promoting healthy smiles through education & prevention · lafayette putnam mercer marion...
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Promoting Healthy Smiles Through
Education & Prevention
Table of contents 1. What is PSP .............................................................................. 3
2. Map of PSP Participants ........................................................... 4
3. The Importance of Oral Health.............................................. 5
4. Chart of Total PSP Participants.............................................. 6
5. Demographics of PSP Participants ......................................... 7
6. Oral Hygiene of PSP Participants .......................................... 12
7. Sealants of PSP Participants .................................................. 15
8. Treated Decay of PSP Participants ....................................... 18
9. Untreated Decay of PSP Participants ................................... 21
10. Treatment Urgency of PSP Participants ............................. 24
11. Caries of PSP Participants ................................................... 27
12. White Spot Lesions PSP Participants ................................. 32
13. Fluoridated Water Supplies and PSP Students ................... 35
14. Map of Fluoridation in Missouri ......................................... 40
15. Map of Dentist Availability in Missouri ............................... 41
16. Conclusion ............................................................................ 42
18. References ........................................................................... 44
2018-2019 PSP Report
17. Glossary................................................................................... 43
The Missouri Oral Health Preventive Services Program (PSP) was created by the Missouri Department of Health and Senior Services (DHSS) to help children with various oral health needs. The program is operated under the guidance of the State Dental Director, and carried out by the Office of Dental Health. The program is coordinated with five regional oral health consultants, all of whom are Registered Dental Hygienists. The consultants support their regions by promoting oral health care at; daycares, schools, head start centers, preschools, health clinics, and other settings where children are present. The consultants facilitate the ordering of PSP supplies for events, all of which are funded through the Office of Dental Health, including:
• Technical Assistance• Offering DHSS Educational Materials• Providing Oral Health Supplies (Toothbrushes, Floss, Toothpaste)• Providing Oral Health Screening Supplies (Disposable Mouth Mirrors and
Screening Forms)• Fluoride Varnish• Online Calibration for Registered Dental Professionals Who Perform Oral
Screenings, as well as Online Training for Parents and Volunteers Who Apply Fluoride Varnish
One of the main reasons for PSP’s success is the community-based aspect. If it were not for the engagement and interest from the school nurses and others promoting the program, this program may not have the level of success it has gained over the last few years. Local volunteers include dentists and hygienists who provide the screenings, and volunteers and parents who help apply the fluoride varnish.
What is PSP?
2018-2019 PSP Report
3
Texas
Dent
Pike
Bates
BarryHowell
Polk
Linn
Cass
Ray
Ozark
Saline
Macon
Henry Franklin
Pettis
Vernon
Butler
ShannonWayne
Miller
Holt
OregonTaney
Benton
Boone
Carroll
Wright
Adair
Douglas
Johnson
Ripley
Laclede
Phelps
Nodaway
Callaway
Jasper
Knox
Stoddard
Clark
Chariton
Osage
Ralls
Greene
Audrain
Dade
Lincoln
Barton
St. Clair
Monroe
Perry
Lewis
Camden
Clay
Sullivan
Newton
Cole
Carter
Cedar
Scott
Maries
Cooper
Pulaski
Jackson
Shelby
Gentry
Daviess
Lafayette
PutnamMercer
Marion
Clinton
McDonald
Hickory
Worth
Iron
Reynolds
Harrison
Dallas
Stone
Crawford
Morgan
Jefferson
Dunklin
BollingerWebster
Platte
Washington
Atchison
Lawrence
Christian
New Madrid
Howard
St. LouisWarren
Madison
Grundy
DeKalbAndrew
Pemiscot
St. Charles
Livingston
Randolph
Caldwell
Scotland
Gasconade
Moniteau
Montgomery
Buchanan
Mississippi
St. Francois
Cape Girardeau
Schuyler
Ste. Genevieve
St. Louis City
Number of Participants
Figure 1:Map of PSP Participants
PSP Participants 2018-2019
2018-2019 PSP Report
4
1-100
101-250
251-500
501-1000
1000-5000
Over 5000
None
Oral Health Care is a growing concern in the United States for a number of reasons. Chronic oral health problems can be precursors to more serious heart and lung diseases, they can be symptoms of serious viral infections such as HIV and Herpes, and they can also cause more serious health issues such as severe bacterial infections. The Oral Health in America: A Report of the Surgeon General defined a four pronged approach to combating oral health issues in America: 1. oral health means much more than a healthy teeth; 2. oral health is integral to general health; 3. safe and effective disease prevention measures exist that everyone can adopt to improve oral health and prevent disease; and 4. general health risk factors, such as tobacco use and poor dietary practices, also affect oral and craniofacial health.1
Since the Missouri Preventive Services Program (PSP) focuses on children, this report will focus on how oral health impacts children only. Studies have shown that children with dental pain and poor oral health often miss school and have difficulties with speaking, eating, and learning.1 More than 51 million school hours are lost each year due to children having a dental related illness.1 Even more concerning, children aged 5-17 years old are 5 times more likely to have had at least one cavity or filling than a reported history of asthma.1
• 51.6% of Children ages 5-9 have had at least one cavity or filling inthe coronal (crown of tooth) portion of their primary orpermanent teeth. 1
• 77.9% of children age 17 have had at least one cavity or filling inthe coronal (crown of tooth) portion of their primary orpermanent teeth. 1
• 84.7% of individuals ages 18 and older have had at least one cavityor filling in the coronal (crown of tooth) portion of their primaryor permanent teeth. 1
Why is Oral Health Important?
