2018’s States with the Best & Worst Dental Health

2:59 AM

Posted by: Richie Bernardo

Many people dislike visiting their dentist, especially if they haven’t kept up with their brushing and flossing. Some even have dental anxiety and phobia. But there are other people who wish they could go yet can’t afford it. According to the CDC, 64% of adults have gone over a year without seeing a dentist. The costs of frequent dental checks are worth it, though. A checkup costs $85-$100 on average while a filling can go for $230-$300 and a crown typically sets you back over $1,100. Prevention is cheaper than treatment.

But brushing, flossing and getting an annual checkup aren’t the only things that impact dental health. Where you live can have an effect, too. For example, certain areas of the U.S. have a higher density of dental professionals. And one of the biggest locational factors is the presence of fluoridated water, which can help prevent tooth decay. It’s so important, in fact, that the CDC projects that by 2020 nearly 80% of public water will have this benefit.

In order to determine which places have the healthiest teeth and gums in the U.S., WalletHub compared the 50 states and the District of Columbia across 25 key indicators of dental wellness. Our data set ranges from share of adolescents who visited a dentist in the past year to dental treatment costs to share of adults with low life satisfaction due to oral condition. Read on for our findings, additional insight from dental experts and a full description of our methodology.

  1. Main Findings
  2. Ask the Experts
  3. Methodology

Main Findings Embed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/31498/geochart-dental.html" width="556" height="347" frameBorder="0" scrolling="no"></iframe> <div style="width:556px;font-size:12px;color:#888;">Source: <a href="http://ift.tt/2EygMQV>

 

States with the Best & Worst Dental Health

Overall Rank (1=Best)

State

Total Score

‘Dental Habits & Care’ Rank

‘Oral Health’ Rank
1 Minnesota 79.13 1 3
2 Wisconsin 76.30 2 6
3 Connecticut 75.33 7 2
4 Illinois 74.11 20 1
5 North Dakota 73.33 3 8
6 District of Columbia 71.45 14 7
7 Michigan 70.95 5 11
8 Massachusetts 69.77 4 13
9 South Dakota 65.74 11 14
10 Idaho 65.08 25 12
11 Rhode Island 65.07 9 17
12 Indiana 64.57 13 15
13 Iowa 64.57 10 16
14 Kansas 64.07 12 19
15 Hawaii 63.55 36 5
16 Ohio 63.07 34 9
17 Nebraska 63.05 16 21
18 New Jersey 62.89 45 4
19 Delaware 62.51 17 20
20 Virginia 61.73 6 29
21 Oregon 60.84 23 23
22 Georgia 59.99 26 18
23 Maryland 59.68 24 25
24 New Hampshire 59.51 15 30
24 Washington 59.51 46 10
26 New York 58.90 19 27
27 Colorado 58.25 8 38
28 Utah 55.98 18 37
29 Pennsylvania 55.12 32 26
30 Arizona 54.99 35 22
31 North Carolina 54.61 27 32
32 Missouri 53.85 39 24
33 Vermont 52.39 29 34
34 New Mexico 52.11 31 33
35 Nevada 50.39 42 28
36 Kentucky 50.10 28 41
37 Wyoming 48.64 38 36
38 Tennessee 47.84 40 39
39 Alaska 46.89 22 46
40 Oklahoma 46.81 50 31
41 Maine 46.79 49 35
42 Texas 45.76 21 47
43 South Carolina 44.87 48 40
44 Florida 44.28 37 42
45 California 43.04 33 45
46 Louisiana 41.07 44 43
47 Montana 37.64 43 48
48 West Virginia 36.80 30 51
49 Alabama 36.28 51 44
50 Arkansas 35.51 41 50
51 Mississippi 34.01 47 49

Artwork-2017-States With the Best & Worst Dental Health-v2  

Ask the Experts

To help you brush up on the importance and benefits of good dental care, we asked a panel of experts in health and family studies to weigh in. Click on the panelists’ profiles below to read their bios and thoughts on the following key questions:

  1. What tips do you have for a person who wants to maintain dental health without breaking the bank?
  2. Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?
  3. Should cities add fluoride to drinking water to improve dental health? What are the pros and cons?
  4. Should school sealant programs be expanded more aggressively, especially in low-income areas, in order to better prevent tooth decay in the school-aged population?
  5. How can dental health care become more affordable?
  6. Should dental coverage be included with standard health insurance or covered by Medicaid?
< > David P. Cappelli Professor in the Department of Comprehensive Dentistry at the University of Texas Health Science Center at San Antonio David P. Cappelli

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

It starts with preventing disease before it happens. Dental diseases are preventable. It is important to practice proper oral hygiene, consume a healthy diet avoiding sugar-sweetened beverages, and maintain a healthy lifestyle. It is also important to promote community-based prevention strategies, like community water fluoridation and dental sealants, that have been shown in studies to reduce the incidence of dental caries.

