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ARRA Investments in Dental and Oral Health Disparities

Public Health Burden
The Nation’s oral health has improved greatly over the years for many, but not for all, Americans. Chronic dental and oral conditions remain among the most common health problems that afflict the disadvantaged and persons living in institutional settings. These problems disproportionately affect low income children, many of whom are racial or ethnic minorities, and who are the most vulnerable members of our society.   A U.S. Government Accountability Office (GAO) report published in 2008 estimated that, in 2005, 6.5 million children aged 2 through 18 enrolled in Medicaid had untreated dental caries (tooth decay). Untreated caries in children can cause discomfort and pain, poor school performance, poor nutrition, and serious health problems. Untreated caries in adults can also lead to severe health problems.

Oral Health Promotion and Disease Prevention in Children and Vulnerable Adults
Practical, cost-effective solutions are possible. One is fluoride varnish, a clear liquid coating that is brushed directly onto the teeth. The varnish slowly releases fluoride over several months, strengthening the teeth and preventing decay. Recent studies established that low-income children who receive periodic fluoride varnish treatment have a lower incidence of tooth decay. These research data were so compelling that Medi-Cal, the Medicaid program in California, implemented policies to reimburse medical and dental providers for administering fluoride varnish treatments to children under age six as many as three times per year. ARRA-funded research aimed at developing additional strategies to tackle disparities in oral health includes the following projects:
  • Improving the maternal and child oral health status of underserved populations is the ultimate objective of a grant that focuses attention on women who are pregnant. This study will provide information needed to launch an oral health promotion intervention.1
  • Dental disease may be largely preventable if more were understood about the most effective age for the first preventive dental visit.  This grant takes a multifaceted and interdisciplinary approach to determining the predictors of the age at the first preventive dental visit as well as the outcomes from the visit.  An important purpose of the grant is to determine the impact of the age at first visit on future dental and medical care costs.2
  • Preventing oral disease in Latino children is the focus of a grant that proposes pilot work to develop and examine the acceptability and feasibility of a culturally appropriate educational intervention for parents of Latino children.  The intervention will be delivered by community-based Latina lay health workers, who are called promotoras.  The intervention is aimed at reducing oral health disparities caused by early childhood caries, a particularly devastating form of dental caries that is highly prevalent among low income, preschool aged Latino children.3
  • This study seeks to understand the determinants of oral health status and treatment needs of adults with developmental disabilities including individual, caregiver, and clinical care factors associated with poor oral health.  The findings hope to serve as a foundation from which to develop effective strategies to preserve and protect the oral health of this vulnerable population.4

  1. 1R21DE019211-01A1 -- Oral Health Promotion During Pregnancy in a Group Prenatal Care Model -- Adams, Sally -- (CA)
  2. 1RC1DE020303-01 -- First preventive dental visit: Disparities in needs, costs + behavioral insights -- Damiano, Peter C -- (IA)
  3. 1R21DE019210-01A1 -- Contra Caries: Preventing ECC Using a Promotora Model for Rural Latino Families -- Barker, Judith C. -- (CA)
  4. 1RC1DE020396-01 -- Oral Health Status and its Correlates in Adults with Developmental Disabilities -- Morgan, John Patrick -- (MA)

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