are important for nutrition and speech development. Both early counseling of mothers and caregivers regarding risk factors and the need for oral hygiene with appropriate fluoride use and the professional application of fluoride varnish have been employed to prevent dental caries. The provision of dental services for women may include education about how their own oral health relates to their children’s oral health. However, in the Medicaid program, only about half the states currently reimburse for the dental care of pregnant women. Finally, there just are not enough pediatric dentists.
Oral health is also critical for elementary school-aged children. At this age, children are forming their health habits and permanent teeth are coming in. School-based interventions, including the application of sealants, can help improve oral health, but such programs are fragmented and may not help those who are most in need of care. In this age group, public health dental hygienists and general dentists are the most important parts of the oral health workforce.
Finally, adolescents have critical oral health needs as well. Among this age group, there is an elevation of behavioral risks such as tobacco use, sports-related injuries, mouth jewelry, and ultimately, for many of those at the highest risk, the loss of Medicaid eligibility.
Among all these age groups, not nearly enough children get dental visits: about 25 percent of children under age 6, about 59 percent of children ages 6–12, and about 48 percent of adolescent children ages 13–20 had a dental visit in 2004 (Manski and Brown, 2007). Dental insurance coverage and the source of this coverage make a difference in utilization of dental services. In 2006, nearly one-fifth of all children had no source of dental insurance (see Figure 3-1). As seen in Figure 3-2, the source of coverage is important to the use of dental services. More specifically, a higher percentage of children who have private dental insurance will receive dental services than children covered by public sources or without dental coverage.
About 80 percent of dental caries occurs among only 25 percent of children (Kaste et al., 1996). The prevalence of tooth decay is also related to income; the highest-income children have the least decay2 and, conversely, the lowest-income children have the highest rates of decay. Three times as many children who are on Medicaid have decay compared to the non-Medicaid population. In spite of this, dentist participation in Medicaid is very low, in large part due to the business model of dentistry. Overall, the prevalence of caries had been improving, but there has been a recent increase among very low-income children and young children. Racial and