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

Consuming a healthy diet is the most important habit to teach children about reducing their risk for dental caries (tooth decay). Children should avoid the consumption of sugar-sweetened beverages, including sports drinks. Children should limit the consumption of fermentable carbohydrates (chips, crackers) that can be metabolized into sugars and can promote tooth decay.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

A resounding yes. Studies over 60 years demonstrated that community water fluoridation reduces the risk for dental caries (tooth decay). Research demonstrates that adjusting the natural fluoride in water to a beneficial level reduces dental disease and has no demonstrable risk. There is no credible scientific study that demonstrates that community water fluoridation at the therapeutic level of 0.8 ppm has any deleterious effect of health risk. Community water fluoridation is the most cost-effective dental preventive measure and was recognized as one of the top ten public health achievements of the 20th century.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

Yes. Dental sealants have been shown to reduce tooth decay on the chewing surface of teeth. While fluorides, including community water fluoridation, have the greatest impact on the smooth surfaces of teeth, dental sealants protect the chewing surfaces. Studies demonstrate that even after ten years, an intact dental sealant can prevent tooth decay. School-based programs are an efficient and effective method to reduce the risk for future dental disease.

How can dental health care be made more affordable?

In 2000, the U.S. Surgeon General stated, “You can’t be healthy without good oral health”. While this is a simple quote, the philosophy that encompasses this statement has not been realized in the U.S. Dental insurance and dental care is separate from overall health care, and is often considered as an afterthought. Dental care for adults was excluded from the Affordable Care Act (ACA). There is no dental benefit in Medicare when seniors address co-morbidities that impact their oral health. Many states are eliminating adult benefits in Medicaid that reduces access to care for uninsured and underinsured people. If we can reduce barriers that keep people from accessing dental services, we, as a nation, can improve the oral health of all people.

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

Yes. See above statement.

Judith E. DiLorenzo Department Chair of Dental Hygiene at Hudson Valley Community College Judith E. DiLorenzo

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

The public can access free or low-cost high-quality dental care by seeking treatment at Dental/Dental Hygiene school, dental clinics and hospital-based Dental Residency Program Clinics. Dental care provided in these settings is completed by students who are supervised by professors who are licensed Dentists and Dental Hygienists. A complete list of these schools can be found on the American Dental Association's website. In addition, non-profit groups such as Mission of Mercy and Dentistry From The Heart provide free services several times per year from volunteer Dentists and Dental Hygienists with the support of numerous community volunteers. The public may also apply for government subsidized programs, such as CHIP, which provides free dental care for children.

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

Parents must be made aware that cavities can develop immediately after a tooth appears in a child's mouth. In order for a cavity to develop, there needs to be a sugar source (food), plus acid resulting from dental plaque on the tooth. Nutrition plays a key role in the early prevention of tooth decay. Parents should take babies for their first dental visit as soon as teeth begin to erupt in order to learn the correct prevention measures for their children. Nutritional counseling, and daily plaque control measures, along with appropriate fluoride recommendations will be part of this first visit. The prevention of Baby-Bottle Syndrome will be discussed which is rampant decay of baby teeth, resulting from putting a baby to sleep with a bottle of formula or any sugar containing beverage. Improper care of baby teeth will cause problems with the development of permanent teeth and will also cause systemic infection.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

75 percent of all water supplies in the U.S. are fluoridated. For over 70 years, water fluoridation has played a major role in lowering the rate of tooth decay. Water fluoridation is highly cost-effective and well-regulated and has proven to be the safest and most effective means for the prevention of tooth decay. Water fluoridation is often the only means of cavity prevention for children who do not have access to dental care. Anti-fluoridation groups have been extremely vocal over the years; however, their anti-fluoridation messages are not based upon scientific evidence.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

School-based sealant programs are especially important for low-income areas where children are less likely to receive dental care. Sealants are a cost-effective prevention measure that protect teeth from developing cavities. We have observed that school-age children without dental sealants have approximately three times more cavities than those with dental sealants. Sealants prevent cavities which can develop into an oral infection that in turn, can result in a systemic infection; this can also result in difficulty chewing, speaking and learning.

