Local Public Health Spreads Importance of Good Oral Health during Children’s Dental Health Month

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston, Texas

The oral cavity, including the teeth and surrounding structures, are necessary for adequate nutrition, proper speech and a positive self-image.  Although tooth decay is largely preventable, it continues to be the most common chronic disease of early childhood.1  Dental health can impact school performance when a child has untreated tooth decay with resulting pain that affects their ability to concentrate, sleep at night or even attend school, “more than 51 million school hours are lost each year to dental related illness.”2 Taxpayers share approximately 11% of the $113.5 billion spent nationally on dental care expenditures, a percentage that has increased over the years as dental care utilization continues to increase among children.3  Children with cavities in their primary (baby) teeth are three times more likely to develop cavities in their permanent (adult) teeth which could contribute to broader health problems including diabetes and cardiovascular disease.4

All year long, many local health departments work to ensure children have access to quality oral health care. February is Children’s Dental Health Month, a time to spread awareness of good oral health habits and highlight the importance of beginning and maintaining oral hygiene in the early childhood years as soon as the first tooth appears.

Start Oral Care Early

In children, maintaining oral health is critical, even before adult teeth begin to form. The way in which primary or “baby” teeth are cared for shapes the way permanent teeth develop, making it important for children to learn effective oral health habits early. The type of care primary teeth receive can affect a child’s speech development, how they chew, and their confidence. Cavities are very common among children in the U.S. Untreated cavities lead to infections that can cause difficulties with eating, speaking, and even learning. A more serious and painful consequence of improper maintenance of primary teeth is formation of an abscess. When an abscess occurs, pus accumulates in a cavity to block an infection from spreading. This accumulation typically causes swelling and can be very painful.5

Making Oral Health a Priority for Children with Special Healthcare Needs

Over ten million children in the U.S. have special healthcare needs.6 Oral healthcare has been identified as one of the most common unfulfilled requirements among children with special healthcare needs (CSHN). Over the years, healthcare and public health professionals, lawmakers, and other advocates have been working to improve access to oral healthcare for CSHN.

NACCHO hosted a webinar titled, “Oral Health Considerations for Children and Youth with Special Health Care Needs,” which focused on oral health problems in CSHN, identified barriers to care, and brainstormed ways to address needs. The webinar also highlighted state and local examples that are working to improve the oral health of CSHN.

Local Health Departments Bridge Access to Dental Care

Luckily, cavities and other oral diseases are preventable through daily brushing with fluoride toothpaste, dental sealants, fluoride varnishing, and fluoridated tap water. Local health departments across the nation are playing their part in promoting good oral health through dental care services and programs.

In 2017, the Clinton County Health Department (CCHD) in New York won NACCHO’s Model Practices Award for their initiative to implement a fluoride varnish program in 100% of pediatric primary care practices in the county for children under the age of five. Their goal was to decrease the number of early childhood cavities and prevent developmental delays, diseases, self-esteem issues, and the prevalence of tooth decay in adulthood. CCHD staff worked with the New York State Association of County Health Officials to learn an overview of implementing a fluoride varnish program including application and billing. Once CCHD staff was trained, 100% of the pediatric provider offices were trained on screening, assessment, proper application, possible barriers, billing, and research, and all agreed to implement fluoride varnish application in their practice.

In Tioga County, NY, the Tioga County Health Department established a school-based mobile dental services program, designed to provide preventive and restorative dental care for underserved children and adults who lack insurance and access to a dental provider. Throughout the school year, the mobile unit travels to schools throughout the county and in the summer, it is stationed at a community center. Mobile unit dental staff perform exams, cleanings, fillings, x-rays, sealants, extractions, and fluoride treatments. Since the program’s inception, thousands of clients have received dental care through this program, many of whom had Medicaid, CHIP, or no insurance at all.

Throughout Harris County, TX the Harris County Public Health (HCPH) Dental Health and Prevention Services utilizes a multifaceted programming approach to improve the oral health of children. The dental programming includes:  dental clinical services for children, adolescents and expectant mothers; a population based oral health education and promotion program that reaches 15 school districts and over 300 schools each year and a school-based early prevention program which provides oral health education, oral assessments, fluoride varnish treatments, referrals and case management to thousands of children in underserved populations throughout Harris County. Recently HCPH embarked on this mission of “taking public health to the public” and acquired several mobile units that can provide a variety of public health services and education where people live, learn work, worship and play. Our Mobile Dental Unit will allow increased opportunities to provide access to dental care for children and promote the importance of oral health at community events.

NACCHO and CDC Launch Joint Local Water Fluoridation Project

The Centers for Disease Control and Prevention (CDC) says, “Children living in communities with fluoridated tap water have fewer cavities than children whose water is not fluoridated.”1 Water fluoridation can be delivered to whole communities regardless of income level or access to oral care. In January 2017, NACCHO, together with the CDC, launched a program called, “Building Capacity for Oral Health: Fluoridation Equipment in Local Communities,” which offers funding and technical assistance to support the replacement of aging water fluoridation equipment or the installation of new equipment. Nearly 30 organizations across 13 states applied, signifying the need for the project. Ultimately, six applicants were awarded based on their community’s need. In all, the oral health of nearly 450,000 people will be positively affected. In October 2017, NACCHO and CDC opened another round of funding for community water fluoridation systems. A total of 17 organizations were awarded funding, furthering efforts in providing communities with fluoridated water, thus improving and maintaining oral health.

Preventing Oral Health Problems

While public health professionals and policymakers work to address barriers in access to dental care, parents and caregivers can prevent oral health problems in their children by ensuring they drink fluoridated water, applying fluoride varnish and dental sealants to teeth, and simply brushing with fluoridated toothpaste. This National Children’s Dental Health Month, let’s champion optimal oral health among all children and promote healthy dental habits, so that America’s children have equal opportunities for success.



  1. Centers for Disease Control and Prevention. 2015. Oral Health Basics. Retrieved from https://www.cdc.gov/oralhealth/basics/index.html.
  2. S. Dept of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, Md. U.S. Dept of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000:12.
  3. https://www.ada.org/en/publications/ada-news/2016-archive/february/dental-spending-remains-stagnant
  4. https://www.cdhp.org/state-of-dental-health/pregnancy-early-childhood
  5. Children’s Dental Health. The Importance of Caring for Baby Teeth. Retrieved from https://childrensdentalhealth.com/prevention-education/for-parents/the-importance-of-caring-for-baby-teeth.
  6. Maternal and Child Health Bureau. 2007. The National Survey of Children with Special Health Care Needs Chartbook 2005– 2006. Rockville, MD: Maternal and Child Health Bureau. http://mchb.hrsa.gov/cshcn05.