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Oral Health Inequities in Children: The Case for Public Health Measures

June 9, 2023

Tooth decay leads to pain, school absenteeism, difficulty concentrating in school with resultant failure, avoidance of smiling, poor self-esteem, and painful eating leading to poor nutrition. Poor oral health not only leads to dental symptoms, but it may have a negative impact on children’s general physical health. Untreated dental caries and lack of regular dental follow-up may result in systemic infections including tooth abscesses, meningitis, osteomyelitis, or infective endocarditis. The American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) have achieved tremendous progress in addressing oral health in children through education and advocacy by training primary care pediatricians in oral health risk assessments, fluoride varnish application, and anticipatory guidance in children less than 3 years of age, and establishment of a dental home—if possible by age 1 year as recommended by the Bright Future Guidelines for Health Supervision. As a result of these advocacy efforts, almost all states now reimburse medical providers for performing an oral health risk assessment and fluoride varnish application as part of early and periodic screening, diagnostic, and treatment.

Good News and Bad News

An analysis of Centers of Disease Control and Prevention (CDC) data conducted by Pew in 20201,2 comparing oral health of white, Black, Mexican American, and higher and lower-income children and adolescents between 1999 and 2004 and between 2011 and 2016 provided good and bad news. On the one hand, untreated decay decreased for all children aged 2 to 5 years in the surveys; on the other hand, the relative differences increased by race and income, with Black, Mexican American, and lower-income children having much higher prevalence of disease than white and higher-income children. The lack of pediatric dentists who treat Medicaid children means that there is a tremendous gap in establishing a dental home for children by 1 year of age as recommended by the AAP and AAPD. Dental caries remains one of the conditions that significantly highlights the persistently existing health disparities linked to social drivers of health The recent review article, Dental Caries: Early Intervention and the Role of the Pediatrician, published in the June 2023 issue of Pediatrics in Review highlights the important role of pediatricians in addressing dental caries in children.

An Ounce of Prevention and Public Health Measures

If we thought that the COVID-19 pandemic highlighted the health inequities in the United States, oral health outcomes serve as another condition that shines the spotlight even brighter on the disparities that persist, despite the limited gains achieved by AAP and AAPD. These disparities can only be overcome through a public health approach. Addressing the access to a culturally-sensitive dental home has many limitations and will not be a quick fix. While advocacy work should continue to address dental workforce diversity in dental schools, insurance coverage, and access issues, the most effective way to address some of the social drivers of dental health is through a public health approach focusing on prevention strategies that have an impact on all patients, such as:

  1. Nutrition education on healthy foods and less cariogenic nutritional practices
  2. Oral hygiene through brushing with fluoridated toothpaste and flossing recommendations
  3. Community water fluoridation and fluoride supplementation when needed
  4. An emphasis on maternal prenatal oral health

As we focus on the above 4 steps, it is hoped that continued progress will be made as oral health champions and advocates—both in pediatrics and the pediatric dentistry fields—continue to collaborate on removing the barriers and aiming to achieve oral health equity through innovative practice models and advocacy.


  1. Koppelman J, Corr A. Oral health status has improved for children, but some gaps in treatment access persist: mixture of gains and losses in disease prevalence illustrates disparities by race/ethnicity, income. Pew Charitable Trust. February 24, 2020.
  2. Corr A, Wenderoff J. Inequitable Access to Oral Health Care Continues to Harm Children of Color. Analysis of outcomes among third-graders highlights gaps in data. Pew Charitable Trust. March 11, 2022.
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