Pew Study Shows Little Progress on Proven Oral Health Strategy

WASHINGTON — States are driving up health care costs for families and taxpayers by not doing enough to use dental sealants, according to States Stalled on Dental Sealant Programs, a new report by The Pew Charitable Trusts. The report, reveals that most states are failing to enact policies that ensure low-income children receive dental sealants—clear plastic coatings applied to the chewing surfaces of molars that are a proven strategy for preventing tooth decay. Applying a sealant is one-third of the cost of filling a cavity. 

The report grades all 50 states and the District of Columbia on their efforts to prevent decay by improving access to sealants for low-income children, and updates Pew’s 2013 research on sealant programs. In the years since the 2013 report, only 12 states improved their grades, while seven states lost ground; most fail to reach even half of eight-year-olds with this preventive service. The majority of states continue to lack sealant programs in most of their “high-need” schools, which most states define as where at least half of the students participate in the National School Lunch Program.

Pew’s report finds that:

• Only five states earned an A or A- for their sealant performance, of which just three (Maine, New Hampshire, and Oregon) received the maximum possible points. 
• Nine states earned a B or B-. Of these states, five continue to reach fewer than half of high-need schools with their sealant programs, and four failed to provide at least half of their 8-year-olds with sealants. 
• Nineteen states received a C or C-. 
• Fifteen states earned a D or D-. 
• Three states (New Jersey, Hawaii and Wyoming) and the District of Columbia earned F’s, the same grade they received in 2013.

Sealants are typically first applied to children’s molars shortly after permanent teeth begin to appear, usually by age eight. Molars are the most cavity-prone teeth, and sealants act as a barrier against decay-causing bacteria. Research shows that providing sealants through school-based programs is a cost-effective way to reach low-income children, who are at greater risk for cavities. Pew’s report offers profiles of the progress and challenges in two states—Ohio and Washington—that sought to eliminate the racial and income disparities among children receiving sealants in school-based programs..  

School sealant programs have been found to reduce the incidence of tooth decay by an average of 60 percent, yet Pew’s report reveals that most states are underperforming on this critical opportunity to improve children’s health. Left untreated, dental disease can lead to emergency room visits, hospitalization, and even death. Despite the compelling evidence on cost efficiency and prevention effectiveness, a survey conducted between 2011 and 2012 found that only four out of ten U.S. children aged six to 19 had even one sealant.

"It's a cost-effective, evidence-based prevention program that every state should make a priority," said Jane Koppelman, research director for children’s dental policy at the Pew Charitable Trusts. "But unfortunately, they are not doing so. The results, in addition to higher health care costs, are needless pain and infection among children who do not receive care."

This report focuses solely on the performance of sealant programs and the degree to which states can improve access to this treatment for at-risk children. However, many other factors affect a state’s overall performance on oral health, such as health insurance coverage, the availability of Medicaid providers, and access to fluoridated water. Therefore, even states that received high grades on sealants may have room for improvement in other areas. 

The Pew Charitable Trusts is driven by the power of knowledge to solve today’s most challenging problems. Learn more at www.pewtrusts.org.