Oral Health. Dental Health Status. Oral Health Snapshot

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Oral Health

The US Surgeon General has called dental decay and disease a “silent epidemic” that is affecting our most vulnerable citizens. Dental decay is the most common chronic disease of childhood – five times more common than childhood asthma. Dental decay and disease are the most prevalent unmet healthcare need nationwide. A comprehensive oral health assessment of Whatcom County was done in 2003 to understand the magnitude of the problem locally.

Dental Health Status

56% of families with a child over 2 years report their child to have had a cavity. This rate increases to 85% in families who report that cost is a barrier to care (Figure 1). In addition to having more cavities, people with financial

limitations are more likely to perceive their oral health to be poor, have teeth removed

because of decay or disease (Figure 2), and not receive treatment recommended by their dental provider (Figure 3).

Figure 1 Incidence of child cavities by cost barrier status

56% 85% 52% 48% 15% 44%

Total Cost barrier to care

No cost barrier to

care

Child has had a cavity

Child has not had a cavity

Whatcom County Oral Health Telephone Survey, 2003

Oral Health Snapshot

% Children >2 with cavity 56% % Children >2 with cavity

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Figure 2 % Adults Have Lost Atleast One Tooth Due to Decay or Disease

38% 48% 43% 33% 32% All Adults Under $20K $20K-$35K $35K-$50K Over $50K Whatcom County Behavioral Risk Factor Survey, 2002

Figure 3 Receipt of Recommended Treatment by Cost Barrier Status

43% 26% 49% 35% 33% _32% 27% 19% 39%

All Adults Cost is a barrier to care

Cost is not a barrier to care

received all treatment Received some treatment Received no treatment

Whatcom County Oral Health Survey, 2003

Access to Dental Care

80% of adults with children in Whatcom County report having some type of dental insurance, including Medicaid, which covers children. 8% of parents report difficulty getting dental care for their children because of cost

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Figure 4 Adults with children, who could not get dental care for child (age 5-12) within last two years, by income

8%

25%

20%

2%

0% Total Under $20K $20-35K $35-50K Over $50K

Whatcom County Behavioral Risk Factor Survey, 2002

Figure 5 Adults who could not find needed dental care for themselves or a family member in the previous 12 months due to cost

21% 42% 30% 27% 15% All Adul ts Low

-income _Unins ured

Women Men

Over 2/3 of adults in Whatcom County pay all or some dental care costs out-of-pocket (Figure 6) and the emergency department is being used increasingly for non-urgent dental

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Figure 6 How Adults Pay for Dental Care

Indian Health Service 2% Insurance 25% Self-Pay 32% Combination Self-Pay and Insurance 36% Medicaid 3% Other 2%

St. Joseph Hospital, 2003

Access for Medicaid-Insured

In Whatcom County, more Medicaid-insured children are accessing dental services yet fewer Medicaid-insured adults are accessing dental services than in the state as a whole (Figure 8). Fewer Hispanic children and adults are accessing services in Whatcom County

than in the state as a whole (34% vs. 40%). However, more Native American children and adults are accessing services in Whatcom County than in the state as a whole (34% vs. 29%). 119 143 165 0 40 80 120 160 200 2001 2002 2003*

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Figure 8 Percent of Medicaid-eligible population who accessed services in 2002 by age

Medical Assistance Administration, 2002 Medicaid-eligible clients in Whatcom County

rely more on Federally Qualified Health Centers (Sea Mar Community Health Center and Interfaith Community Health Center), than

private dentists for dental care. This is not true for the state as a whole. (Figure 9).

Medical Assistance Administration, 2002 However, between 2000 and 2002, the number

of children under age 6 that were seen by a private practice dentist more than doubled.

Children under age 2 that were seen by any dental provider jumped from 10% to 18%.

10%

23%

67%

14%

44%

_41%

Other

Health Centers

Private Dentist

% of Medicaid-insured

patients served

WA

Whatcom

Figure 9 Medicaid-eligible Dental Patients Served

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Prevention

While 6% of Whatcom County residents actually receive optimally fluoridated water, many residents either don’t know if their water supply is fluoridated or incorrectly believe that it is (Figure 10).

Fluoride varnish is a high concentration of fluoride painted directly on teeth by a health professional. 64% of dentists routinely provide fluoride varnish to children under 5; 46% routinely provide it to children aged 5-18.

Figure 10 Responses to the question “Does your water supply have fluoride in it?”

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Data Sources – Chapter 4

Figures 1, 3, 5, 6, 10: Whatcom County Oral Health Survey, 2003

A telephone survey of 400 adults in Whatcom County was conducted in 2003 to gather information regarding the oral health status of community members.

Figures 2, 4: Whatcom County Behavioral Risk Factor Survey, 2002

The Behavioral Risk Factor Survey (BRFS) is a telephone-based survey of adults developed by the Centers for Disease Control and Prevention to gather information about health behaviors. In 1996 and 2002 the Whatcom County Health Department conducted a BRFS of 400 and 802 adult residents of Whatcom County respectively. Figures 8, 9: Medical Assistance Administration, 2002