The oral health of Kentucky’s school children is worsening, even though more of them are covered by dental insurance today than 15 years ago.
A new report was presented Wednesday to the state’s legislature’s Interim Health and Welfare Committee, following on an earlier statewide study conducted in 2001. The report’s authors found that 41 percent of third- and sixth-graders surveyed by a dentist had at least one untreated cavity. In Eastern Kentucky, that figure rose to 53 percent, amounting to about 15,100 children in immediate need of a filling.
Barely half of Kentucky children entering a public kindergarten during the 2014-15 school year had had a documented dental screening or exam, although that’s supposed to be a requirement for admission, according to the report.
Children from poor families typically have the least dental care, Terry Brooks, executive director of Kentucky Youth Advocates, told the legislative panel.
“We know that the state of a kid’s mouth in Kentucky is heavily influenced by their ZIP code, by their income level and by their ethnicity,” Brooks said. “None of us, and none of you, wants oral health to be a matter of luck.”
The $360,000 study was organized by Kentucky Youth Advocates, working in cooperation with the University of Louisville School of Dentistry, and financed by Delta Dental of Kentucky. A total of 2,109 parent surveys and dental screenings of children’s mouths were analyzed. Among the other findings:
▪ Since 2001, the number of third- and sixth-graders in need of early or urgent dental care rose from 32 percent to 49 percent statewide. Early dental care addresses tooth decay that is not accompanied by pain, infection or swelling; urgent dental care does involve those serious risk factors. Again, the numbers were worse in Eastern Kentucky, where nearly 20 percent of the children needed urgent dental care, compared to 8 percent statewide.
▪ There was a 14 percent increase between 2001 and 2016 in the number of children observed with dental sealants on at least one permanent molar. However, even with that gain, more than half of the children did not have any sealants, which are clear plastic coatings that protect the chewing surface of a tooth. Sealants are usually one-third the cost of filling a cavity.
▪ Statewide, 88 percent of third- and sixth-graders now are covered by public or private dental insurance. That percentage is lower — 81 percent — for Hispanic or Latino children.
The study’s authors said it’s not clear why more children have insurance and yet fewer of them are getting dental care. Among the parents who said their children don’t routinely see a dentist, the most commonly cited reasons were a lack of insurance, affordability, difficulty in scheduling an appointment or getting to the dentist’s office, and too few dentists in the area.
The federal government reported that 538,182 Kentucky children had dental coverage through Medicaid in 2014. (This coverage would be unaffected by the restrictions Gov. Matt Bevin wants to impose on Kentucky’s Medicaid expansion, which is aimed at able-bodied adults just above the poverty level.) However, only 46 percent of those children received any dental services that year, according to federal data.
Cliff Maesaka, president of Delta Dental of Kentucky, said that just having dental coverage through Medicaid doesn’t necessarily help families in rural communities, where there are few pediatric dentists who accept the state’s relatively low Medicaid reimbursement rates. Parents also need to be better educated about the importance of taking children to the dentist for preventative treatment, Maesaka said.
The report contained a number of recommendations for lawmakers, such as establishing voluntary sealant programs in high schools and encouraging parents to have their children drink fluoridated tap water rather than sugar-sweetened beverages.
Several lawmakers said they’re troubled by the many Kentucky children who drink sugary soda on a daily basis. State Sen. Jimmy Higdon, R-Lebanon, who is a grocer, said he has watched poor families use food stamps to buy four cases of Mountain Dew, one gallon of milk and no fresh fruit or vegetables.
Sen. Max Wise, R-Campbellsville, who is married to a pediatric dentist, said, “My wife sees a lot of 2- and 3-year-olds who go to bed with Ski Cola at nighttime. It’s a matter of education.”
Parents in his southern Kentucky Senate district sometimes take their children to a mobile dental clinic for emergency care but fail to follow up with regular dental visits that could prevent future problems, Wise added.
Poor oral health can lead to pain and illness for children and contribute to tooth loss as they become adults. Kentucky has one of the nation’s highest rates of tooth loss, according to a separate report released earlier this year by the Center for Health Workforce Studies at the State University of New York. Nearly 25 percent of Kentuckians 65 and older have lost all of their teeth to tooth decay or gum disease, according to that study.
“Oral health is a gateway to other facets of physical health,” Brooks told lawmakers Wednesday. “We know in a very pragmatic way that a young person with a toothache probably is not paying attention to the multiplication tables at school.”