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Report: More than half of 3rd graders in Minnesota have cavities

Minnesota's first comprehensive oral health plan includes new information that while tooth decay is nearly 100 percent preventable, it is still one of Minnesota's most common chronic childhood diseases, with 55 percent of third graders surveyed in 2010 experiencing tooth decay. This compares to the national rate of 53 percent for children six to eight years old.

In collaboration with a wide array of stakeholders, the Minnesota Department of Health (MDH) has produced the Minnesota Oral Health Plan: Advancing Optimal Oral Health for All Minnesotans. This strategic plan outlines the populations most at risk for oral disease, the obstacles to routine dental care, and strategies for improving oral health and reducing millions of dollars of unnecessary medical costs.

Low-income children bear the greatest burden of oral diseases in the state. Children eligible for free or reduced lunch were almost one and a half times more likely to experience tooth decay and almost three times more likely to have the decay go untreated than more affluent peers. One encouraging finding is the proportion of Minnesota third graders with untreated tooth decay (18 percent) was lower than the national target (26 percent) set by Healthy People 2020.

Inadequate dental care has long-term health and cost consequences. Most telling is the $148 million in emergency department charges in Minnesota between 2007 and 2010 for preventable, non-traumatic conditions that could have been treated by a dental provider in a more appropriate setting. The figure points to possible barriers to routine oral health care such as the lack of affordable dental insurance and clear information regarding public program dental benefits, along with the undervaluing of the importance of dental health to overall health.

"It is simply unacceptable to have so many of our children and adults negatively affected by these preventable dental conditions," said Dr. Ed Ehlinger, Minnesota commissioner of health. "We have to do a better job investing in public health and access to routine dental care. If we do this, we can significantly reduce oral disease and health care costs in Minnesota."

The state plan also cites income and education levels as risk factors for adults and the elderly. The poorest Minnesota adults, defined as making $15,000 or less yearly, were three times less likely to visit a dentist in 2010 than adults making $50,000 or more. Among the elderly, a person without a high school degree was 10 times more likely to have all teeth extracted than someone with a college degree. A bright spot for the elderly was the slight decline in permanent teeth extractions from 36 to 33 percent while national trends remained stagnant at 44 percent between 2004 and 2010.

"A healthy mouth is fundamental to overall health, our ability to secure a job, and even our very sense of self-worth," said Merry Jo Thoele, dental director for the Minnesota Oral Health Program, which was established in 2008 with grant funding from the CDC and Health Resources and Services Administration. "That is why it is so important that we implement the proven strategies that are already available for eliminating most oral diseases."

The state oral health plan calls for a range of solutions, such as providing dental sealants, increasing water fluoridation, enhancing the dental workforce, increasing use of public insurance programs, implementing a statewide dental health tracking system, and improving the integration of medical and dental care.

Sealants are a proven strategy for preventing tooth decay. A majority of Minnesota third graders (64 percent) show evidence of dental sealants on at least one permanent molar, which is two times higher than the national rate (32 percent) and supersedes the Healthy People 2020 goal of 28 percent. However, Minnesota's high sealant rate drops off to the low rate of 42 percent among the state's poorest children in families earning 75 percent or less then federal poverty levels. Hispanic children lag behind white children in dental sealant prevalence rates both nationally and locally; the gap in sealant rates between Hispanic and white children is twice as wide (50 percent) at the national level when compared to Minnesota (26 percent).

The plan also calls for the state to bolster its dental workforce through more innovative strategies to recruit, prepare, retain and equitably distribute oral health care providers throughout the state. In response to workforce shortages, Minnesota has been a trailblazer in sanctioning mid-level dental professionals such as dental therapists, advanced dental therapists, and dental hygienists, to provide dental services to patients. As the first and only state to license dental therapists under a 2009 law, Minnesota has been at the national forefront on institutionalizing these models.

"Minnesotans have a lot to be proud of on many key oral health indicators," said Deb Jacobi, board chair of the Minnesota Oral Health Coalition, one of MDH's key partners providing strategic direction for the state plan, "but clearly there is much work to be done with health disparities and helping both the public and especially the dental and medical communities better understand how important oral health is to longevity and quality of life. The time is long overdue for putting oral health front and center rather than relegating it to the periphery of health care."

On February 22, 2013, the Minnesota Oral Health Program and Minnesota Oral Health Coalition will convene a spectrum of stakeholders to move the work forward around strategies outlined in the Minnesota Oral Health Plan. Specifically, the theme of the day, Coming Together: Integrating Oral Health and Total Health, will focus on steps to improve the integration of oral health into the work of a cross-section of dental, health, medical, educational and social service sectors.

The Minnesota Oral Health Plan is available online at: