Preventing Chronic Diseases:

Investing Wisely in Health

Preventing Dental Caries

Meeting Healthy People 2010 Objectives

*There is no Healthy People 2010 objective for adult caries; 94% of adults who

have one or more natural teeth have experienced tooth decay.

Source: U.S. Department of Health and Human Services. Healthy People 2010,

vol II. 2nd ed. Washington, DC: U.S. Government Printing Office, 2000:21-11

to 21-15.

The Reality

• Although dental caries (tooth decay) is largely preventable, it remains the most common chronic disease of

children aged 5 to 17 years—5 times more common than

asthma (59% versus 11%).

• Once established, the disease requires treatment. A cavity

only grows larger and more expensive to repair the longer

it remains untreated.

• Fewer than 1 in 5 Medicaid-covered children received

at least one preventive dental service in a recent year;

many states provide only emergency dental services to

Medicaid-eligible adults.

• Poor children have nearly 12 times more restrictedactivity days because of dental-related illness than children from higher-income families. Pain and suffering due

to untreated tooth decay can lead to problems in eating,

speaking, and attending to learning.

• Many adults also have untreated dental caries (e.g., 27%

of those 35 to 44 years old and 30% of those 65 years

and older).

Community-Based Strategies

Prevent Tooth Decay

Community Water Fluoridation

• Community water fluoridation has been ranked one of

10 great public health achievements in the 20th century.

• Community water fluoridation effectively prevents dental

caries in communities with varying disease prevalence.

Children in communities with water fluoridation experienced 29% fewer cavities.

• At present, 66% of individuals on public water systems—

over 162 million people—are receiving the benefits of

community water fluoridation.

School-Based Sealant Programs

• Children receiving dental sealants in school-based programs have 60% fewer new decayed pit and fissure

surfaces in back teeth for up to 2 to 5 years after a single

application. Among children, 90% of decay is in pits and

fissures.

• School-based sealant programs provide sealants to children unlikely to receive them otherwise (e.g., children in

low-income households). Children of racial and ethnic

minority groups have about three times more untreated

decay and teeth missing due to caries but are about onethird as likely to receive sealants.

• Although 29 states reported dental sealant programs

serving 193,000 children, this number represents only

about 3% of poor children who could receive sealants.

0

10

20

30

40

50

60

70

2–4 6–8 15 35–44*

Age in Years

Percentage

Baseline caries experience

Baseline untreated decay

Healthy People 2010 Target 

U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES
For more information or updates, visit www.cdc.gov/nccdphp.

For additional copies of this document, E-mail

ccdinfo@cdc.gov or oralhealth@cdc.gov.

Community-Based Strategies to

Prevent Tooth Decay Save Money

• Every dollar spent on community water fluoridation saves

from $7 to $42 in treatment costs depending on the size of

the community. Savings are greatest in large communities.

• At least 60% of the U.S. population on public water

systems has received fluoridated water since 1990, translating to savings in dental treatment costs of over $25.7

billion in the past decade.

• School-based dental sealant programs are cost saving when

delivered to populations at high-risk for tooth decay, such

as children in low-income households.

Effective Strategies

• Community and school partnerships raise awareness of the

value of school sealant programs. Healthy Smiles for Wisconsin, a CDC-supported state-wide effort to improve the

oral health of Wisconsin children through school and

community partnerships, began in October 2000; it helped

to establish 40 new community-based sealant programs

during the 2000-2001 school year. During that year, more

than 4,500 children in 40 counties received dental sealants.

• Community coalitions are essential for gaining approval

for community water fluoridation. During the past decade,

broad-based citizen coalitions in several large U.S. cities

have educated residents about the benefits of water

fluoridation. Water fluoridation was approved in many of

these jurisdictions, including Los Angeles and Sacramento, CA; Manchester, NH; Las Vegas, NV; San Antonio, TX; and Salt Lake City, UT.

Hope for the future

Many Americans now enjoy markedly better oral health than

their parents did. However, certain segments of the

population (e.g., those who are poor, who are members of

racial or ethnic minority groups, or who are elderly) still have

severe dental decay, much of which remains untreated.

Healthy People 2010 seeks to eliminate these disparities, so

that all Americans receive the benefits of good oral health.

Community-based programs are a particularly cost-effective

way to help achieve this goal. For example, extending

fluoridated water to the remaining 34% of the population on

public water systems would save over $1.5 billion dollars per

year. Increasing the percentage of children at high risk for

tooth decay who participate in school sealant programs to

50% would prevent over half of the caries that these children

would otherwise have and save public health dollars.

State Programs in Action: Ohio

School-based sealant programs in

Ohio began in 1984 with a single

demonstration program in one city.

By 2000, 34 of Ohio’s 88 counties had

programs. These programs target

children who are at high risk for tooth

decay and least likely to receive dental care.

As the program has expanded, the percentage of 8-yearolds statewide who have dental sealants has increased

steadily, from 11% in 1987–88 to 30% in 1998–99.

Although this percentage still falls short of the Healthy

People 2010 objective of 50%, children from all

demographic groups in schools with sealant programs

have achieved or exceeded the objective.

• Among children eligible for the free and reduced-cost

lunch program, 54% of those in schools with sealant

programs have sealants, compared with 19% of those

in schools without programs.

• Among children covered by Medicaid, 58% in schools

with sealant programs have sealants, compared with

22% in schools without programs.

• In schools with sealant programs, the same

proportion of children on Medicaid (58%) have

sealants as those with private dental insurance, thus

eliminating a common disparity.

Although the Ohio program has met only a portion of

the need for dental sealants, it has shown that schoolbased programs can reach children at high risk for tooth

decay with this effective preventive measure.