as follows:
Oral health is a vital component of overall health. Access to oral health care, good oral hygiene, and adequate nutrition are essential component of oral health to help ensure that children, adolescents, and adults achieve and maintain oral health. People with limited access to preventive oral health services are at greater risk for oral diseases.

Oral health care remains the greatest unmet health need for children. Insufficient access to oral health care and effective preventive services affects children's health, education, and ability to prosper. Early dental visits teach children that oral health is important. Children who receive oral health care early in life are more likely to have a good attitude about oral health professionals and dental visits. Pregnant women who receive oral health care are more likely to take their children to get oral health care.

State Title V Maternal Child Health programs have long recognized the importance of improving the availability and quality of services to improve oral health for children and pregnant women. States monitor and guide service delivery to assure that all children have access to preventive oral health services. Strategies for promoting oral health include providing preventive interventions, such as dental sealants and use of fluoride, increasing the capacity of State oral health programs to provide preventive services, evaluating and improving methods of monitoring oral diseases and conditions, and increasing the number of community health centers with an oral health component.

Data and Statistics

National Survey of Children's Health (NSCH). Funded by the Health Resources and Services Administration's (HRSA's) Maternal and Child Health Bureau (MCHB), this survey provides national and state-level data on the physical and emotional health of American children 0 - 17 years old. Information is collected on factors related to the health and well-being of children, including access to and utilization of health care, receipt of care in a medical home, family interactions, parental health, school and after-school experiences, and neighborhood characteristics.

Since 2003, the NSCH has provided both national and state-level prevalence estimates for a variety of child health and health care indicators. MCHB also fielded the National Survey of Children with Special Health Care Needs (NS-CSHCN) in 2001, 2005-2006, and 2009-2010. Its purpose was to assess the prevalence and impact of special health care needs among children and their families in the U.S. The 2016 NSCH underwent significant redesign and administration changes and differs greatly from the prior survey cycles. From 2016 onward, the purpose of the NSCH remains the same, but the two individual surveys were combined into a single survey conducted every year.

You can access data from and information about the current NSCH through the Health Resources and Services Administration’s Maternal and Child Health Bureau, the Data Resource Center for Child & Adolescent Health, or the U.S. Census Bureau. Data from and information about past NSCH and NS-CSHCN are available through the Data Resource Center for Child & Adolescent Health or the CDC’s National Center for Health Statistics.
HealthyPeople 2020 Leading Health Indicators (LHI): Oral Health.
Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is a surveillance project of the Centers for Disease Control and Prevention (CDC) and state health departments. PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. Forty states and New York City currently participate in PRAMS. Click on the map or the name of the state to see state information. The CDC PRAMS Online Data for Epidemiologic Research (CPONDER) V2.0 web-based query system also provides access to data collected through PRAMS surveys.

Key Websites

Association of State and Territorial Dental Directors (ASTDD). Provides leadership support to promote a governmental oral health presence in each state and territory, formulate and promote sound oral health policy, increase awareness of oral health issues, and assist in the development of initiatives for the prevention and control of oral disease. Provides information about Proven and Promising Best Practices for State and Community Oral Health Programs. See Perinatal Oral Health and Prevention and Control of Early Childhood Tooth Decay. State and community practice examples included.
American Association for Community Dental Programs. Supports the efforts of staff working in local or county organizations to meet the oral health needs of vulnerable populations.
National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health. Helps states improve their oral health programs, extends the use of proven strategies to prevent oral diseases, enhances efforts to monitor oral diseases, contributes to the scientific knowledge base on oral health and disease, and guides infection control in dentistry.
National Maternal and Child Oral Health Resource Center (OHRC). Responds to the needs of health professionals working in states and communities in addressing current and emerging public oral health issues by collecting, developing, and sharing high-quality information and materials.
National Network for Oral Health Access (NNOHA). Provides advocacy and support for health centers working to improve the oral health status of underserved populations. Promising Practices: Access to Care highlights ways that health centers' safety-net oral health programs have increased access to care in their communities.
Rural Assistance Center. Helps communities and other stakeholders access available programs, funding, and research that can enable them to provide health and human services to people living in rural areas. The Rural Oral Health Toolkit comprises seven modules to help professionals identify and implement an oral health program. Topics include an overview of oral health in rural communities, program models and ways to adapt them to meet community needs, and strategies to ensure program sustainability. The toolkit also includes a framework for evaluation, methods for disseminating results, and examples of programs that have been implemented in rural communities.

Policy Recommendations

Johnson K. From Evidence to Improved Policy and Program Practices: Oral Health. 2014. National Center for Education in Maternal and Child Health. Georgetown University: Washington, DC.
American Academy of Pediatric Dentistry, Committee on the Adolescent. 2014. Policy on the dental home. Pediatric Dentistry 36(6):25.
American Academy of Pediatric Dentistry, Committee on the Adolescent. 2014. Policy on model dental benefits for infants, children, adolescents, and individuals with special health care needs. Pediatric Dentistry 36(6):88-90.
American Academy of Pediatric Dentistry, Committee on the Adolescent. 2014. Policy on oral health care programs for infants, children, and adolescents. Pediatric Dentistry 36(6):23.
American College of Obstetricians and Gynecologists, Committee on Healthcare for Underserved Women. 2013. Oral health care during pregnancy and through the lifespan. Committee opinion no. 569. Obstetrics & Gynecology 122(2 Pt 1):417-422.
National Maternal and Child Oral Health Resource Center. 2012. Oral health care during pregnancy: A national consensus statement. Washington, DC: National Maternal and Child Oral Health Resource Center. 12 pp. [Funded by the Maternal and Child Health Bureau]

Interventions

American Academy of Pediatric Dentistry. 2014. 2014-15 definitions, oral health policies, and clinical guidelines. Chicago, IL: American Academy of Pediatric Dentistry. Provides guidelines on infant oral health care including caries-risk assessment and management, oral health care for the pregnant adolescent, perinatal oral health care, periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents.
American Dental Hygienists' Association. 2014. Direct access states [upd. ed.]. Chicago, IL: American Dental Hygienists' Association.
Association of State and Territorial Dental Directors. 2014. Summary report: Synopses of state dental public health programs-Data for FY2012-2013. Sparks, NV: Association of State and Territorial Dental Directors.
Borck R, Vine M, Crall J, Norris L, Rosenbach M. 2014. Improving oral health care delivery in Medicaid and CHIP: A toolkit for states. Baltimore, MD: U.S. Centers for Medicare and Medicaid Services.
Casamassimo P, Holt K, eds. 2014. Bright Futures in practice: Oral health—Pocket guide (2nd ed.). Washington, DC: National Maternal and Child Oral Health Resource Center.
Centers for Disease Control and Prevention. 2014. Use of selected clinical preventive services to improve the health of infants, children, and adolescents: United States, 1999-2011. Morbidity and Mortality Weekly Report 63(2, Suppl.):1-107.
Chou R, Cantor A, Zakher B, Priest Mitchell J, Pappas M. 2013. Preventing dental caries in children [under] 5 years: Systematic review updating USPSTF recommendation. Pediatrics 132(2):332-350.
Moyer VA on behalf of the U.S. Preventive Services Task Force. 2014. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. Pediatrics 133(5):1-10.