Dental health needs of children: Louisiana receives failing grade

One of Nine States to Receive an "F" grade

Louisiana is failing to ensure the dental health needs of its children, according to a report released 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 children.

Louisiana received a failing grade for meeting just two of the eight policy benchmarks in Pew's analysis. Fewer than one in three Medicaid-enrolled children statewide received dental care in 2007. The state is one of 14 states that do not report data to the National Oral Health Surveillance System on untreated tooth decay making it difficult to identify the scope and size of its problems.  Louisiana has made some progress toward implementing more preventive strategies by passing a recent mandate for communities to fluoridate their water.  Currently, the water of 60 percent of the state's residents is not fluoridated. But the budget crisis has hampered the effort: Louisiana has not allocated the necessary funds to pay for the improvements it promised community systems under the legislation. The state also does not reimburse physicians for providing basic preventive dental services to children, a measure that would allow more children to receive care.

"Louisiana's policy makers need to do more to expand dental care to reach more children," said Shelly Gehshan, director of the Pew Children's Dental Campaign. "By enacting a handful of effective policies, Louisiana can help eliminate the long-term health and economic consequences of untreated dental disease among kids."

February is National Children's Dental Health Month.  Nationwide, an estimated one in five children, or 17 million, goes without dental care each year and two thirds of states do not have key policies in place to ensure proper dental health and access to care for children.

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 at their disposal 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 children; new workforce models that expand the number of qualified dental providers; and gathering data to gauge progress and improve performance.

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. Eight states and Colorado received a grade of "B": Alaska, 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. Louisiana and eight other states earned an "F," meeting only one or two policy benchmarks: Arkansas, Delaware, New Jersey, Hawaii, Florida, 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.

Report Shows Need for Low-Cost Solutions

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.  
• Water fluoridation 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 could 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.
• New workforce models can expand the number of qualified dental providers who can fill the unmet needs of children.  A growing number of states are exploring innovative models that increase the involvement of physicians, hygienists, and new types of dental professionals.

The report can be found at: www.pewcenteronthestates.org/costofdelay

The Pew Children's Dental Campaign works to promote policies that will help millions of children maintain healthy teeth, get the care they need and come to school ready to learn.