2018-2019 PSP Report
5
There were a total of 91,384 participants in the Preventive Services Program (PSP) for the 2018-2019 school year.
4,377
7,362
18,976
35,949
54,187
64,657
63,949
72,088
76,320
83,258
83,139
92,692
88,138
91,384
2018-2019
2017-2018
2016-2017
2015-2016
2014-2015
2013-2014
2012-2013
2011-2012
2010-2011
2009-2010
2008-2009
2007-2008
2006-2007
2005-2006
Figure 2: Total PSP Participants by School Year
2018-2019 PSP Report
6
Preschool11%
Kindergarten13%
Elementary School65%
Middle School9%
High School2%
Preschool
Kindergarten
Elementary School
Middle School
High School
Preschool Kindergarten Elementary School Middle School High School
9,607 12,138 57,992 7,953 1,970
Demographics of PSP Participants
PSP events are mostly held in school settings. Due to the timing of these events being held during the school year months, it is easier to categorize children based on their school type rather than their specific grade level.
Similar to previous years, the bulk of students seen are Elementary School aged students.
Figure 3: PSP Participants by Grade Category
Tabel 2: Total Number of PSP Participants by Grade Level
2018-2019 PSP Report
7
PSP Participants by Gender
Gender Number Percent
Male 46492 51%
Female 44569 49%
Female49%
Male51%
Age Group Male Percent Female Percent Total
0-5 years old 9362 20.6% 8728 20.00% 18090
6-12 years old 33949 74.6% 32867 75.30% 66816
13 years and older 2213 4.9% 2048 4.69% 4261
Total 45524 43643 89167
Tabel 3: PSP Participants by Age Group
Tabel 2: PSP Participants by Gender
There were 1,923 more male students than female participants. The split between the genders has increased compared with 2017-2018 report.
Figure 4: PSP Participants by Gender
2018-2019 PSP Report
8
The 6-12 year old age group has the highest number of participants among both genders. The second highest number of participants were in the 0-5 age group category, and the last was in the 13 years and older group.
African-American Asian/Pacific Islander
Hispanic Other White
7498 1349 3785 4868 72717
Male Female
20.6% 20.0%
74.6% 75.3%
4.9% 4.7%
0-5 Years Old 6-12 Years Old 13 years and Older
Figure 5: Age Group by Gender
Tabel 4: PSP Participants by Race/Ethnicity Totals
2018-2019 PSP Report
9
8%2%
4%
81%
5%
African-American
Asian or Pacific Islander
Hispanic
Other
White
Designation Number of Participants
Rural 48,260
Urban 43,124
Figure 6: PSP Participants by Race/Ethnicity
2018-2019 PSP Report
10
A majority of participants were identified as “White”. The category “Other” includes all categories the screeners have identified as “Unknown Non-White”, “American Indian”, and “Mixed-Race”.
Of the 115 counties in Missouri, students were screened from 109 of them. Nienty-six of them are designated as rural counties and 14 are designated as urban counties. There are 5.6% more PSP participants in rural counties than urban ones.
Tabel 5: Geographic Distribution of PSP Participants
Number of Dentists Number of Particpants At least 1 89207 None 2177
Rural Urban
52.8%
47.2%
98%
2%
At Least 1 Dentist No Dentist
Figure 7: Geographic Distribution of PSP Participants
There are 12 counties in Missouri without a licensed dentist with a local address in these counties: Caldwell, Holt, Mercer, Monroe, Oregon, Ralls, Reyolds, Ripley, Shannon, Sullivan, Wayne, and Worth. All 12 counties had PSP participants. However, the number of children in these counties combined accounted for only 2% of all PSP participants.
Figure 8: PSP Participants by Number of Dentists
Tabel 6: PSP Participants by Number of Dentists
2018-2019 PSP Report
11
Male Female
16%13%
26%
21%
31%
20%
0-5 years old 6-12 years old 13 years and older
Oral Hygiene of PSP Participants
Poor oral hygiene is defined by moderate to heavy plaque on the teeth with red gums and tissue. Male 13 years and older were more likely than females of any age group and males in the other two groups to have poor oral hygiene. The group with the highest percent of good oral hygiene was female ages 0-5 years old.
Figure 9: Poor Oral Hygiene by Age Group and Gender
2018-2019 PSP Report
12
African-American Asian/PacificIslander
Hispanic Other White
20.3%
25.9%
23.2%
28.3%
21.2%
Rural Urban
81.2%75.1%
18.8% 24.9%
Satisfactory Not Satisfactory
The highest percent of poor oral hygiene was detected in children whose race was marked as “Other.” The second highest group was children marked as “Asian/Pacific Islander.”
Figure 10: Poor Oral Hygiene by Race/Ethnicity
Urban children had a higher percent of children with poor oral hygiene (25%) compared to rural children (19.0%). Rural children had a higher rate of good oral hygiene (81%) compared to urban children (75%).
Figure 11: Oral Hygiene by Geography
2018-2019 PSP Report
13
Children who lived in a county with at least one dentist had a higher rate of poor oral hygiene (21.8%) than children in counties with no dentist (16.2%).
Satisfactory Not Satisfactory
78.2%
21.8%
83.8%
16.2%
At least 1 Dentist No Dentist
Figure 12: Oral Hygiene by Number of Dentists
2018-2019 PSP Report
14
Dental sealants are a clear plastic coating that are applied to the chewing surface of permanent molars to help prevent cavities. Once a permanent molar erupts, it is best to have a dental staff member apply sealants as soon as possible. Typically, around the age of 7 is when the first permanent molar will erupt, and age 10 is when the second permanent molar erupts.
Unfortunately, there were more children screened that did not have dental sealants than those that did. However, among those that had sealants, female ages 6-12 years old were more likely to have had their teeth sealed than males in both age groups.
Male Female
23%
34%
30%
24%
6-12 yrs old 13 yrs and old
Sealants of PSP Participants
Figure 13: Dental Sealants by Gender and Age
2018-2019 PSP Report
15
African-AmericanAsian or Pacific
Islander HispanicOther
White
17% 19%21%
20%20%
Sealants No Sealants
17.9%
82.1%
21.3%
78.7%
Rural Urban
Figure 14: Dental Sealants by Race/ Ethnicity
Hispanic children had the highest percent of dental sealants, and African-American children had the lowest.
Children in urban counties were 3% more likely to have dental sealants than those in rural ones.
Figure 15: Dental Sealants by Geography
2018-2019 PSP Report
16
Children who resided in counties with at least 1 dentist had higher percent of sealants present compared with children who resided in counties with no dentist.
No Sealants Sealants
80.4%
19.6%
85.4%
14.6%
At least 1 Dentist No Dentist
Figure 16: Dental Sealants by Number of Dentists
2018-2019 PSP Report
17
Treated tooth decay is apparent by the number of fillings recorded on the teeth (either primary or permanent) during the screening. Primary teeth are more colloquially referred to as baby teeth.
Decay None Decay None
Male Female
16%
84%
16%
84%
38%
62%
35%
65%
37%
63%
35%
65%
Figure 17: Treated Decay by Gender and Age Group
0-5 years old 6-12 years old 13 years and older
Treated Decay by Tooth Type
Male Percent Female Percent Total
Permanent Only 1919 6.5% 2014 6.8% 3933
Primary and Permanent
2121 7.2% 1946 6.6% 4067
Primary Only 11465 38.8% 10056 34% 21521
Treated Decay of PSP Participants
Tabel 7: Treated Decay by Gender and Tooth Type
Males ages 6-12 year olds had the highest percent of total treated decay. The percent of treated decay were tied for both male and female children 0-5 year olds.
2018-2019 PSP Report
18
Treated Decay by Tooth Type
African-American
Asian/Pacific Islander
Hispanic Other White
None 5312 71% 806 60% 2348 62% 3112 64% 48869 68%
Permanent Only 303 4% 42 3% 148 4% 183 4% 3217 4%
Primary and
Permanent 296 4% 79 6% 186 5% 263 5% 3188 4%
Primary Only 1536 21% 410 31% 1078 29% 1284 27% 16990 24%
None Decay
71%
29%
60%
40%
68%
32%
64%
36%
68%
32%
African-American Asian/Pacific Islander Hispanic Other White
Tabel 8: Treated Decay by Race/Ethnicity and Tooth Types
Overall, children identified as “African-American” had the lowest percent of treated decay. Children identified as “Asian” and “Other” had the highest percent of treated decay.