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

Dental health care must be more accessible through increasing the number of lower-cost, government subsidized options for the public to obtain proper dental care, and should be included as basic coverage in all health insurance policies, including Medicaid. The mouth is where many diseases and infections evident in the mouth go on to affect a person's general health status. Diabetes, cardiovascular diseases and adverse pregnancy outcomes such as preterm labor and low birth weight are examples of this oral-systemic link. In addition, regular dental care will result in the early diagnosis of oral cancer, which if caught and treated early, is highly curable. As mentioned above, children should see their dentist as soon as the first tooth erupts in the mouth to not only ensure that parents receive necessary information regarding the prevention of dental diseases, but to start developing positive habits for their children.

Jay W. Friedman Dental Consultant and Author of “The Intelligent Consumer’s Complete Guide to Dental Health: How to Avoid Being Overcharged and Overtreated” Jay W. Friedman

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

Here’s the long answer for background to what is a very complicated question. I would advise them to read my book. Here’s the full title: “The Intelligent Consumer’s Complete Guide to Dental Health: How to Maintain your Dental Health and Avoid Being Overcharged and Overtreated.” Unfortunately, there hasn’t been anything published then or since that contains the sort of information and advice the intelligent consumer needs. This revised edition (2002) is short on implants and some advances in current concepts and methods of caries prevention, but generally, the book is still relevant to the issues you raise.

People are encouraged to “brush your teeth twice a day and see your dentist twice a year,” a slogan from the 1930s popularized by Ipana toothpaste. While brushing twice a day -- or at least once a day thoroughly -- has a scientific-based rationale, not everyone needs six-monthly exams or scaling of teeth. Many people benefit from six-monthly prophylaxis/scaling if they form significant tartar, and many people with periodontal disease benefit from scaling every three or four months. But many people do not need six-monthly scaling, if they do not form calculus or have periodontal pockets (disease). Every nine or twelve months would be sufficient. In other words, patients should have their needs assessed by their dentist/hygienist to determine on an individual basis how often this service should be recommended.

Simply put, we do not have any good studies to demonstrate that six-monthly prophys/sealings are better than nine- or twelve-monthly.

As for examinations, for most people, including children, the six-monthly examination is worthless. They are usually done in a most cursory way. Six-monthly X-rays (usually bitewing films) likewise are worthless, with some exceptions, since it takes about 18 months for a cavity to develop to a significant degree. Annual exams are sufficient. Check-up X-rays can be taken at most at 12-18 months. For people who have never had a cavity, every two-three years would be sufficient.

A process for assessing need has been developed, called CAMBRA -- Caries Management by Risk Assessment -- but it is not widely used. The concept is to identify people who are at high risk of developing dental caries, and then to prescribe more intensive preventive procedures, such as brushing with more concentrated fluoride toothpastes, rinsing with antibacterial and fluoride rinses, applying fluoride varnish to teeth. High-risk patients would also have more frequent examinations and check-up X-rays. Although the American Dental Association (ADA) recommends 6-monthly exams and BW X-rays for some categories (without any sound evidence, except possibly for very high-risk patients), annual exams and BWs are sufficient, and for some people, excessive.

To make matters worse, there is increasing challenge to the “drill and fill or cap” baby teeth, since the decay process can be retarded or stopped by applying Silver Diamine Fluoride (SDF). The liquid will turn the decay black. It eliminates the need and risk of hospitalization of young children with general anesthesia -- and the high cost. SDF can also be applied to adult teeth. The downside is the discoloration. And what mother wants babies with black teeth? So, the pediatric dentists will still find employment placing cosmetic plastic veneers on the baby teeth.

Don’t be sold on “gum irrigation,” “tooth whitening,” replacement of amalgam fillings for “prevention” of mercury poisoning, or CT scans. Unless teeth are visually discolored and dark from a few feet away, tooth whitening will not make a perceptible difference. The natural color of healthy teeth is lightly yellow, not white like chalk. But if one is determined a go a shade or two lighter, over-the-counter whitening kits work for many people at a significant savings.

I wish there was a shorter answer to the question. Following are recommendations at the end of my chapter on Prevention and Treatment of Caries:

