PDF: Policy Options for Reducing Early Childhood Tooth Decay


Despite being largely preventable, tooth decay remains the most prevalent chronic health condition among U.S. children and adolescents.


Nearly half of all children entering kindergarten have had at least one cavity and three-quarters have untreated cavities.


While prevalence has significantly decreased in recent years among most children, early childhood caries (ECC)—tooth decay in children from birth through age 5—is becoming more frequent among those ages 2-5. 

The increase in tooth decay is especially pronounced among children living in low-income families, which indicates that the current oral health care system is not adequately addressing the needs of children with the highest risk for poor oral health.


In addition to proven public health practices such as community water fluoridation, opportunities exist in the use of risk assessment tools, improved clinical guidelines, and innovative care models to prevent and manage ECC by providing early and appropriate care to children based on their unique levels of risk for disease. 

Unfortunately, dental benefit designs and resulting dental practice often fail to reflect the clinical understanding that ECC prevention and management requires individually-tailored care plans that may require more frequent treatment than the traditional one-size-fits-all, six-month prevention “recall visit.”


State Medicaid programs for children may constrain preventive care to such six-month visits despite Medicaid’s benefit structure which is designed to ensure “that individual children get the health care they need when they need it” in the appropriate time and setting. 



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