Figure 18: Treated Decay by Race/Ethnicity
2018-2019 PSP Report
19
Rural Urban
32.7% 32.5%
67.3% 67.5%
Decay None
None Treated Decay
67.4%
32.6%
65.2%
34.8%
At least 1 Dentist No Dentist
Figure 19: Treated Decay by Geography
Rural and urban students had similar rates of treated decay during their screenings with rural children having slightly higher rates than urban children.
Counties that have no dentist have higher rates of treated decay than counties that have at least one dentist residing in the county.
2018-2019 PSP Report
20
Figure 20: Treated Decay by Number of Dentists
Untreated Decay byTooth Type
Male Percent Female Percent Total
Permanent Only 1513 3% 1550 4% 3063
Primary and Permanent 1058 2% 1132 3% 2190
Primary Only 7307 16% 6330 15% 13637
None 35424 78% 34434 79% 69858
Decay None Decay None
Male Female
22%
78%
20%
80%
22%
78%
21%
79%
20%
80%
16%
84%
0-5 years old 6-12 years old 13 years and older
Untreated Decay of PSP Participants
Male children had slightly higher rates of untreated decay on primary teeth. Untreated decay on permanent only and primary and permanent teeth was higher among girls.
Teenagers had the lowest amount of untreated decay, with females slightly better than males. 0-5 year old and 6-12 year old males had the highest percent of untreated decay, however it was only slightly more than females ages 6-12.
Untreated decay is determined during the oral screening when obvious decay is noted with a flashlight and disposable mouth mirror. Decay is caused by plaque, a sticky substance that forms on the teeth which causes a breakdown in the tooth’s enamel and eventually leads to cavity, also called decay, and can be found on a primary or permanent tooth.2
Tabel 9: Untreated Decay by Gender and Tooth Type
Figure 21: Untreated Decay by Gender and Age Group
2018-2019 PSP Report
21
Untreated Decay by Tooth Type
African-
American Asian/Pacific
Islander Hispanic Other White
None 5487 73.6% 973 72.6% 2799 74.5% 3641 75.2% 57733 79.8%
Permanent Only
379 5.1% 39 2.9% 142 3.8% 159 3.3% 2455 3.4%
Primary and Permanent
302 4.1% 54 4.0% 118 3.1% 168 3.5% 1578 2.2%
Primary Only
1288 17.3% 275 20.5% 698 18.6% 872 18.0% 10625 14.7%
Decay None
20.2%
79.8%
26.4%
73.60%
25.5%
74.50%
27.4%
72.60%
24.8%
75.20%
White African American Hispanic Asian/Pacific Islander Other
Tabel 10 : Untreated decay by Race/Ethnicity and Tooth Type
Overall, children identified as “White” had the lowest percent of untreated decay. Children identified as “Asian/Pacific Islander” had the highest percent of untreated decay for primary only tooth type. Children identified as “African American” had the highest percent of untreated decay among permanent only tooth type.
2018-2019 PSP Report
22
Figure 22: Untreated Decay by Race/Ethnicity
Designation None Permanent Primary and Permanent Primary
Rural 38268 1863 1297 7906
Urban 33201 1353 955 6067
Untreated Decay None
22.3%
77.7%
20.3%
79.7%
Rural Urban
Untreated Decay None
21.2%
78.8%
27.3%
72.7%
At least 1 Dentist No Dentist
Figure 23: Untreated Decay by Geography
Tabel 11 : Total Number of Untreated decay by Geography and Tooth Type
Children in rural counties had a higher rate of untreated decay than children in urban counties. However, children who lived in a county with no dentist had significantly higher rates of untreated decay.
2018-2019 PSP Report
23
Figure 24: Untreated Decay by Number of Dentists
Male Female Age None Early Dental Urgent Care None Early Dental Urgent Care 0-5 years old 78.4% 18.9% 2.7% 79.9% 17.3% 2.8% 6-12 years old 78.2% 18.3% 2.9% 78.9% 18.0% 2.8% 13 years and older
80.1% 17.6% 2.3% 83.8% 14.7% 1.6%
Male Children Ages 0-5 years had the most referrals for early dental care. Male children ages 6-12 years had the most referrals for urgent care. Teenage girls had the lowest number of referrals for dental care among all age groups for both genders.
