Oral Health of Georgia's Children

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Oral Health of Georgia's Children

  1. 1. ORAL HEALTH OF GEORGIA’S CHILDRENResults from the 2005 Georgia Third Grade Oral Health Survey IntroductionOral health is an essential and integral component of health throughout life. Poor oral health and untreated infections can havea significant impact on the quality of life for school aged children.1 Evidence-based studies indicate oral health prevention iscost-effective and saves children from pain and lost days of school:ƒ The National Institutes of Dental and Craniofacial Research and the National Education Association cite research showing that American children miss 52 million hours of school each year due to oral health problems.2 In addition to lost days of school due to dental treatment and pain, dental problems distract children from learning.ƒ Dental sealants are a cost effective means of preventing dental caries in at risk groups; in the U.S. 80% of tooth decay in permanent teeth is experienced by only 25% of the children. 3 Dental sealants cost approximately one-third ($27) the cost of an average filling ($73). Every dollar invested in dental prevention saves as much as $147 in future expenses. 4ƒ Preventive dental services reduce costly dental problems. Pediatric Dentistry reported a study on Medicaid dental expenditures indicating that hospital care is ten times more expensive ($6,498) than preventive treatment ($660). 5ƒ Dental disease puts our children at-risk for expensive chronic diseases. Studies have shown a link between oral disease and cardiovascular disease, diabetes, respiratory infections, and low birth weight. Tooth decay is five times more common than asthma. 6The purpose of this oral health report is to highlight the status of the oral health of third (3rd) grade children in Georgia whoparticipated in the 2005 Georgia Third Grade Oral Health Survey. This basic screening survey7 provides a valuable oral healthstatus update to information gathered in the 1989 Georgia dental disease prevalence survey 8 . The survey also collectedmeasurements of height and weight. Results are available in the Obesity in Georgia’s Third Grade Children, 2005 report.9 Key Findings ƒ 1 in 2 (56%) 3rd grade children in Georgia have caries experience. ƒ 1 in 4 (27%) 3rd grade children in Georgia have untreated dental decay. ƒ 4 in 10 (40%) 3rd grade children in Georgia have dental sealants. ƒ 1 in 4 (26%) 3rd grade children in Georgia need either early (22%) or urgent (4%) dental care. ƒ Children from high socioeconomic (SES) households are more likely to have good oral health than children from low SES households. ƒ Children from Metropolitan Atlanta are more likely to have good oral health than children from other regions, except for dental sealants. ƒ Children with access to dental insurance are more likely to have good oral health than children without access to dental insurance. ƒ Children who visited a dentist in the last year are more likely to have good oral health than children who had not visited the dentist in the last year. ƒ 1 in 8 (13%) of 3rd grade children in Georgia could not get dental care when needed. Conclusionsƒ Poor oral health is a significant public health problem among children in Georgia.ƒ The percent of 3rd grade children in Georgia with caries experience, untreated dental decay, and dental sealants do not meet Healthy People 2010 objectives.ƒ Significant differences in oral health were found between SES households.ƒ Access to insurance and utilizing dental care are important factors in promoting good oral health. Actions to Improve the Oral Health of Georgia’s ChildrenHistorically, oral health program development in Georgia has been both a public and private collaborative effort.ƒ Provide documentation of local level needs through reporting of public health, community and school oral health data.ƒ Continue statewide needs assessments and funding to build oral health infrastructure that increases access to care.ƒ Increase the proportion of eligible low-income elementary school children who establish a dental home, receive dental treatment, and are free of oral-related pain and active oral disease.ƒ Continue concerted public health collaborations with private dental professionals, organizations and the Department of Community Health (Medicaid/PeachCare) that will result in improved oral health status for all of Georgias children.ORAL HEALTH OF GEORGIA’S CHILDREN - Results from the 2005 Georgia Third Grade Oral Health Survey–April 2006 1
