Kindergarten Round-Up Oral Health Assessment Clare Public Schools and Harrison Community Schools

KEY FINDINGS OF CLARE COUNTY CHILDREN ENTERING KINDERGARTEN THIS FALL

n Half of all children have some level of tooth decay.

n 1 in 20 children needs immediate dental care.

n 6 in 10 children are enrolled in Medicaid.

n Boys are more likely to have untreated dental decay.

Acknowledgements

Support for this publication was provided by Michigan Oral Health Coalition, through the Oral Health 2014 Initiative of the DentaQuest Foundation.

Thank you to Larson Elementary Principal Julie Rosekrans and Clare Primary School Principal Mandy Bolen and their staffs for allowing Michigan Oral Health Coalition to participate in Kindergarten Round-Ups.

KEY FIN2012

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Kindergarten Round-Up Oral Health Assessment

PROJECT OVERVIEWEarly childhood caries—tooth decay among children younger than 6 years—is prevalent and consequential, despite being highly preventable. In 2000, the United States Surgeon General’s Report: Oral Health in America documented a “silent epidemic of oral disease affecting our most vulnerable citizens. This report identified a substantial unmet need for dental care and disparities in oral disease. Oral health care is essential to overall health and well-being. Poor oral health can contribute to difficulties learning, nutritional deficiencies, and low self-esteem.

In April 2012, the Michigan Oral Health Coalition collected oral health data from children that attended the Kindergarten Round-Up from two school districts in Clare County, Michigan—Harrison Community Schools and Clare Public Schools. The data collection method was two-fold: 1) a dental hygienist performed an oral health screening of each participating child and 2) parents of participating children filled out a self-assessment that spanned their children’s and their own oral health, insurance status, fluoridation status, behaviors and knowledge pertinent to oral health, and family history. This report is intended to provide the reader with an overview of oral health in the Kindergarten Round-Up population within these two Clare County school districts. It will also break down oral health by school district, insurance status, and gender.

DATA MEASURESMeasures of oral health included the following:

Early Childhood Caries: Tooth decay found on any ONE surface of a tooth in a child under 6 years of age. This includes white spot lesions as well as cavities, or holes in the teeth.

Treatment Urgency: The following Treatment Urgency Codes are used to determine how soon a child needs dental treatment.

• Referred for Treatment - No obvious, immediate problems visible. Refer to a dentist for an exam within six months or sooner if caries risk is determined to be moderate or high.

•Early Dental Care - Dental treatment is needed soon, preferably within 1-2 weeks.

• Urgent Care - Noticeable decay with possible pain and swelling. Immediate treatment is needed. Refer child to dentist within 24 hours if possible.

White Spot Lesions: The earliest sign of decay. The appearance of a chalky white spot or line on the surface of the tooth, usually along the gum line, indicating an area of demineralized enamel.

Teeth with Untreated Decay: An untreated cavity. Child needs to find dental care soon.

Treated Teeth: Treatment such as a filling (permanent or temporary), a crown, or a tooth that is missing because it was extracted due to decay.

Primary “Baby” Teeth: Most children have their first set of teeth by the time they are 2 years old. These are called the primary or baby teeth, and there are 20 in all. Between age 5 and 6, these teeth begin falling out, one by one.

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KEY FINDINGS FOR ALL STUDENTS

Oral Health Data Measures

The oral health screening uncovered a great deal of information regarding oral health among the Kindergarten Round-Up population in Clare County. Regarding positive attributes, 93% of children had 20 or more teeth, over 20% did not have any of their teeth treated, and over 70% did not have teeth with untreated decay. However, over 20% of the children had white spot lesions and, perhaps most disconcerting, nearly 50% of all children had early childhood caries (for referential purposes, white spot lesions are the demineralization of tooth enamel and the first sign of early childhood caries; early childhood caries are the presence of one or more decayed, missing, or filled tooth surfaces in any primary tooth in a child younger than 6 years). Over 5.5% of children were deemed as requiring urgent treatment, while nearly 30% required early dental care. Finally, over 40% of all children were referred for dental treatment.

