As Congress enters the July 4 recess, the debate over the American Families Plan continues on, and questions remain as to how families will pay their bills, support their kids and afford health care. Missing from the discussion, however, is how America has failed children by ignoring the importance of routine pediatric dental care. And the plan to fix it is nowhere to be found.
COVID-19 interrupted basic and preventive dental care — for both adults and children, and many states restricted dental care access to emergency procedures only. Now, as states prepare to return to in-person schooling, many students will be required to show proof of a doctor-administered physical and immunization history. A large number will still lack access to basic dental care, which can lead to lower educational achievement; children in the U.S. miss an estimated 51 million hours of school each year due to tooth decay and other oral health conditions.
As Congress tackles the issue of improving the health of children and families, the lack of support for child dental care is unacceptable. It is especially sad considering there has been in place a decade-long policy by the Centers for Medicare and Medicaid Services (CMS) to make state-based dental screenings and care for underserved children routine practice — a policy that has failed due to a lack of commitment and support by the federal government. While well-intentioned, it offers states no federal resources to ensure its successful implementation. For nearly 10 years it’s been an unfunded federal mandate that has done nothing to advance children’s health and wellbeing.
States have responded in a variety of ways — from ignoring the problem altogether to trying to make dental health a focus moving forward. A recent measure adopted in New Mexico requires district and charter schools to verify that students receive a dental exam within the past year prior to class enrollment. (Parents and guardians may sign a waiver if they do not wish to have the dental exam performed.) New Mexico, like many states across the country, is lacking in dentists, dental technicians and dentists who accept Medicaid. The state plans to collect data on children who are not screened to develop a strategy to provide the care they need. With a largely rural and Native American population in New Mexico, the data will offer guidance to address the child dental health gap across the state.
The New Mexico measure can be a model for the nation. Since many states already require students to undergo physicals and be up to date on their immunizations before returning to school, can they not be required to show they are in good dental health as well? New Mexico has proven the creation of a state-based policy to improve the long-term health of children by making school eligibility conditional on a yearly dental exam is neither too complex nor too arduous to successfully implement.
The Centers for Disease Control and Prevention (CDC) estimates nearly 20 percent of children between five and 11 years of age have at least one untreated decayed tooth. Over 10 percent of adolescents between 12 and 19 experience the same issue. The California Society of Pediatric Dentistry states that decay can become “irreversible” if it’s not managed in its early development. Left untreated, it can impact a child’s eating habits, sleeping patterns, ability to function at home or at school. And “[t]he unaesthetic nature of untreated dental decay,” they write, “compromises the child’s self-esteem and social development.” Dental health is worse for children of color, where statistics show they are less likely than white children to visit a dentist, receive preventative dental care, and are more likely to experience untreated tooth decay. Dental care advocates have called on the Biden administration to include Medicare oral health coverage in future COVID-19 legislative relief efforts — an important step in the right direction.
Summer will be over before we know it, and while the current focus is on COVID-19 vaccine availability for children this fall, we can’t lose sight of the fact that dental health is an important public health issue in America. Adults have a responsibility to protect and manage their child’s dental health — and when there’s no other option, the federal government must do its part to improve access to care to those who need it most.
We need to prioritize the dental wellbeing of America’s youth, especially in communities of color. We can no longer expect states to put money toward an unfunded federal initiative that’s been ineffectual for nearly a decade. It’s time we have a national plan — with meaningful federal resources — to make it happen.
Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.