  2. 2. Oral Health by Sex, Race, and Socioeconomic Status Percent of 3rd grade children who have caries Caries Experience experience by sex, race, and SES*, Georgia, 2005 80 ƒ Boys are more likely to have caries experience (58%) than girls (54%). 60 56 58 56 58 61 54 51 ƒ White children are more likely to have caries Percent 40 experience (58%) than black children (56%). Healthy People 2010 Objective: 42% 20 ƒ Children from low SES households are more likely to have caries experience (61%) than children from 0 high SES households (51%)*. Overall Boys Girls Blacks Whites Low High SES SES •Based on Free and Reduced School Lunch Program eligibility ƒ All sex, race, and SES groups did not meet the Healthy People 2010 objective for caries experience (42%). Untreated Dental Decay Percent of 3rd grade children who have untreated dental decay by sex, race, and SES*, Georgia, 2005 ƒ Boys are more likely to have untreated dental decay 80 (28%) than girls (25%). 60 ƒ Black children are more likely to have untreated Percent dental decay (30%) than white children (24%). 40 33 28 30 27 25 ƒ Children from low SES households are more likely to 24 20 20 have untreated dental decay (33%) than children Healthy People 2010 Objective: 21% from high SES households (20%)*. 0 Overall Boys Girls Blacks Whites Low High ƒ Children from high SES households are the only SES SES •Based on Free and Reduced School Lunch Program eligibility group to meet the Healthy People 2010 objective for untreated dental decay (21%). Dental Sealants Percent of 3rd grade children who have dental sealants by sex, race, and SES*, Georgia, 2005 ƒ Girls are more likely to have dental sealants (41%) 80 than boys (39%). 60 Healthy People 2010 Objective: 50% ƒ White children are more likely to have dental sealants 46 Percent 44 40 41 (46%) than black children (32%)*. 40 39 32 35 ƒ Children from high SES households are more likely to 20 have dental sealants (44%) than children from low SES households (35%)*. 0 Overall Boys Girls Blacks Whites Low High SES SES ƒ All sex, race, and SES groups did not meet the •Based on Free and Reduced School Lunch Program eligibility Healthy People 2010 objective for dental sealants (50%). Percent of 3rd grade children who need dental Need Dental Care care* by sex, race, and SES†, Georgia, 2005 ƒ Boys are more likely to need dental care (27%) than 80 girls (25%). 60 ƒ Black children are more likely to need dental care Percent (29%) than white children (24%). 40 34 27 29 26 25 24 ƒ Children from low SES households are more likely to 18 20 need dental care (34%) than children from high SES households (18%)*. 0 Overall Boys Girls Blacks Whites Low High SES SES * Includes children who need early or urgent dental care †Based on Free and Reduced School Lunch Program eligibility.* Differences are statistically significant: p < 0.05ORAL HEALTH OF GEORGIA’S CHILDREN - Results from the 2005 Georgia Third Grade Oral Health Survey–April 2006 2
  3. 3. Oral Health by Region Percent of 3rd grade children who have caries Caries Experience experience by region, Georgia, 2005 80 ƒ Children from Metropolitan Atlanta are least likely to 61 62 57 have caries experience (46%). 60 46 Percent 40 ƒ Children from rural areas (62%) and Suburban Atlanta Healthy People 2010 Objective: 42% (61%) are most likely to have caries experience. 20 ƒ None of the regions in Georgia met the Healthy People 0 2010 objective for caries experience (42%). Metropolitan Suburban Small Cities Rural Atlanta Atlanta Percent of 3rd grade children who have untreated caries by region, Georgia, 2005 Untreated Dental Decay 80 ƒ Children from Metropolitan Atlanta are least likely to 60 have untreated dental decay (20%). Percent 40 36 ƒ Children from rural areas are most likely to have 20 25 23 untreated dental decay (36%). 20 Healthy People 2010 Objective: 21% ƒ Only Metropolitan Atlanta met the Healthy People 0 Metropolitan Suburban Small Cities Rural 2010 objective for untreated dental decay (21%). Atlanta Atlanta Percent of 3rd grade children who have dental sealants by region, Georgia, 2005 Dental Sealants 80 Healthy People 2010 ƒ Children from Metropolitan Atlanta (35%) and rural 60 Objective: 50% 48 areas (36%) are least likely to have dental sealants. 