Bright Smiles for Bright Futures Basic Screening Survey A Report on the Oral Health Status of Louisiana’s Third Grade Children Rishu Garg, MD, MPH Oral Health Program Epidemiologist/Evaluator May 2011 628 N. 4 th Street Baton Rouge, LA 70821-3214 Phone: (225) 342-2645
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Bright Smiles for Bright Futures Basic Screening Survey
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The need for dental care is critical in the areas where
access to care and availability of dentists is limited.
13
Map of the 9 DHH Administrative Regions
Map 2
Region 1 - 13 Schools: Jefferson, Orleans, Plaquemines and Saint Bernard
Region 2 - 8 Schools: Ascension, East Baton Rouge, East Feliciana, Iberville, Point Coupee, West
Baton Rouge and West Feliciana
Region 3 - 6 Schools: Assumption, Lafourche, Saint Charles, Saint James, St. John the Baptist,
Saint Mary and Terrebonne
Region 4 - 13 Schools: Acadia, Evangeline, Iberia, Lafayette, Saint Landry, Saint Martin and
Vermillion
Region 5 - 4 Schools: Allen, Beauregard, Calcasieu, Cameron and Jefferson Davis
Region 6 - 5 Schools: Avoyelles, Catahoula, Concordia, Grant, La Salle, Rapides, Vernon and Winn
Region 7 - 10 Schools: Bienville, Bossier, Caddo, Claiborne, De Soto, Natchitoches, Red River,
Sabine and Webster
Region 8 - 6 Schools: Caldwell, East Carroll, Franklin, Jackson, Lincoln, Madison, Morehouse,
Ouachita, Richland, Tensas, Union and West Carroll
Region 9 - 10 Schools: Livingston, Saint Helena, Saint Tammany, Tangipahoa and Washington
14
Statistics and Findings By DHH Administrative Regions
Untreated Cavities:
The percent of children with untreated cavities is higher in regions 2, 5, 6 and 8 than the
others and lowest in region 9.
Caries Experience:
More than 70% of the children screened from regions 2, 5 and 7 have experienced dental
decay in their life, which is higher than the state average of 65.7%.
The lowest percentage of dental decay was experienced by the children from region 1.
Presence of Dental Sealants:
Currently 33.2% of Louisiana third graders have dental sealants; less than the Healthy
People 2010 goal of at least 50%.
The children from regions 1, 4 and 5 have demonstrated the highest presence of dental
sealants on at least one of the permanent molar teeth.
The lowest presence of dental sealants was found in regions 3 and 8.
DHH has nine administrative regions. Because the sample size was not
designed for nine regions, there is a large standard error (SE) in
regions 5 and 6 when analyzing by region.
Standard error: A statistic indicating how greatly the estimate obtained from
the sample is likely to differ from the population.
15
Figure 7: BSS - DHH Regional Estimates for Oral Health
Figure 6
36.5
55.4
39.2
50.4
71.1
33.838.5
68.6
21.8
35
61.2
39
56.1
70.6
50.1
54.8
64.4
27.3
43.1
71.8
32.5
53
70.3
21.826
67.8
28.6
0
20
40
60
80
100
Un
trea
ted
Cav
itie
s
Car
ies
Exp
erie
nce
Seal
ants
Pre
sen
t
Un
trea
ted
Cav
itie
s
Car
ies
Exp
erie
nce
Seal
ants
Pre
sen
t
Un
trea
ted
Cav
itie
s
Car
ies
Exp
erie
nce
Seal
ants
Pre
sen
t
Un
trea
ted
Cav
itie
s
Car
ies
Exp
erie
nce
Seal
ants
Pre
sen
t
Un
trea
ted
Cav
itie
s
Car
ies
Exp
erie
nce
Seal
ants
Pre
sen
t
Un
trea
ted
Cav
itie
s
Car
ies
Exp
erie
nce
Seal
ants
Pre
sen
t
Un
trea
ted
Cav
itie
s
Car
ies
Exp
erie
nce
Seal
ants
Pre
sen
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Un
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ted
Cav
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Car
ies
Exp
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nce
Seal
ants
Pre
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Un
trea
ted
Cav
itie
s
Car
ies
Exp
erie
nce
Seal
ants
Pre
sen
t
1 2 3 4 5* 6* 7 8 9
Per
cen
tage
DHH Regions
Oral Health Status Among DHH Administrative Regions Louisiana 2007-2009
Source: Louisiana Basic Screening Survey, 2007-2009* High Standard Error
16
Figure 8: BSS – DHH Regional Estimates of Treatment Urgency
The children from regions 1 and 9 have demonstrated (Figure 8) the best oral health in
Louisiana.
The demand for the early care is abundant in the regions 5 and 8, and urgent care is most
critical in region 6 followed by 3 and 7.