None Early Dental Urgent Care None Early Dental Urgent Care
Male Female
78%
19%
3%
80%
17%
3%
78%
18%
3%
79%
18%
3%
80%
18%
2%
84%
15%
2%
0-5 years old 6-12 years old 13 years and older
Treatment Urgency for PSP Participants
One of the biggest services PSP offers is that parents and guardians are informed when a dental issue that needs immediate attention is detected during a screening. If a problem is detected, PSP organizers will provide referrals to local dental offices or clinics so the child can receive proper follow up. There are two classifications for need of treatment; early dental care and urgent dental care. Early dental care is recommended for injuries or conditions that need to be addressed within the coming months. Urgent dental care is recommended for injuries or conditions that need to be addressed immediately and typically recommended they be remedied within the next 24 hours.
Tabel 12: Treatment urgency by Gender and Age Group
Figure 25: Treatment Urgency by Age Group
2018-2019 PSP Report
24
Race No Obvious Problem Early Dental Urgent Care
African-American 73.6% 23.0% 3.4%
Asian/Pacific Islander 73.1% 21.8% 5.1%
Hispanic 74.4% 21.3% 4.3%
Other 75.0% 21.6% 3.4%
White 79.9% 17.5% 2.6%
African-American children had the highest percent of students needing early dental care. Asian/ Pacific Islander students had the highest percent of students needing urgent care. Overall, white students had the lowest percent for any treatment urgency.
No Obvious Problem Early Dental Urgent Care
74%
3%
73%
5%
74%
21%
4%
75%
22%
3%
80%
18%
3%
African American Asian/Pacific Islander Hispanic Other White
23% 22%
Figure 26: Treatment Urgency by Race/Ethnicity
Tabel 13: Treatment Urgency by Race/Ethnicity
2018-2019 PSP Report
25
No Obvious Problem Early Dental Care Urgent Care
77.7%
19.1%
3.2%
79.9%
17.7%
2.4%
Rural Urban
Early Dental Care No Obvious Problem Urgent Care
18.3%
78.9%
2.8%
24.2%
72.9%
2.9%
Treatment Urgency by Number of Dentists
At least 1 Dentist No Dentist
Figure 27: Treatment Urgency by Geography
Children living in rural counties had higher rates for treatment urgency referrals than kids in urban counties. Children living in counties with no dentist had a slightly higher rates for treatment urgency referrals than those residing in counties with at least 1 dentist. Figure 28:Treatment Urgency by Dentist Availability
2018-2019 PSP Report
26
In the 2018-2019 school year, males ages 6-12 had the highest rate of rampant caries. Females ages 13 years and older had the lowest rate of rampant caries.
Age Group Male Female
No Rampant Caries
Rampant Caries Present
No Rampant Caries
Rampant Caries Present
0-5 years old 91.6% 8.4% 92.2% 7.8%
6-12 years old 90.6% 9.4% 91.8% 8.2%
13 years and older 96.5% 3.5% 96.9% 3.1%
91.6% 90.6% 96.5% 92.2% 91.8% 96.9%
8.4% 9.4% 3.5% 7.8% 8.2% 3.1%
No Yes No Yes
Male Female
0-5 years old 6-12 years old 13 years and older
Caries for PSP Participants
Dental Caries is one of the most common childhood diseases. Caries is the Latin word for “rotten.”1 Caries is just a more technical term for cavity. A cavity is a late manifestation of a bacterial infection.1 A cavity is the result of plaque forming over a tooth and dissolving the enamel. Plaque occurs when bacteria form a gelatinous film that adheres to the tooth’s surface.1 When plaque is considered cariogenic (causing decay) a single site on a tooth could have close to half a billion bacteria living there, including Streptococcal mutans.1 Once these bacteria are on the tooth, they begin to ferment sugars and carbohydrates that form lactic and other acids that lead to the eventual erosion of the enamel covering the tooth.1 Once that protective enamel layer is gone, the tooth begins to decay from bacterial infection.
Tabel 14: Rampant Caries by Gender and Age Group
Figure 29: Rampant Caries by Age/Group
2018-2019 PSP Report
27
Males aged 0-5 years old had the highest percent of childhood caries while teenage girls had the lowest childhood caries.
Age Groups Male Female
No Childhood Caries
Childhood Caries Present
No Childhood Caries
Childhood Caries Present
0-5 years old 89.2% 10.8% 90.7% 9.3%
6-12 years old 97.7% 2.3% 98.0% 2.0%
13 years and older 99.4% 0.6% 99.6% 0.4%
13 years and older6-12 years old0-5 years old
Female Male
Yes No Yes No
2.0% 0.4% 9.3%
2.3% 0.6% 10.8%
89.2% 90.7% 98.0% 99.6% 97.7% 99.4%
Figure 30: Early Childhood Caries by Age Group/Gender
Tabel 15: Early Childhood Caries by Age Group and Gender
2018-2019 PSP Report
28
Yes No
91.5%
8.5%
91.6%
8.4%
Rural Urban
Yes No
4.8%
95.2%
7.1%
92.9%
Rural Urban
Figure 31: Rampant Caries by Geography
Children in rural counties had slightly higher percent of rampant caries and the highest percent of early childhood caries.