44 Percent 40 35 36 ƒ Children from small cities are most likely to have 20 dental sealants (48%). 0 ƒ None of the regions in Georgia met the Healthy Metropolitan Suburban Small Cities Rural Atlanta Atlanta People 2010 objective for dental sealants (50%). Percent of 3rd grade children who need dental care* by region, Georgia, 2005 80 Need Dental Care 60 Percent ƒ Children from Metropolitan Atlanta are least likely to 40 36 need dental care (18%). 26 22 18 20 ƒ Children from rural areas are most likely to need 0 dental care (36%). Metropolitan Suburban Small Cities Rural Atlanta Atlanta * Includes children who need early or urgent dental careORAL HEALTH OF GEORGIA’S CHILDREN - Results from the 2005 Georgia Third Grade Oral Health Survey–April 2006 3
  4. 4. Access to Dental Care ƒ 8 in 10 (83%) 3rd grade children have access to either public or private dental insurance. Oral Health by Insurance StatusDental Insuranceƒ Children with access to dental insurance are less likely Percent of 3rd grade children who have caries experience, to have caries experience (54%) than children without access to dental insurance (58%). untreated decay, sealants, and need dental care* by dental insurance status, Georgia, 2005ƒ Children with access to dental insurance are less likely 80 Insured Uninsured to have untreated dental decay (24%) than children without access to dental insurance (37%)*. 58 60 54ƒ Children with access to dental insurance are more likely 42 Percent to have dental sealants (42%) than children without 37 38 40 access to dental insurance (30%)*. 30 24 23 20ƒ Children with access to dental insurance are less likely to need dental care (23%) than children without access to dental insurance (38%)*. 0 Caries Untreated Dental Sealants Need Dentalƒ The percentage of children with caries experience, Experience Caries HP 2010: 50% Care HP 2010: 42% HP 2010: 21% untreated dental decay, and dental sealants do not meet Healthy People 2010 objectives regardless of dental * Includes children who need early or urgent dental care insurance status. Barriers to Dental Care ƒ 1 in 8 (13%) 3rd grade children who needed dental care during the last year were not able to get it. Most Common Barriers Most common reasons why 3rd grade children can rd ƒ 1 in 4 (27%) 3 grade children in Georgia could not get not get dental care, Georgia, 2005 dental care due to no insurance. No insurance 27 ƒ Difficulty in getting appointment (13%), could not afford insurance (11%), no transportation (7%), inconvenient Other 19 hours (7%), and dentist did not accept insurance (6%) Difficulty in getting an appointment 13 are other reported barriers to dental care. Could not afford insurance 11 No transportation 7 Hours not convenient 7 Dentist did not accept insurance 6 0 10 20 30 40 Percent * Differences are statistically significant: p < 0.05ORAL HEALTH OF GEORGIA’S CHILDREN - Results from the 2005 Georgia Third Grade Oral Health Survey–April 2006 4
  5. 5. Utilization of Dental Care Time Since Last Visit ƒ 81% of 3rd grade children visited a dentist in the last Percent of 3rd grade children who visited a dentist year. by time since last visit, Georgia, 2005 ƒ 15% of 3rd grade children visited a dentist more than 1 4%: Never been to a dentist year ago. 3%: More than 3 years 15%: More than 1 year 62%: 6 months or less 12%:1 - 3 years ƒ 4% of 3rd grade children have never been to a dentist. ƒ The percentage of 3rd grade children in Georgia visiting a dentist (81%) met the Healthy People 2010 objective 19%: 7-12 months for utilization of the oral health system (56%). 81%: In the last year* * Met Healthy People 2010 objective (56%) Oral Health by Time Since Last Visit Percent of 3rd grade children who have caries experience, ƒ Children who visited a dentist in the last year are less likely to have caries experience (55%) than children who untreated dental decay, dental sealants, and need dental visited the dentist more than 1 year ago (57%). care* by time since last visit, Georgia, 2005 1 year or less More than 1 year ƒ Children who visited a dentist in the last year are less 80 likely to have untreated dental decay (22%) than 55 57 children who visited the dentist more than 1 year ago 60 44 45 Percent (44%)*. 