promoting healthy smiles through education & prevention · lafayette putnam mercer marion...

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?


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


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?


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


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


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


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


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


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


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


12

African-American Asian/PacificIslander


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


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%).


78.2%

21.8%

83.8%

16.2%

At least 1 Dentist No Dentist

Figure 12: Oral Hygiene by Number of Dentists


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


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


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%


Figure 16: Dental Sealants by Number of Dentists


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


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.


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Treated Decay by Tooth Type

African-American

Asian/Pacific Islander


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


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Rural Urban

32.7% 32.5%

67.3% 67.5%

Decay None

None Treated Decay

67.4%

32.6%

65.2%

34.8%


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.


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%


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


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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.


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%


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.


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%


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


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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


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


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


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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


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


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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


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.


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%


No Yes

92.5%

7.5%

83.0%

17.0%

88.5%

11.5%

89.4%

10.6%

91.9%

8.1%


Figure 33: Early Childhood Caries by Race/Ethnicity


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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%


No Yes

91.6%

8.4%

89.5%

10.5%


Figure 35: Early Childhood Caries by Dentist Availability

Children in counties with no dentists had higher percentages of rampant caries and early childhood caries.


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


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.


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


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


35


78%

22%

81%

19%

81%

19%




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.


36

None Permanent Only Primary andPermanent

Primary Only

67%

4% 5%

24%

66%

5% 4%

25%

74%

5% 2%

19%




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




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.


37

No Yes

91%

9%

89%

11%

95%

5%




No Yes

95%

5%

91%

9%

96%

4%


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


38

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%


Figure 48: White Spot Lesions by Fluoride Accessibility


39

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


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


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


42

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


44

http://www.mouthhealthy.org/en

http://www.colgate.com/en/us/oc/oral-health/life-stages/infant-oral-care/article/what-

http://www.colgate.com/en/us/oc/oral-health/life-stages/infant-oral-care/article/what-

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