  • Brush and floss thoroughly at least once a day, preferably twice, morning and night.
  • Use fluoride toothpastes and include fluoride supplements in the diets of infants and children, where the water does not contain an adequate fluoride level.
  • Avoid the expense of professionally applied topical fluoride if your children are essentially caries-free, use fluoridated toothpaste, and reside in a fluoridated community. If you decide on professionally-applied topical fluorides, ask your dentist about fluoride varnish.
  • If you or your children have lots of cavities, ask your dentist about fluoride and antimicrobial (chlorhexidine) mouth rinses.
  • If your child has a lot of cavities, ask your dentist about Silver Diamine Fluoride (SDF) treatment instead of fillings and caps.
  • Don’t let the dentist charge you extra for gum irrigation when your teeth are cleaned.
  • The dental prophylaxis includes scaling and removal of subgingival calculus. Don’t let the dentist charge extra for scaling and root planing, unless you have diagnosed periodontal disease.
  • Under age 19, have sealants applied, but only to defective pits and grooves, especially of the permanent molars.
  • Do not have interproximal fillings, unless the dentist documents caries through the enamel into the dentin in the X-ray film.
  • Discuss remineralization or pulp capping of very large cavities with your dentist before consenting to root canal therapy.
  • Don’t ask for or accept composite fillings on chewing surfaces of posterior teeth. Stick with amalgam.
  • Don’t let your dentist replace large fillings with crowns unless there is something demonstrably wrong with the filling and the tooth cannot be refilled.
  • If a new filling or crown is hypersensitive to heat or cold more than two or three weeks, do not rush into root canal treatment. Ask your dentist to consider removing the new restoration in order to treat the nerve with a temporary sedative filling or crown.
  • If a new crown is sensitive to touch along the gum line and your dentist refuses to replace it, obtain a second opinion.
  • Don’t accept a crown on a tooth with nonsymptomatic cracks and minor fractures.
  • Don’t accept charges for pulp caps, buildups, and dowel posts in conjunction with a crown, unless at least 50 percent of the tooth is decayed or has fractured. This is best discussed before the procedure, not afterwards.
  • Be wary of upgrades and add-ons, which are more likely to benefit the dentist than yourself.
  • Don’t be taken in by televised images of your teeth, which magnify supposed defects to “sell” dentistry.
  • Cosmetic Dentistry is an appeal to your vanity. Only you can protect yourself.

The short answer to your question -- the best way to maintain your dental health without breaking the bank is to:

  • Practice good preventive home care -- brush your teeth thoroughly with a fluoridated toothpaste, preferably morning and evening. Flossing helps. Limit sugar in your diet and avoid carbonated drinks, including sugar-free “diet” drinks. Avoid excessively chewing gum and use sugar-free gum with xylitol if you must chew.
  • An annual dental exam is all you need, unless you have special problems. Check-up X-rays at most once a year, and if you haven’t had a cavity in a couple of years, then every 2-3 years.
  • If you develop tartar, a six-monthly prophylaxis (with scaling) is OK, although 9-12 months is sufficient for many people.
  • Children’s prophylaxis and six-month bitewing X-rays are worthless.
  • Avoid “upgrade and add-on” charges, such as “oral irrigation” with routine cleaning.
  • Don’t replace functional amalgam fillings. Amalgam fillings that are not visible are more durable than plastic composites.
  • If you are not sure you need a recommended treatment, ask for more information/justification, or a second opinion.
  • Wisdom teeth, whether unerupted or impacted, do not need to be extracted unless causing a specific problem.
  • Avoid general anesthesia and IV sedation at any age for routine dental care, extraction of wisdom teeth, etc.
  • “Cosmetic Dentistry” is an appeal to your vanity and your bank account. Caveat emptor.

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

  • Diet, diet, diet. Eat healthy, nutritious food. Avoid food such as sugared cereals, cookies, candy, chewing gum, etc.
  • Have non-carious snacks available, including vegetables and nuts.
  • Avoid carbonated drinks in normal activity, including sugar-free “diet” and sports drinks, which have an overload of sugar.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

All cities and towns should fluoridate their communal water supply to the level recommended by their public health agencies. The safety of fluoridation has been so well-documented, it is fully accepted by all public health and scientific authorities. Opposition to fluoridation is based on unproved assertions that have been debunked by numerous studies for over 50 years.

The only known negative effect is mottling or discoloration of the enamel that is usually so slight that it is unrecognizable, except by close dental inspection. More severe mottling has been observed in communities with an excessive amount of natural fluoride, in which case the fluoride has to be reduced to recommended levels to eliminate the problem.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

Preventive health programs should be part of every school, with special emphasis in elementary schools where they are most effective for the low-income, underserved child population. Sealant programs are highly effective in preventing tooth decay in imperfect grooves of the posterior (chewing) teeth. The smooth surfaces of all the teeth can also be protected by application of topical fluoride varnish. Dental care for low-income children is often not accessible and too costly. Sealants and topical fluoride varnish administered by trained dental hygienists, dental assistants, and dental therapists significantly reduce dental decay among children, which is one of the, if not the greatest, cause of suffering and absenteeism in the school-age population.

How can dental health care be made more affordable?

Dental care could be made more affordable by implementation of “evidence-based” practice that would result in fewer “procedures” and charges to patients. The profession needs to adopt policies that reduce FUN (functionally unnecessary) procedures that are highly remunerative to the dentist, but of little value to the patient, such as too frequent examinations and X-rays, worthless children’s prophylaxis, gum irrigation, etc.