42 40 ƒ Children who visited a dentist in the last year are more 22 18 22 likely to have dental sealants (45%) than children who 20 visited the dentist more than 1 year ago (18%)*. 0 Cavities Untreated Dental Need Dental ƒ Children who visited a dentist in the last year are less Experience Dental Decay Sealants Care likely to need dental care (22%) than children who HP 2010: 42% HP 2010: 21% HP 2010: 50% visited the dentist more than 1 year ago (42%)*. * Includes children who need early and urgent dental care Most common reasons why 3rd grade children last visited the dentist, Georgia, 2005 Reasons for Last Visit 100 ƒ The most common reason why 3rd grade children last 79 visited a dentist was they went in on their own (79%). 80 Percent ƒ Treatment from earlier visits (7%), something was wrong 60 (6%), and called in by dentist (5%) were other reported 40 reasons for the last visit to a dentist. 20 7 6 5 0 Went in on own Treatment from Something was Called in by earlier visit wrong dentist* Differences are statistically significant: p < 0.05ORAL HEALTH OF GEORGIA’S CHILDREN - Results from the 2005 Georgia Third Grade Oral Health Survey–April 2006 5
  6. 6. Methodology and Sample SizeSamplingThe Georgia Department of Human Resources, Division of Public Health conducted a statewide oral health screening in spring2005. All public schools with 25 or more students enrolled in 3rd grade were eligible to participate in the screening. During the2002-2003 school year, there were 1,145 schools with 115,523 children in the 3rd grade. The sampling frame was ordered bythe proportion of students eligible for the free and reduced lunch (FRL) program. The 15th school was randomly selected toparticipate and every 20th school thereafter. If a school refused to participate, a replacement school within the same samplingstrata was selected.Screening methodsOnly those children in third grade who returned a positive consent form were screened. Public health dentists and dentalhygienists completed the screenings using gloves, penlights, and disposable mouth mirrors. The diagnostic criteria outlined inthe Association of State and Territorial Dental Directors publication Basic Screening Surveys: An Approach to MonitoringCommunity Oral Health 6 were used. The public health dentists and dental hygienists attended a full-day training session,which included a didactic review of the diagnostic criteria along with a hands-on calibration session. Calibration wasmonitored during the screening process to ensure consistency.Parent questionnaireParents were asked to complete a one page questionnaire designed to obtain information on the prevalence of toothaches,time since last dental visit, reason for last dental visit, problems accessing dental care, and medical and dental insurancecoverage. Parents also provided information on the child’s race, ethnicity, age, and eligibility for the free or reduced schoollunch program.Participation2,961 children (51% participation rate with parental consent) from 57 public schools in Georgia were screened. Completedparent questionnaires were gathered for 2,363 children. Data from both the parent questionnaire and screening wereavailable for 2,326 children.WeightingResults were weighted for non-response and the race and sex distribution of 3rd grade students by geographic regions inGeorgia. The sample was weighted by race-only groups due to a substantial proportion of children with unknown or missingethnicity (26%). Race-only weights were derived by re-classifying Hispanic children in the school enrollment data into race-only groups based on the racial distribution of Hispanic children ages 5-9 in Georgia reported by the U.S. Census.Definition of socioeconomic status (SES) and geographic regionsEligibility in the FRL program was used as an indicator of SES in this analysis. Eligibility is based on the income and numberof persons in the household. For example, households with four individuals were eligible to participate in the FRL programduring the 2004-2005 school year if their annual income was less than $34,873. The classification of regions in the state wasbased on county population density estimates in 2002. Metropolitan Atlanta included counties with 1,500 residents per squaremile or more. Counties with 290-900 residents per