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ND closes gap in childhood tooth decay

GRAND FORKS -- North Dakota has gone from the back to the front of the class in efforts to prevent childhood tooth decay.

It is one of just five states in the country to earn an A, according to the 2012 Pew Center on the States report, "Falling Short: Most States Lag on Dental Sealants."

Minnesota earned a B, and South Dakota a D.

The report focuses on prevention, examining states' efforts to improve access to sealants for low-income youths. The grades are based on four indicators that it says should be part of a state's tooth decay prevention strategy:

- Having sealant programs in high-need schools. Sealants are clear plastic coatings applied to the chewing surfaces of molars that prevent decay at one-third the expense of filling a cavity. Molars are the most cavity-prone teeth, and sealants act as a barrier against decay-causing bacteria.

- Allowing hygienists to place sealants in school-based programs without requiring a dentist's exam.

- Collecting data regularly about the dental health of school children and submitting it to a national oral health database.

- Meeting a national health objective on sealants.

"We're very pleased that North Dakota has achieved an A," said Sharon Ericson, CEO of Valley Community Health Centers in Northwood, which operates a dental clinic in Grand Forks, as well as clinics in Northwood and Larimore.

"At one point, we were one of the top five states in rates of people losing their teeth," she said.

Five-year change

That was back in 2007, the year the dental clinic opened in Grand Forks.

At the time, 38.6 percent of North Dakotan 65 and older were missing all their natural permanent teeth. The rate was the third highest in the nation, trailing only Kentucky and West Virginia.

In 2007, Minnesota was at 22.7 percent; the national average was 24.4 percent.

An estimated 7,500 Medicaid recipients, including nearly 4,300 children, in Grand Forks and Polk counties had little or no access to dental care in 2007.

In a 2010 report, the Pew Center listed both North Dakota and Minnesota among the two-thirds of the states failing to ensure that disadvantaged children get the dental health care they need.

State dental association officials at the time attributed that to low state reimbursement rates, which few dentists were willing to accept. They also noted that disadvantaged children often failed to keep dental appointments even after financial arrangements had been made.

In 2012, the Grand Forks clinic treated about 3,200 patients, about 45 percent of them children, according to Ericson.

In 2007, about 80 percent of low-income children in the region hadn't had oral healthcare in the previous five years. The rate now is 14 percent.

Other community public dental clinics are operated in Fargo, Bismarck and Beulah.

Ericson credits the North Dakota Department of Health's Oral Health Program, which has conducted an aggressive campaign in recent years to build a fluoride varnish dental sealant program.

National issue

North Dakota is one of just five states to earn an A grade in the latest report. The others are Alaska, Maine, New Hampshire and Wisconsin, according to the Pew Report.

States joining Minnesota with B grades are Colorado, Connecticut, Idaho, Maryland, Massachusetts, Oregon and Washington.

The report indicates that 20 states and the District of Columbia received either D or F grades, when it comes to providing children with dental sealants.

Sealants are typically first applied to children's molars when they are in the second grade, shortly after their permanent teeth appear.

Research shows that providing sealants through school-based programs is a cost-effective way to reach low-income children, who are at greater risk of decay, according to the report. In addition to protecting a healthy tooth, sealants also can prevent a cavity from forming when applied during the early stages of tooth decay.

The report also confirmed that preventable dental disease is punishing state budgets. Between 2010 and 2020, annual Medicaid spending for dental care is expected to climb from $8 billion to more than $21 billion. Children account for roughly one-third of the program's total spending on dental services.

In 2009, U.S. children made more than 49,000 visits to hospital emergency rooms for preventable dental problems. In South Carolina, for example, nearly three out of four dental emergency room trips in 2009 were made by Medicaid recipients or the uninsured, meaning taxpayers or other hospital consumers assumed a significant portion of these costs.

"Children's health isn't the only thing that suffers when states don't invest in sealant programs," Shelly Gehshan, director of the Pew Children's Dental Campaign, said in a news release. "States that miss this opportunity to prevent decay are saddling taxpayers with higher costs down the road through Medicaid or other programs."