Removing state regulations that limit the scope of practice of dental hygienists, dental therapists (the equivalent of nurse practitioners), and denturists would allow them to provide the same treatment for which they are qualified as dentists, but at lower costs.

Expanding school health programs to include publicly financed salaried dental therapists, dental assistants and hygienists, who can provide nearly all the dental care required by children at lower cost.

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

Many studies show an association between dental diseases, particularly periodontal disease, and systemic diseases including diabetes, heart disease, and increased risk of cancer. While “association” is not “causation,” there is mounting evidence moving in that direction. Preventive treatment can reduce that risk. People with dental insurance obtain preventive dental care more frequently than those without insurance. Therefore, expanding standard health insurance and Medicaid to include dental care will improve the overall health of the population, and reduce the need for more expensive medical and dental care. In terms of the public’s health and the economics of health care, expanding health care insurance to include dental care should be considered a social and moral imperative.

Laurel L. Risom Clinical Associate Professor in the Fones School of Dental Hygiene at the University of Bridgeport Laurel L. Risom

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

The best advice to maintain optimum dental health is prevention, prevention, prevention. Daily brushing and flossing, removing the daily accumulation of plaque biofilm twice a day is the best prevention for preventing dental disease. Visiting your dentist and dental hygienist every six months can help you become aware of problems when they are small -- for example, restoring a simple cavity when they are small saves money vs. letting it grow and ending up with a big costly restoration. We now know untreated gum disease can put one at higher risk for heart disease, stroke, low birthweight and premature births. Prevention keeps your teeth healthy, and also, your body.

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

I teach the pediatric dental hygiene public health rotation, with my dental hygiene students we see over 800 preschool-age children annually. Children need to learn how to brush their teeth and have parents help them with the process. Young children learn by example, parents taking good care of their teeth will teach children the same. Diet plays a very important role as well -- children need to eat healthy foods low in sugar, healthy cereals, snacks low in sugar and limit sugary drinks, drink plain milk and water to feed their bodies and their teeth. Beyond brushing and flossing, visit the dentist and the dental hygienist for preventative services, such as sealants and fluoride varnish to help prevent tooth decay.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

Yes, the addition of the optimal amount of fluoride to water can help prevent cavities. Children now have the advantage to grow up cavity-free with the addition of fluoride, by drinking eight glasses of fluoridated water a day. Children should drink the town and city water; so many times, I see children drinking bottled water. Most bottled water does not have adequate fluoride, if any, and will not protect a child’s teeth. I am a public health hygienist; I do not see any contraindications to fluoride in the drinking water.

The American Dental Association (ADA) will tell you that more than 70 years of scientific research has consistently shown that an optimal level of fluoride in community water is safe, and effective in preventing tooth decay simply by drinking water. The Centers for Disease Control and Prevention named community water fluoridation one of ten great public health achievements of the 20th century.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

School sealant programs should be readily accessible to all school-age children regardless of income; that being said, children in low-income areas have higher rates of dental decay and dental health disparities, so yes, they would benefit. The best care scenario for them would be to have a program or dental health clinic right in their very own school.

A National PEW Report informs us on the health of our children and sealant programs. The availability of programs varies from state to state. Their 2016 data shows that school-based programs do benefit low-income children and save money.

In Connecticut, we are lucky we have public health dental hygienists who can provide preventative care, such as sealants to children in public clinic settings. The dentist does not have to be present. This gives us better access to care for programs such as sealants, dental cleanings, and fluoride varnish application.

How can dental health care be made more affordable?

Two options readily come to my mind. The additional use of a relatively new treatment for childhood caries with silver diamine fluoride treatment. This has been used outside the United States and in other Countries for some time, but is pretty new to us. The SDF in a very small amount (one drop) is carefully placed on the “cavity”, sometime requiring more than one treatment. The SDF “arrests” or stops the decay. The treatment does carry some side effects, for instance, the cavity lesion turns black, and depending on its location, this could be a deterrent to the parent and the child for esthetics.

The American Academy of Pediatric Dentistry (AAPD) now recommends the use of silver diamine fluoride (SDF) to treat active dental caries in primary teeth in pediatric and special-needs patients.

Option two, the inclusion and development of a mid-level dental care provider model, like the accepted Physician’s Assistant (PA) and Nurse Practitioner (NP) in medicine, the expansion of the oral health care workforce can help provide cost-effective treatment to our underserved and uninsured.

This mid-level oral health professional can help provide dental care to those who need it most, more cost-effectively in public health and community clinics. Some states have already passed their version of this oral care provider. In 2009, Minnesota passed legislation to have both a dental therapist and an Advanced dental therapist, based on the dental hygiene model of care. Maine recently passed the dental hygiene therapist in 2014. And Alaska uses a dental therapist model to provide care on tribal lands.