square mile bordering counties in Metropolitan Atlanta were classified asSuburban Atlanta and those not bordering Metropolitan Atlanta were classified as small cities. Rural areas included countieswith fewer than 290 residents per square mile.Data analysisThe screening dataset was the source for estimating the percent of children who have caries, untreated dental decay, dentalsealants, and need dental care by sex, race, SES, and region. The merged dataset linking data from the screening and parentquestionnaire was the source for all other estimates. SAS was used to calculate weighted prevalence estimates with 95%confidence intervals.ORAL HEALTH OF GEORGIA’S CHILDREN - Results from the 2005 Georgia Third Grade Oral Health Survey–April 2006 6
  7. 7. References1. U.S. Department of Health and Human Services, Oral Health in America: A Report of the Surgeon General. Rockville, MD: HHS, National Institutes of Health, National Institute of Dental and Craniofacial Research, 2000. http://www.nidr.nih.gov/sgr/execsumm.htm#challenge2. National Institutes of Dental and Craniofacial Research (NIDCR): Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits, Am J Public Health 1992; 82(12): 1663-8. http://drc.nidcr.nih.gov/report/17_1.htm3. Partners in Information Access for the Public Health Workforce, Healthy People 2010 Information Access Project, Healthy People 2010 Oral Health objectives: http://www.healthypeople.gov/Document/HTML/Volume2/21Oral.htm4. California Dental Association5. American Academy of Pediatric Dentistry: Hospital Charges for Dental Caries-related Emergency Admissions, Pediatr Dent. 2000; 22: 21-26 http://www.aapd.org/searcharticles/article.asp?ARTICLE_ID=656. Department of Health and Human Services Centers for Disease Control and Prevention Preventing Chronic Disease: Investing Wisely in Health - Preventing Dental Caries, January 2006 http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/oh.pdf7. Association of State and Territorial Dental Directors publication Basic Screening Surveys: An Approach to Monitoring Community Oral Health http://astdd.org/index.php?template=surveybss.html, manual: http://www.astdd.org/docs/BSS_Manual_9-25-03.pdf8. Georgia Dental Association Action: Georgia Dental Disease Prevalence Survey: Alderman, E. J., White, Shelia, Johnson, W.T. April 1994, 17-19.9. Obesity in Georgia’s Third Grade Children, 2005 http://health.state.ga.us/pdfs/epi/3rdGradeBMISummary.pdf AcknowledgementsFunding for the 2005 Georgia Third Grade Oral Health Survey was provided through the Health Resources and ServicesAdministration, States Oral Health Collaborative Systems Grant, Georgia’s Access to Dental Services Grant/GADS III. Thisproject was a collaborative effort between the Georgia Department of Human Resources, Division of Public Health, FamilyHealth Branch, Oral Health and Nutrition Sections and the Epidemiology Branch, Chronic Disease, Injury, and EnvironmentalEpidemiology Section, as well as the Association of State and Territorial Dental Directors and Georgia’s District Oral HealthPrevention and Nutrition Programs.The Oral Health Section extends a special thank you to the District Dental Directors, Dental Hygienists and Dental Assistantswho conducted the on site screening survey. We also thank the Georgia Department of Education, School Superintendents andteachers for their essential support in this important assessment of third grade children’s oral health and nutrition status.For more information and resources about programs to address oral health in Georgia, please visithttp://health.state.ga.us/programs/oral/ or contact:Thomas E. Duval DDS, MPH Linda L. Koskela RDH, MPHDirector, Oral Health Section Director, GA Oral Health Prevention Program2 Peachtree Street, NW, 11-106 2 Peachtree Street, NW, 11-105Atlanta, GA 30303-3142 Atlanta, GA 30303-3142(404)-657-2571 (404)-463-2449teduval2@dhr.state.ga.us llkoskela@dhr.state.ga.us Suggested citation: Falb M, Kanny D, Duval T, Koskela L. Oral Health of Georgia’s Children: Results from the 2005 Georgia Third Grade Oral Health Survey. Georgia Department of Human Resources, Division of Public Health, April 2006. Publication Number: DPH06.028HW.ORAL HEALTH OF GEORGIA’S CHILDREN - Results from the 2005 Georgia Third Grade Oral Health Survey–April 2006 7

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