2018-2019 PSP Report
29
Figure 32: Early Childhood Caries by Geography
No Yes
92.8%
7.2%
86.0%
14.0%
89.5%
10.5%
91.4%
8.6%
95.1%
4.9%
African-American Asian/Pacific Islander Hispanic Other White
No Yes
92.5%
7.5%
83.0%
17.0%
88.5%
11.5%
89.4%
10.6%
91.9%
8.1%
African-American Asian/Pacific Islander Hispanic Other White
Figure 33: Early Childhood Caries by Race/Ethnicity
2018-2019 PSP Report
30
Children who were identified as “Asian/Pacific Islander had the highest rate in rampant caries and childhood caries. Children who were identified as “White” had the lowest early childhood caries while children identified as “African- American” had the lowest rampant caries.
Figure 34: Rampant Caries by Race/Ethnicity
No Yes
94.6%
5.4%
92.8%
7.2%
At least 1 Dentist No Dentist
No Yes
91.6%
8.4%
89.5%
10.5%
At least 1 Dentist No Dentist
Figure 35: Early Childhood Caries by Dentist Availability
Children in counties with no dentists had higher percentages of rampant caries and early childhood caries.
2018-2019 PSP Report
31
Figure 36: Rampant Caries by Dentist Availability
White Spot lesions are only included for children ages 0-5 years old. Males were more likely to have white spot lesions.
Yes No
15.6%
84.4%
13.8%
86.2%
Figure 37: White Spot Lesions by Gender
Male Female
White Spot Lesions of PSP Participants
White spot lesions are the first signs of decay in children under the age of 5. White spots appear pale and chalky just around the gum line.3 While white spots are a sign of decay, they are reversible. When treated with fluoride early enough, the enamel can strengthen and help fight off the decay. If fluoride isn’t applied, the spots will continue to decay and turn yellow or brown.3
2018-2019 PSP Report
32
Yes No
11.0%
89.0%
21.6%
78.4%
25.0%
75.0%
14.5%
85.5%
16.6%
83.4%
African-American Asian or pacific Islander Hispanic White Other
Yes No
12.5%
87.5%
18.5%
81.5%
Figure 39: White Spot Lesions by Geography
Rural Urban
Figure 38: White Spot Lesions by Race
Children identified as ‘‘Hispanic’’ had the highest percent of white spot lesions, and children identified as ‘‘African-American’’ had the lowest percent of white spot lesions.
Children in urban counties had a higher percent of white spot lesions than children in rural counties.
2018-2019 PSP Report
33
Yes No
15.0%
85.0%
3.7%
96.3%
At Least 1 Dentist No Dentist
Children residing in counties with at least one dentist had a higher percent of white spot lesions compared with those who resided in counties with no dentist.
Figure 40: White Spot Lesions by Dentist Availability
2018-2019 PSP Report
34
Fluoridated County Water System
No Fluoride in Any Water System
Fluoridated Water Systems, but Not County System
11,324 8,845 71,015
Fluoridated CountyWater System
No Fluoride in Any WaterSystem
Fluoridated WaterSystems, but Not County
System
12.4% 9.7%
77.7%
Fluoridated Water Supplies and PSP Students
Figure 41: PSP Participants by Fluoride Accessibility
Fluoridated water supplies are very beneficial to oral health. According to the CDC, fluoride helps strengthen permanent teeth for children under 8 years old while it leads to strong and healthy teeth among adults.4 Fluoridated water can help prevent at least 25% of tooth decay in children. 5 Fluoridated water also saves money over time. The American Dental Association estimates that every $1 spent in water fluoridation saves about $38 in dental costs in most cities.5 Despite numerous claims suggesting fluoridated water supplies are toxic, erode lead pipes, and can cause health problems, scientists have shown through many evidence based studies that there is no scientific basis to these claims.5
Since water fluoridation varies from county to county, the fluoridated variable is broken into three groups: Counties with fluoridated county water systems, counties with no fluoride in any waters systems, and counties with fluoride in some water systems but not the county water system.
Tabel 16: PSP Participants by Fluoride Accessibility
2018-2019 PSP Report
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Satisfactory Not Satisfactory
78%
22%
81%
19%
81%
19%
Fluoridated County Water System
No Fluoride in Any Water System
Fluoridated Water Systems, but Not County System
Early Dental Care No Obvious Problem Urgent Care
20%
78%
2%
20%
77%
3%
18%
79%
3%
Figure 43: Treatment Urgency by Fluoride Accessibility
Fluoridated County Water SystemNo Fluoride in Any Water SystemFluoridated Water Systems, but Not County System
Figure 42: Oral Hygiene by Fluoride Accessibility
Counties with some fluoride water in their supplies were tied with counties with no fluoride in their water system and they had lower percentage of poor oral hygiene.
For non-fluoridated counties, children were screened at slightly higher rates for treatment urgency issues than children from fluoridated counties, particularly in urgent care situations.
2018-2019 PSP Report
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None Permanent Only Primary andPermanent
Primary Only
67%
4% 5%
24%
66%
5% 4%
25%
74%
5% 2%
19%
Fluoridated County Water System
No Fluoride in Any Water System
Fluoridated Water Systems, but Not County System
None Permanent Only Primary andPermanent
Primary Only
79%
3% 2%15%
77%
4% 3%
17%
78%
5% 3%15%
Figure 45: Untreated Decay by Fluoride Accessibility
Fluoridated County Water System
No Fluoride in Any Water System
Fluoridated Water Systems, but Not County System
Figure 44: Treated Decay by Fluoride Accessibility
Counties with fluoridated county water supplies had much lower rates of treated and untreated decay. Primary teeth were the most commonly seen with both treated and untreated decay, and in both instances, counties with some fluoridated water supplies had the lowest decay rate. For ‘Permanent Only’ tooth type, counties with fluoridated water system had the lowest decay rate in both treated and untreated decay.
2018-2019 PSP Report
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No Yes
91%
9%
89%
11%
95%
5%
Fluoridated County Water System
No Fluoride in Any Water System
Fluoridated Water Systems, but Not County System
No Yes
95%
5%
91%
9%
96%
4%
Fluoridated County Water SystemNo Fluoride in Any Water SystemFluoridated Water Systems, but Not County System
Figure 46: Rampant Caries by Fluoride Accessibility
Counties that have some fluoridated water systems had the lowest rate of rampant and childhood caries followed by counties with fluoridated water supplies.
Figure 47: Early Childhood Caries by Fluoride Accessibility
2018-2019 PSP Report
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Counties with fluoridated water supplies had the lowest rate for white spot lesions.
Yes No
8.4%
91.6%
15.7%
84.3%
15.9%
84.1%
Fluoridated County Water SystemNo Fluoride in Any Water SystemFluoridated Water Systems, but Not County System
Figure 48: White Spot Lesions by Fluoride Accessibility
2018-2019 PSP Report
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Texas
Dent
Pike
Bates
BarryHowell
Polk
Linn
Cass
Ray
Ozark
Saline
Macon
Henry Franklin
Pettis
Vernon
Butler
ShannonWayne
Miller
Holt
OregonTaney
Benton
Boone
Carroll
Wright
Adair
Douglas
Johnson
Ripley
Laclede
Phelps
Nodaway
Callaway
Jasper
Knox
Stoddard
Clark
Chariton
Osage
Ralls
Greene
Audrain
Dade
Lincoln
Barton
St. Clair
Monroe
Perry
Lewis
Camden
Clay
Sullivan
Newton
Cole
Carter
Cedar
Scott
Maries
Cooper
Pulaski
Jackson
Shelby
Gentry
Daviess
Lafayette
PutnamMercer
Marion
Clinton
McDonald
Hickory
Worth
Iron
Reynolds
Harrison
Dallas
Stone
Crawford
Morgan
Jefferson
Dunklin
BollingerWebster
Platte
Washington
Atchison
Lawrence
Christian
New Madrid
Howard
St. LouisWarren
Madison
Grundy
DeKalbAndrew
Pemiscot
St. Charles
Livingston
Randolph
Caldwell
Scotland
Gasconade
Moniteau
Montgomery
Buchanan
Mississippi
St. Francois
Cape Girardeau
Schuyler
Ste. Genevieve
St. Louis City
County-Wide Fluoridation Water Systems
FluoridationFluoridated County Water SystemNo Fluoride in Any Water SystemFluoridated Water Systems, but Not County System
40
Figure 49: Fluoridation Map
2018-2019 PSP Report
Texas
Dent
Pike
Bates
BarryHowell
Polk
Linn
Cass
Ray
Ozark
Saline
Macon
Henry Franklin
Pettis
Vernon
Butler
ShannonWayne
Miller
Holt
OregonTaney
Benton
Carroll
Wright
Adair
Douglas
Johnson
Ripley
Laclede
Phelps
Nodaway
Jasper
Knox
Stoddard
Clark
Chariton
Osage
Ralls
Greene
Audrain
Dade
Lincoln
Barton
St. Clair
Monroe
Perry
Lewis
Camden
Clay
Sullivan
Newton
Cole
Carter
Cedar
Scott
Maries
Cooper
Jackson
Shelby
Lafayette
Putnam
Marion
McDonald
Hickory
Worth
Iron
Boone
Callaway
Reynolds
Harrison
Dallas
Stone
Crawford
Morgan
Pulaski
Jefferson
Dunklin
BollingerWebster
Gentry
Daviess
Platte
Washington
Atchison
LawrenceChristian
Mercer
New Madrid
Howard
St. Louis
Clinton
Warren
Madison
Grundy
DeKalbAndrew
Pemiscot
St. Charles
Livingston
Randolph
Caldwell
Scotland
GasconadeMoniteau
Montgomery
Buchanan
Mississippi
St. Francois
Cape Girardeau
Schuyler
Ste. Genevieve
St. Louis City
Dentist Availability
Atleast 1 DentistNo Dentist
None PSP Particpant
41
Dentist Availability in Missouri Counties
Figure 50: Dentist Availability Map
2018-2019 PSP Report
The 2018-2019 school year had a 3.6% increase in students participating in PSP.
