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State Fights Tooth Decay But Fails Report

North Carolina Department of Health and Human Services

Sink your teeth into this: about half of all children will have tooth decay before the age of 12. A common procedure called a dental sealant can extract most of that risk. But a new report gives North Carolina, along with only five other states, an “F” for its use of dental sealants. The failing mark stems partially from the lack of sealants administered in high need schools, but also specific grading criteria that state officials say does not score North Carolina’s accomplishments.

It takes Dr. Gary Kushner just a few minutes to seal a tooth. First, he gives 10-year old Briana Fulwiley the usual cleaning.

“First I’m going to brush some of the plaque off of your teeth here,” he tells her in a sing-song voice. “You’re doing absolutely fantastic.”

He soaps, rinses, and dries the tooth.

“And then the last thing I’m going to do is go ahead and put on our special plastic coating. This is the sealant—protects your tooth. And, it’s a liquid,” Kushner says. “And then I’m going to take my special magic light, and shine it on your tooth and it makes this liquid very hard and it sticks it onto your tooth.”

After a few beeps from the “magic light,” the sealant is dry, and the tooth is less than half as likely to develop infections and cavities.  The cost of sealing all of a child’s molars is under $200, or around the same as filling just one cavity.

Kushner is also the dental director for Mecklenburg County. He says tooth decay is avoidable, but there’s a shortage of public dentists and hygienists, so it’s important to focus on prevention. A 2008 report in the North Carolina Medical Journal reported the state has an average of one public hygienist for every 13,800 elementary school child. The county sends these hygienists to schools, where they screen children, recommend sealants, and educate parents.

In Mecklenburg, “four public health hygienists screened essentially 20,000 children within a six month period of time,” Kushner says. “They also screened other children as well, but just in our public schools, 20,000 children. They’re booking it.”

That means 85 percent of the kindergartners and fifth graders in CMS have a public hygienist looking into their mouths. But, last week, the Pew Center on the States gave North Carolina an “F” for its dental sealant efforts.  Pew’s Jane Koppelman says states shouldn’t rely on parents to take their children to the dentist’s office—they should bring the office to the school.

“Dental hygienists go into the school and it’s a very simple process. They just line the kids up and they paint sealants onto their molars,” Koppelman says.

The state has hygienists who seal teeth in some high need schools in 93 counties, but less than Pew’s lowest benchmark of 25 percent. The state also got docked for too much red tape for a child to get a sealant at school.  North Carolina’s chief dentist, Dr. Rebecca King lays out the current process:

“Our public health dental hygienist will screen the children and look for ones that might benefit from sealants, and then send information home to the parents to get permission,” King says.

Then, King says, after a permission form comes back, a state dentist visits and examines the children’s teeth, again. After that, the public hygienist can come back to the school, and administer the sealants.

The staff at Pew argue that process is too complicated. Instead of requiring an examination by a dentist, they say medical science shows it is better to cut out the multiple visits and just let the hygienist handle the entire process in one. The state of Virginia found it saved 20 percent on the cost of sealing teeth, using this process. But Dr. Kushner describes that as a medical disagreement, and one example of how Pew’s grading scale misrepresents North Carolina’s accomplishments.

“I just can’t believe our efforts haven’t met the goal, and I think they have. We just haven’t captured them on paper,” Kushner says. “We’ve captured them in the children’s mouths, but not on paper.”

For instance, the rate of fifth graders in North Carolina with dental sealants—arguably the most important number—is 44 percent. That ranks 20th compared to reported data from other states, but the report does not give any points for a score below the national goal of 50 percent (which 12 states have reached). And, North Carolina has steadily improved from 28 percent in 1996. Kushner says more can be done, but the report is misleading.

“We’re not getting an F. We’re doing well in some areas, we could be doing better in others,” He says.

The state’s chief dentist, Dr. King, is part of a task force to improve the state’s sealant program. She expects to have recommendations within the next six months to take another bite at the issue.