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

As a public health hygienist, I would love to see dental coverage included as a part of standard health insurance. Even to just consider covering preventative treatments, such as the ones mentioned above. Prevention saves money, the CDC agrees: “Lack of Dental Care Leads to Costly Emergency Department Visits and Temporary Solutions.” Medicaid does cover some dental benefits; the coverage differs for children and adults as to what is covered, and varies from state to state.

Mia L. Geisinger Associate Professor in the Department of Periodontology and Director of the Advanced Education Program in Periodontology at the University of Alabama at Birmingham Mia L. Geisinger

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

First and foremost, an ounce of prevention is worth a ton of cure. The average annual dental expenditure in the U.S. in 2013 was $685. The average yearly cost of oral hygiene supplies for a year is $97. The main causative factor for the top two most common dental diseases, dental caries (tooth decay) and periodontal disease (gum disease), is bacterial plaque and the main defense against bacterial plaque is effectively cleaning your teeth at home. If a patient spends two minutes twice a day cleaning their teeth, they spend 15 times more time on oral health than in the dental office getting two cleanings per year.

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

After effective brushing, cleaning between teeth and regular preventative dental visits, there are several things that greatly impact oral health. Eating a healthy diet and limiting consumption of between meal snacks and sugary beverages limits the exposure of teeth to acids produced by bacteria that cause tooth decay. Smoking cessation (or never starting in the first place) is good for your overall health, but can lower your risk of gum disease 2-6 times. Finally, we are learning that extended exposure to dietary acids (like sour candies and acidic drinks) can cause dental erosion and loss of dental hard tissues that can never re-grow.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

For every $5 that is spent on water fluoridation, $32 is saved in the treatment of dental caries (tooth decay). This is a great return on investment. While infrastructure limitation and budgetary issues from government have made water fluoridation programs a low priority, there is a big benefit to water fluoridation, particularly for patients with low access to dental care.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

Fluoride varnish, fluoride rinses, and tooth sealant programs have been shown to reduce decayed-missing-teeth scores in children. Furthermore, given CHIP programs investment in childhood caries prevention, this can allow for dental professionals to provide these services and get reimbursed by Medicaid funding in most states. This is critically important, as caries rates in the poorest individuals is double that of the population as a whole.

How can dental health care be made more affordable?

Investment in preventative therapies, loan repayment programs tied to providing care to low-income individuals or practicing in areas with limited access to dental care, and adequate education is critical to reducing costs to the public and societal costs (pain and suffering, lost work, time away from school) as a whole.

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

Oral health is integral to overall health. Studies have demonstrated that treatment of periodontal disease reduces health care costs in diabetic patients and other patients with systemic disease. Most states currently have provisions that allow for dental care for children under Medicaid/CHIP, and many allow for some dental care with Medicaid for adults as well. This is, again, an investment that may pay dividends going forward with a healthier and wealthier population.

Leon A. Assael Director of Community-Based Education and Practice and Clinical Professor in the Department of Preventive and Restorative Dental Sciences at UCSF School of Dentistry Leon A. Assael

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

Dental caries is an infectious disease, caused by bacteria that feed on sugar and create acids that destroy the calcified matrix and protein of teeth. It is prevented by improving the bacterial environment of the mouth, just like probiotics can improve gut health, not by blindly eliminating all bacteria. So, a healthy diet, not including sugary acidic foods or sticky sweets, brushing to reduce the thick plaque on teeth and leave a healthy pellicle, the moist, not squeaky feeling of a healthy oral microbiome.

Also, Americans spend about $120 billion per year on oral health care (about half of what is actually needed). It is mostly paid for out of pocket, so the family budget needs to set aside sufficient funds for care, especially for children and elderly when disease rates are highest.

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

Stop snacking with sugars, eliminate all soft drinks that are sweet, even diet ones.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

Yes, optimal exposure to fluoride is essential to human health. Water is the best vehicle to optimize exposure.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

Yes, dental therapists and dental hygienist are the best oral health team members to gain the benefits of this preventive care for children, and should add the use of fluoride varnish or silver diamine fluoride to remineralize and treat carious lesions.

How can dental health care be made more affordable?

Advance the oral health team to include dental therapy, so that a robust team can provide more care at a lower-unit cost, which is great for the public and patients. All patients have gained greater access to care when a broad, well-functioning team works together.