Parent Self-AssessmentSelected Assessment Factors PercentageChild’s Teeth in Excellent/Very Good Condition 57.0%Parent’s Teeth in Excellent/Very Good Condition 38.3%Child’s Teeth in Fair/Poor Condition 8.6%Parent’s Teeth in Fair/Poor Condition 26.2%Family Member with Cavity in Last 2 Years 67.5%Fluoridated Water 14.0%Medicaid Insurance 61.3%Private Insurance 30.7%Uninsured 8.0%

The most striking aspect of the preceding table is that only 14% indicated they have fluoridated water (according to the CDC, 73.8% of Michigan’s population received fluoridated water in 2006). Over 89% indicated they know fluoride prevents cavities (not in table). In addition to the data cited above, the questionnaire found that 86% of children visit the dentist on a routine basis. 32% of parents indicated their child has had a cavity, which is lower than what the dental hygienist found during the oral screening (48.9%). Parents also overwhelmingly indicated they know why cavities occur (96.0%) and what they look like (84.7%). Another interesting finding is that over 85% cited their children snack on sugary foods or foods with white flour. Finally, over 87% said their children brush their teeth at least twice daily and every parent indicated their child had their own toothbrush.

Clare Public Schools and Harrison Community Schools

33.3% National Average

Source: National Health and Nutrition Examination Survey, CDC, NCHS

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Harrison Community Schools vs. Clare Public SchoolsData Measure Harrison ClareEarly Childhood Caries 56.3% 17.7%Urgent Care Required 9.5% 0.0%Teeth with Untreated Decay 33.3% 22.2%White Spot Lesions 26.2% 17.7%Treated Teeth 19.0% 18.8%Less than 20 Teeth 7.5% 6.3%Child’s Teeth in Excellent/Very Good Condition 50.0% 65.2%

Family Member with Cavity in Last 2 Years 75.6% 58.0%

Medicaid 72.8% 47.8%Private 23.5% 39.1%Fluoridated Water 11.3% 32.6%

A district-specific analysis showed that children of Harrison Community Schools generally have worse oral health than their Clare counterparts. Clare outperformed Harrison on every clinical factor in the oral health screening and, perhaps unsurprisingly, parents of Clare students provided answers commensurate with the screening results. Insurance status and the presence of fluoridated water may be particularly illuminating: nearly 73% of Harrison children have Medicaid, while less than half of Clare children do; Clare also has a greater percentage of children with private insurance. In terms of water fluoridation, the difference is stark—only 11.3% of Harrison children have fluoridated water in their homes compared to 32.6% for Clare children (note that 36% of all respondents indicated they did not know if their water was fluoridated). In general, Clare parents also reported they have a better knowledge of – and engage in more – behaviors that affect oral health.

Insurance StatusData Measure Medicaid (n=91) Private (n=46)Early Childhood Caries 50.0% 46.5%Teeth with Untreated Decay 30.3% 27.9%Urgent Care Required 6.8% 2.4%Early Dental Care 33.0% 23.8%White Spot Lesions 25.8% 21.4%Treated Teeth 20.0% 16.3%Less than 20 Teeth 7.0% 4.7%Referred for Treatment 41.9% 37.2%

It can be deduced from above that children within Harrison and Clare School Districts that have Medicaid generally have worse oral health than children with private insurance. Moreover, parents of children with private insurance generally rate their children’s teeth better (not in table). Mitigating behaviors and knowledge are relatively equal between insurance types. However, a greater percentage of those with private insurance indicated they have fluoridated water (21.7%) compared to those with Medicaid (9.9%). Those reporting no insurance were omitted from the results since the sample was too small (12 respondents) to compare across insurance types.

Kindergarten Round-Up Oral Health Assessment

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Conclusion

Male vs. FemaleData Measure Male (n=67) Female (n=75)Early Childhood Caries 20.0% 25.5%Teeth with Untreated Decay 36.9% 23.0%Urgent Care Required 11.1% 8.3%Early Dental Care 13.9% 31.3%White Spot Lesions 7.5% 13.7%Treated Teeth 16.9% 21.3%Less than 20 Teeth 7.9% 6.9%Referred for Treatment 44.4% 29.2%

Overall, the oral screening data is roughly equivalent between males and females. Despite this, a greater percentage of males (36.9%) have teeth with untreated decay than their female counterparts (23.0%). This trend was constant between both Harrison and Clare School Districts.

CONCLUSIONSThere are significant oral health concerns among children that participated in the in 2012 Clare County Kindergarten Round-Up Oral Health Assessment. Perhaps most alarming is that nearly half of these children have early childhood caries. The low prevalence of water fluoridation in the county may certainly be affecting this. Regarding school districts, Harrison Community Schools lag in oral health status compared to Clare Public Schools, which may be attributed to the greater proportion of students with Medicaid and fewer reports of homes with water fluoridation among children in the Harrison Community School District. In addition, those with Medicaid generally have worse oral health than those with private insurance. Finally, males and females showed similar clinical data in general, though a greater proportion of males had teeth with untreated decay.

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