Preventive Factors:
78.3% of the children that participated in PSP events had what was considered good oral hygiene. Males ages 13 and up, and children whose race was marked as “Other” had the highest frequency of poor oral hygiene.
Dental sealants were found on 23.9% of children screened ages 6 years and older. African-American children were the least likely to have dental sealants while Hispanic children were most likely.
Tooth Decay:
67.4% of screened students had no treated decay, and approximately 78.6% had no untreated decay. Children of other races were the most likely to have signs of treated and untreated decay.
Rampant caries were seen in 8.4% of screened students. Children identified as “Asian or Pacific Islanders” had the highest percent of rampant caries. Children identified as “African-Americans” had the least percent of rampant caries.
Treatment Urgency:
Approximately 21% of students screened were identified as needing early or urgent dental care. These students were sent home with a notification to their parent/guardian about the issue. Urgent dental care was required most in female children ages 6-12 years old.
Early Childhood Findings:
White spot lesions were found in approximately 15% of screened children under the age of 5 years. White spot lesions were observed more in children whose race was marked as Hispanic.
Conclusion
2018-2019 PSP Report
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Caries: Technical term for cavity
Decay: The breakdown of the enamel surface or staining in pits or fissures of primary or
baby molars 6
Dental Sealants: Clear plastic coating that is applied to the chewing surface of
permanent molars that help prevent cavities
History of Decay: The presence of decay and/or filled teeth 6
Poor Oral Hygiene: Moderate to heavy plaque on teeth with red gums and tissue
Rampant Caries: Suddenly appearing, widespread, rapid burrowing types of caries
that result in early pulp involvement 7
Treated Decay: Defined as having a dental filling, crown, or a tooth extracted because
of decay
Untreated Decay: Defined as having dental cavities or tooth decay that have not
received appropriate treatment
Urgent Care: A child who needs care within the next 24-48 hours due to pain or an
infection
White Spot Lesions: First signs of decay in children under five years old and appear
pale and chalky around the gum line 7
Glossary
43
1. U.S. Department of Health and Human Services, Oral Health in America: A Report of the Surgeon General, 2000. Retrieved fromhttps://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf
2. American Dental Association. (2017). Decay. Retrieved September 28,2017, from http:// www.mouthhealthy.org/en /az-topics/d/decay
3. Freeman, A. (2015, October 23). What Causes White Spots on Baby Teeth?Retrieved September 29, 2017, from http://www.colgate.com/en/us/oc/oral-health/life-stages/infant-oral-care/article/what- causes-white-spots-on-baby-teeth-1015
4. Centers for Disease Control and Prevention. (2019). Community Water Fluoridation. Water Fluoridation Basics. Retrieved fromhttps://www.cdc.gov/fluoridation/basics/index.htm
5. American Dental Association. (2019). 5 Reasons Why Fluoride in Water is Good for Communities. Retrieved from https://www.ada.org/en/public-programs/advocating-for-the-public/%20fluoride-and-fluoridation/5-reasons-why-fluoride-in-water-is-good-for-communities
6. Iowa Department of Public Health. Bureau of Oral and Health Delivery System. 2019 WIC Oral Health Survey Report. Des Moines: Iowa Dept. of Public Health, 2019. Web. https://idph.iowa.gov/ohds/oral-health-center/reports.
7. Varghese S, Bhat V, Devi LS. Adult rampant caries: A clinical report. Indian J Oral Sci [serial online] 2016 [cited 2019 Dec 13];7:42-6. Available from: http://www.indjos.com/text.asp?2016/7/1/42/176388
References
2018-2019 PSP Report
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