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

It is covered variably by Medicaid, but there is no coverage in Medicare, which is desperately needed. There should in fact be only health insurance, since oral diseases are diseases like any other, and the need to treat them is no more or less than with any other essential human organ system. A person whose mouth has been ravaged by oral diseases has had an essential human organ system destroyed, which causes severe damage to digestion, speech, airway and breathing, and inflammatory load. Effects of this include poor diet, obesity, heart disease, GERD, and, of course, loss of self-esteem, social and economic consequences of disfigurement, among others.

Pin-Chuang "Patrick" Lai Diplomate of the American Board of Periodontology and Assistant Professor in the Department of General Dentistry & Oral Medicine at the University of Louisville School of Dentistry Pin-Chuang

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

Prevention is better than cure. It is suggested to brush the teeth twice a day, at least two minutes each time, and use dental floss once a day. Good oral hygiene is essential to prevent dental caries and gum disease (and further complications). In addition, regular dental visits (every 6 to 12 months) help identify dental problems when they are relatively easier (and cheaper) to fix.

With regard to treatment cost, dental schools usually provide services that are competitive in fees and quality, but the trade-off is time (may require more and longer appointments because of frequent checks by faculty).

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

Brushing teeth within five minutes of meals could be ideal for reducing substrates for caries-producing bacteria; however, this could never be easy. Two habits that could provide some levels of help include drinking water after consuming acidic or sugary food/drinks (to remove sugary substrates and neutralize pH value in the mouth), and use of sugar-free chewing gum (for example, xylitol-sweetened gum) to stimulate salivary flow (as buffer for acid in the mouth) and remove some bacteria plaque and food debris from teeth.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

Water fluoridation is the adjustment of the natural fluoride concentration of fluoride-deficient water to the recommended level for optimal dental health. This has been proven as a cost-effective way reduce dental caries rate at community-wide levels by many public health studies. Therefore, in cities and towns where the natural fluoride concentrations in drinking water are below the recommended level, water fluoridation will be beneficial.

There is evidence that water fluoridation could increase risk of dental fluorosis, which is a change in the appearance of teeth (caused by a disruption in enamel formation during tooth development). Dental fluorosis was present in 22.3% of U.S. school children in a 1986-87 national survey, and 94% of all dental fluorosis was very mild to mild (not of esthetic concern). The prevalence has been significantly reduced with more appropriate use of other fluoride sources. There is insufficient evidence for other possible negative effects of water fluoridation.

The United States Public Health Service (USPHS) established the optimum concentration for fluoride in drinking water in the range of 0.7 – 1.2 ppm. On the website of the Center for Disease Control and prevention (CDC), the internet based “My Water’s Fluoride” tool (http://ift.tt/1LFeIXU) helps to find out the fluoride concentration in drinking water. Fluoride supplements (drops for infants and chewable tablets for children and adolescents) should only be prescribed for children living in non-fluoridated areas.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

The use of pit-and-tissue sealants on the occlusal surfaces of primary and permanent molars in children and adolescents has been recommended by American Dental Association and American Academy of Pediatric Dentistry due to their effectiveness in caries prevention.

Compared to complications associated with dental caries (the need for root canal therapy, extraction of tooth, dental prostheses), the school sealant programs, along with good oral hygiene habits, could largely reduce the dental treatment cost in the long term.

How can dental health care be made more affordable?

It’s very complicated because the cost of dental care involves with dental materials, staff, equipment, rent, insurance, and student loans of the dentists. It needs joint efforts from policy-makers, insurance companies, and dentists to possible make dental health care more affordable.

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

It has been shown that dental/oral health is highly associated with general health. The bacteria, bacterial products, and the biological mediators involved in an oral infection could affect other parts of the body, and vice versa. Those who suffer from dental problems may even have problems getting enough nutrient intakes. Basic and disease-controlling dental procedures should be covered by Medicaid to help those specific groups in need.

Robert J. Weyant Associate Dean of Dental Public Health and Community Outreach & Professor and Chair of the Department of Dental Public Health in the School of Dental Medicine at the University of Pittsburgh Robert J. Weyant

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

Prevention. Don’t eat sugary foods, use fluoride toothpaste twice a day, don't smoke, get dental sealants on your children’s teeth.

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

Don’t drink sugar-sweetened beverages (soda, energy drinks, etc.), get dental sealants.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

No cons, all pros. Yes, get the fluoride.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

Yes, sealants are the most effective decay preventive intervention we have. They should be provided to all children. It will save tons of money in the long run.

How can dental health care be made more affordable?

Ask Congress to expand Medicaid and the CHIP program. Add a dental benefit to Medicare, and in my dreams, provide a public option for all health care that includes dental care (in other words, join the rest of the developed world).

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

Yes. Dental should be integrated in all health care and health insurance. No rational reason to keep them apart.

