Conference aims to increase dental sealant programs across Missouri

Friday, August 28, 2009 | 6:14 p.m. CDT; updated 2:50 p.m. CST, Monday, December 7, 2009
In order to prevent tooth decay, dental sealants, which keep out bacteria and food, are applied to fissures and pits, where cavities form. Molars are the most likely to receive sealants, which should be applied shortly after molars appear but before they have a chance to decay.

COLUMBIA — Oral health professionals from across the state gathered for two days last week to formulate a strategy for preserving children's dental health in the face of a funding crisis.

An increase in uninsured and under-insured patients combined with a growing lack of dental providers is pushing dental care to the forefront of Missouri health needs. The Missouri Foundation for Health issued an Oral Health Promotion and Access letter in 2008, which reported that "five counties in the state are currently without a single active dentist, resulting in 29,085 people without immediate access to a dentist."

Less than 40 percent of Missouri employees have dental insurance. For every 70 dentists that retire, roughly 50 new dentists stay in Missouri, according to the report. Fewer dentists mean fewer openings for patients in general, especially for those without insurance or who are on Medicaid.

The strategy discussed last week centers on expanding school-based dental sealant programs, important in preventing cavities and other oral health issues. Up to 90 percent of tooth decay in children occurs in fissures and pits on molar teeth, as opposed to smooth surfaces.

Dr. Mark Siegal, from the Ohio Health Department Bureau of Oral Health Services, who was the keynote speaker at the event, said up to one third of children in  school dental health programs have untreated dental problems.

The purpose of the event, called "Show-Me Healthy Teeth! A Missouri Dental Sealant Convening," was to produce a Missouri Dental Sealant Plan, according to the University of Missouri-Kansas City School of Dentistry, a sponsor of the event. "Dental sealants, along with water fluoridation, have been found to be effective in preventing tooth decay," the school's Web site said. Missouri currently does not have a statewide sealant program.

Research has found that sealants are effective in lowering bacteria levels, even if they are applied over current decay, Siegal said. And X-rays aren't necessary because dentists can visually check teeth and safely apply sealants over a small amount of existing decay without harm. That means sealants could be applied in schools fairly easily.

Funding such an effort could be far more difficult. Dr. Moncy Matthew from the UMKC School of Dentistry said the state's initial investments in dental sealants are coming to an end, and no commitment has been made for further funding. The Missouri Foundation for Health currently funds 12 sealant programs in 84 counties. Programs that receive these funds are asked to build sustainability options into their plans, said Julie Johnson from the Foundation's communication office.

"Our funding cannot be more than 25 percent of their budget because we want them to be able to sustain themselves," Johnson said. "We want them to be able to keep their programs going."

Even in hard economic times, it might be possible to launch a larger state dental sealant program because treating children is relatively inexpensive and there is scientific evidence showing the success of sealants, said Marcy Frosh, associate director of the Children's Dental Health Project (CDHP) in Washington, D.C.

Harold Kirbey from the Missouri Department of Health and Senior Services told participants that it is important to understand what Missouri needs in dental care.  "We've done a poor job of communicating how important oral health is to overall health," Kirbey said. "Oral health is not just the dentist’s concern. All health professionals and individuals have a role in assuring good oral health. Ignoring oral health is an invitation to disease.”

The sponsors for the event included the Missouri Dental Association, Missouri Dental Hygienist Association, Missouri Primary Care Association, Missouri Department of Health and Senior Services, Missouri Dental Association Foundation, Head State State Collaboration Office and the UMKC School of Dentistry.

"This is the first time this many groups have gotten together to sponsor a convening to discuss an issue as timely as oral health," Matthew said in an interview after the conference.

Frosh and Booth agreed that the gathering was a significant step in addressing oral health concerns. Sealants offer an "infrastructure that will support all prevention programs down the road," Frosh said. "The fact that 100 people are taking two days at the end of their summer to talk about this shows how important this is."

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