Figure 7
67.5
28.4
5.8
4744.2
8.8
62.8
27.5
9.7
63.4
29.8
6.7
46.452.2
1.4
46.4
35.4
18.1
53
37.8
9.2
4548.4
6.6
72.7
25.3
2.1
0
20
40
60
80
100
No
Pro
ble
m
Earl
y C
are
Urg
ent
Car
e
No
Pro
ble
m
Earl
y C
are
Urg
ent
Car
e
No
Pro
ble
m
Earl
y C
are
Urg
ent
Car
e
No
Pro
ble
m
Earl
y C
are
Urg
ent
Car
e
No
Pro
ble
m
Earl
y C
are
Urg
ent
Car
e
No
Pro
ble
m
Earl
y C
are
Urg
ent
Car
e
No
Pro
ble
m
Earl
y C
are
Urg
ent
Car
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No
Pro
ble
m
Earl
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are
Urg
ent
Car
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No
Pro
ble
m
Earl
y C
are
Urg
ent
Car
e
1 2 3 4 5* 6* 7 8 9
Per
cen
tage
DHH Administrative Regions
DHH Administrative Regional Distribution of Children with Treatment UrgencyLouisiana 2007-2009
Source: Louisiana Basic Screening Survey, 2007-2009* High Standard Error
17
Figures 9-17: BSS – Comparison of Oral Health Status by State and DHH
Regions
Figure 9: BSS – Comparison of Oral Health Status by State and DHH Region 1
Figure 8
Figure 10: BSS – Comparison of Oral Health Status by State and DHH Region 2
Figure 10
41.936.5
65.7
55.4
33.2 39.2
57.3
67.5
35.628.4
7.1 5.8
0
20
40
60
80
100
State Region 1 State Region 1 State Region 1 State Region 1 State Region 1 State Region 1
Untreated Cavities
Caries Experience
Sealants Present No Problem Early Care Urgent Care
Per
cen
tage
Comparison of Oral Health Status Louisiana and Region 1
2007-2009
41.9
50.465.7 71.7
33.2 33.8
57.3
4735.6
44.2
7.1 8.8
0
20
40
60
80
100
State Region 2 State Region 2 State Region 2 State Region 2 State Region 2 State Region 2
Untreated Cavities
Caries Experience
Sealants Present No Problem Early Care Urgent Care
Per
cen
tage
Comparison of Oral Health StatusLouisiana and Region 2
2007-2009
18
Figure 11: BSS – Comparison of Oral Health Status by State and DHH Region 3
Figure 91
Figures 12: BSS – Comparison of Oral Health Status by State and DHH Region 4
Figure 12
41.9 38.5
65.7 68.6
33.2
21.8
57.362.8
35.627.5
7.1 9.7
0
20
40
60
80
100
State Region 3 State Region 3 State Region 3 State Region 3 State Region 3 State Region 3
Untreated Cavities
Caries Experience Sealants Present No Problem Early Care Urgent Care
Per
cen
tage
Comparison of Oral Health StatusLouisiana and Region 3
2007-2009
41.935
65.7 61.2
33.239
57.363.4
35.6 29.8
7.1 6.7
0
20
40
60
80
100
State Region 4 State Region 4 State Region 4 State Region 4 State Region 4 State Region 4
Untreated Cavities
Caries Experience Sealants Present No Problem Early Care Urgent Care
Per
cen
tage
Comparison of Oral Health StatusLouisiana and Region 4
2007-2009
19
Figures 13: BSS – Comparison of Oral Health Status by State and DHH Region 5
Figure 13
Figures 14: BSS – Comparison of Oral Health Status by State and DHH Region 6
Figure 14
41.9
56.165.7 70.6
33.250.1
57.3
46.435.6
52.2
7.1 1.40
20
40
60
80
100
State Region 5 State Region 5 State Region 5 State Region 5 State Region 5 State Region 5
Untreated Cavities
Caries Experience Sealants Present No Problem Early Care Urgent Care
Per
cen
tage
Comparison of Oral Health StatusLouisiana and Region 5
2007-2009
41.9
54.865.7 64.4
33.227.3
57.3
46.435.6 35.4
7.1
18.1
0
20
40
60
80
100
State Region 6 State Region 6 State Region 6 State Region 6 State Region 6 State Region 6
Untreated Cavities
Caries Experience Sealants Present No Problem Early Care Urgent Care
Per
cen
tage
Comparison of Oral Health StatusLouisiana and Region 6
2007-2009
20
Figures 15: BSS – Comparison of Oral Health Status by State and DHH Region 7
Figure 15
Figures 16: BSS – Comparison of Oral Health Status by State and DHH Region 8
Figure 16
41.9 43.1
65.771.8
33.2 32.5
57.3 53
35.6 37.8
7.1 9.2
0
20
40
60
80
100
State Region 7 State Region 7 State Region 7 State Region 7 State Region 7 State Region 7
Untreated Cavities
Caries Experience
Sealants Present No Problem Early Care Urgent Care
Per
cen
tage
Comparison of Oral Health StatusLouisiana and Region 7
2007-2009
41.9
5365.7 70.3
33.2
21.8
57.3
4535.6
48.4
7.1 6.6
0
20
40
60
80
100
State Region 8 State Region 8 State Region 8 State Region 8 State Region 8 State Region 8
Untreated Cavities
Caries Experience Sealants Present No Problem Early Care Urgent Care
Per
cen
tage
Comparison of Oral Health StatusLouisiana and Region 8
2007-2009
21
Figures 17: BSS – Comparison of Oral Health Status by State and DHH Region 9
Figure 17
41.9
26
65.7 67.8
33.2 28.6
57.3
72.7
35.6
25.3
7.1 2.10
20
40
60
80
100
State Region 9 State Region 9 State Region 9 State Region 9 State Region 9 State Region 9
Untreated Cavities
Caries Experience Sealants Present No Problem Early Care Urgent Care
Per
cen
tage
Comparison of Oral Health StatusLouisiana and Region 9
2007-2009
22
Discussion
Despite the continuous improvement in the oral health of children in the US since 1970’s, dental
caries has remained the most prevalent childhood chronic disease.1 In Louisiana, almost two out
of every three children experience cavities before entering the fourth grade.2 To address this
problem, the Louisiana Oral Health Program conducts two population-based interventions aimed
at prevention: the school-based dental sealant program and the community water fluoridation
program (CWF). Both are designated best practices by the Centers for Disease Control and
Prevention (CDC). Studies have shown that in children, after administration of a dental sealant,
the median decrease in caries on the occlusal (chewing) surface of posterior teeth is 60%.3 The
CDC has proclaimed water fluoridation as one of ten great public health achievements of the 20th
century; every $1 invested in water fluoridation saves $38 in dental treatment costs.
