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January 2014
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Overview
Oral health is an essential component of overall health and well-being. Good oral health improves a person’s ability to speak, smile, smell, taste, touch, chew, swallow, and make facial expressions to show feelings and emotions.1 As our knowledge and understanding regarding the importance of and basis for oral health care has improved, U.S. efforts to improve oral health have been successful.2 One such success is community water fluoridation, which in 2012 was available to 74.6 percent of the U.S. population who get their water through public water systems. This represents an increase in population served of more than 20 percent since 1992.3 Fluoride helps to stop and even reverse the tooth decay process.4
Even as overall oral health has improved across the U.S., disparities continue. Oral health disparities exist for many racial and ethnic groups and according to socioeconomic status, gender, age, and geographic location. The economic factors that often contribute to poor oral health include access to health services and an individual’s ability to get and sustain dental insurance.5 Children from low-income families are at an increased risk of untreated tooth decay. Data from 2009 and 2010 also showed that more than 33 percent of adults aged 65 to 74 living in poverty did not have any of their natural teeth, compared to 12.5 percent of adults living above the poverty threshold.6 Addressing these disparities in oral health is critical to improving the population’s health as a whole.
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Oral Health and the Affordable Care Act
Oral health is an important part of overall health for children and adults. Under the Affordable Care Act, dental coverage for children is an essential health benefit in the Health Insurance Marketplace. This means it must be available as part of a health plan or as a free-standing plan. To learn more about available oral health care and other services through the Health Insurance Marketplace, please visit healthcare.gov.
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Leading Health Indicators
Leading Health Indicators (LHI) are critical health issues that – if tackled appropriately – will dramatically reduce the leading causes of death and preventable illnesses. The Oral Health LHI is:
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Where We’ve Been and Where We’re Going
Over the past decade, the percentage of persons aged 2 years and over who had a dental visit in the past 12 months decreased slightly from 43.7 percent in 2001 to 41.8 percent in 2011 (age adjusted). The ability to access oral health care differs by sex, educational attainment, family income, race and ethnicity, age, disability status, geographic location, health insurance coverage, marital status, and obesity status.
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Who’s Leading the Leading Health Indicators?
The I-Smile Program — Bringing Healthy Smiles to Families in Iowa Through Oral Health Care
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 According to the Centers for Disease Control and Prevention, untreated tooth decay affects about 25 percent of children aged 3 to 9 living in poverty.6 Compounding the problem, many children enrolled in Medicaid lack access to dental health services and do not receive timely treatment for oral health issues.7
To increase access to oral health care for low-income children, the state of Iowa passed legislation in 2005 that required every child aged 12 or younger who received Medicaid to have regular access to oral health care. In 2006, the Iowa Department of Public Health (IDPH) and their partners created the I-Smile dental home initiative to meet this objective and provide Medicaid-enrolled and Title V eligible children with dental services. The I-Smile dental home initiative uses a team-based approach to dental care; dentists provide treatment and evaluation while other health professionals (such as dental hygienists, primary care providers, and nurses) provide oral screenings, education, anticipatory guidance, and preventive services as needed.
The I-Smile program provides both direct services to low-income children and oral health education to parents and guardians. To fill gaps in dental services, IDPH provides funds to agencies supported by federal Title V monies to hire dental hygienists and nurses to provide direct services to low-income children. To make dental care more accessible, providers also conduct screenings and apply fluoride varnish to children at Women, Infant, and Children (WIC) clinics and Head Start centers.
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