According to the Healthy People 2010 Objective for dental sealants, 50% of children should
have sealants on their permanent molars. In Louisiana, only 33.2% of children have one or more
dental sealants on their permanent molars.4 The goal of the statewide school-based/linked dental
sealant program is to increase the number of children with one or more dental sealants on their
permanent teeth. To achieve this goal, the program utilizes three different strategies: contracting
with local dental providers, working with local clinics (e.g. Federally Qualified Health Centers),
and providing direct services using Oral Health Program staff. Operationally, to conduct a dental
sealant day in a school setting, the program identifies disparate populations for interventions,
works with local school systems/administrators and school nurses and identifies dental providers
for program delivery.
According to the Healthy People 2010 Objective for community water fluoridation, 75% of the
population should receive optimally fluoridated water. In Louisiana, only 41% of the population
benefits from community water fluoridation as compared to 69.2% percent of the United States
(2006).5 In the 2008 regular session, Louisiana enacted Act 761, which requires water systems
with more than 5,000 service connections to fluoridate. To achieve this goal, the program’s
1 U.S. Department of Health and Human Services. Oral health in America: A Report of the Surgeon General. DHHS,
Rockville, MD. 2000. 2 Basic Screening Survey 2007-2009, Louisiana Oral Health Program
3 Truman BI, Gooch BF, Sulemana I, et al. Reviews of evidence regarding interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. Am J Prev Med 2002;23(suppl 1): 21-54. Available from: http://www.thecommunityguide.org/oral/oral-ajpm-ev-rev.pdf
4 Basic Screening Survey 2007-2009, Louisiana Oral Health Program
5 Center for Disease Control and Prevention, Oral Health Program, Water Fluoridation Statistics for 2006. Available
from http://www.cdc.gov/fluoridation/statistics/2006stats.htm
fluoridation engineer and community educator work with local governments and residents to
educate on the health benefits and ensure the safe delivery of optimally fluoridated water.
Access to care is a primary indicator of good oral health. In Louisiana, access to oral health care
is challenging. In the FFY 2007-2008, only 32.5% of the Medicaid-eligible (LACHIP enrolled)
children in Louisiana received any dental services.6 Only 27% of the Medicaid-available dentists
(enrolled and billing) see Medicaid-eligible children and only 12% of all available dentists bill
Medicaid for $10,000 or more. Compounding the problem, 56 out of the 64 parishes (87.5%) are
designated by HRSA as Dental Health Professional Shortage Areas7. On average in Louisiana,
among Medicaid- eligible children, one dentist is available for 1,161 children. Socio-economic
status is another indicator of good oral health. As evidenced in the National Survey of
Children’s Health 2007 which says, “of children with household incomes below the federal
poverty level (FPL), about half were reported to have teeth that were in excellent or very good
condition (49.8 %), compared to 61.3 % of children with household incomes between 100 and
199 percent of the FPL, 76.0 % of children with household incomes between 200 and 399
percent of the FPL, and 84.8 % of children with household incomes of 400 percent or more of
the FPL.”8 In the BSS survey, the program did not collect socio-economic data; however, the
survey indicated that children from the private schools tended to have better oral health than
children in the public schools.9
The Oral Health Program will conduct the next BSS in 2012-2013 school year. Survey design
and methodology will aim to increase the sample size to obtain better regional data.
6 Louisiana Medicaid Management Information Systems, Department of Health and Hospitals-Medical, CMS 416
7 Department of Health and Hospitals, Primary Care and Rural Health, Dental Health Professional Shortage Areas Map. Available from http://www.dhh.louisiana.gov/offices/miscdocs/docs-88/hpsa/dental.pdf
8 The National Survey of Children’s Health, 2007. Available at http://mchb.hrsa.gov/nsch07/moreinfo/pdf/nsch07.pdf 9 Basic Screening Survey 2007-2009, Louisiana Oral Health Program