Elmer E. Gonzalez Program Director and Assistant Professor of Dental Hygiene at New Mexico State University Elmer E. Gonzalez

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

My best advice for a person to maintain good oral health without breaking the bank is to be proactive and prevent disease. An easy way to do this is by maintaining a strict oral hygiene regime at home, that includes brushing with a soft bristled toothbrush, flossing daily or at least every other day, and rinsing with mouthwash. Professional dental cleanings by their dental hygienists must be a component of the plan. If people cannot afford a cleaning twice a year, they should at least try for once a year if they have a strict and effective oral hygiene regime at home. In addition, healthy habits, such as minimizing the consumption of soft drinks and sports drinks that are high in sugars and acids is essential to maintaining the pH balance, to mitigate the risk of getting cavities. Quitting smoking and good dietary habits are also essential to maintaining good oral health. Patients can save a lot of money and maintain good oral health by following simple, yet strict protocols.

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

Children are the future of our society; therefore, it is essential to address with children the risk factors for tooth decay and periodontal diseases. Children should be taught early on about the risks associated with smoking, consuming high sugary beverages, and diet. In addition, children should be taught the importance of maintaining their visits to a dental hygienist and their annual checkups with the dentist in order to prevent bigger, costly dental-related problems.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

Water fluoridation is a hot topic for many, however, in my personal opinion, it has been one of the greatest public health advantages in mitigating the risk of developing dental cavities. In some cities, children and adults do drink tap water, and adding fluoride to it is a great way to introduce a little prevention and enhance the tooth’s ability to re-mineralize. The biggest con about water fluoridation is the push back from people and groups who are anti-fluoridation.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

I think school sealant programs and other school dental-based programs should be extended to counteract the effects of one of the most prevalent oral diseases in children, dental decay. It is imperative to work more aggressively in fighting dental decay to ensure children are pain-free, and can attend and focus in their classes without the worry or struggle of dealing with pain or stigma from bad teeth.

How can dental health care be made more affordable?

Dental health care, in my opinion can be made more affordable when dental hygienists are allowed to practice more independently and in different settings, without the direct supervision of dentists. The expansion of dental hygiene mid-level providers (dental therapists) could potentially fill the gap in access to care, and reduce costs with dental care as well. In addition, dental insurance companies need to expand their fee schedules to include dental hygienists and therapists as individuals who can bill for services. Hygienists/therapists are prevention specialists who are trained to educate the public on possible oral systemic links affecting their well-being in relation to the oral cavity.

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

Dental coverage should be part of both Medicaid and Medicare, and standard health insurance. Many dental problems that go untreated end up in emergency rooms costing the health care system hundreds, if not thousands, of dollars to take care of a problem that should have been taken care by prevention. If dental coverage comes as a standard provision in any medical insurance, then individuals will have the opportunity to access dental providers to address those issues, and will not have to wait until they become emergencies, which may cost more in the end.

Joana Cunha-Cruz Research Associate Professor of Oral Health Sciences at the University of Washington Joana Cunha-Cruz

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

The best way to maintain dental health is trough diet and oral hygiene. The two most important things are to limit your intake of sugar and to brush your teeth daily with a toothpaste that contains fluoride. Any toothpaste that contains fluoride, regardless of price, is good for your dental health, and you don’t need a large amount of it for it to work

Children should have their teeth brushed with a small amount of fluoride toothpaste every day. Beginning when the first tooth comes out, parents can use a smear of fluoride toothpaste everyday until the child is three years old, and then can increase to a pea-size amount. Teenagers and adults also only need a pea-size amount of toothpaste. It works, and a toothpaste tube will last a long time.

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

The most important habit and behaviors for children is to limit the consumption of sugar, like candies and sodas. One way of helping children is to make healthy choices the easiest choices. So, for example, we can promote healthy drinking habits by having refillable water bottles for each child, and not having sodas or sweetened juices at home.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

Cities and towns should be involved in promoting oral health by implementing policies and programs to limit availability of sugary foods and drinks, making fluoride toothpaste easily available to children and adults, and making sure that school-based preventive services, such as sealants and topical fluorides, are available to all children from early childhood to high school. Water fluoridation has been endorsed by several organization and academy stakeholders, and should be maintained.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

Tooth decay prevention programs using the best available preventive strategies should be extended as mentioned above. Currently, prevention strategies should be tiered when provided to schoolchildren. Individual or community risk for decay may dictate which prevention strategy to use. The idea is that a child who never had decay still needs prevention such as fluoride toothpaste, but not as much as a child that already had decay would need. The child with decay experience is at elevated risk of developing more decay. She or he would need more intensive preventive strategies, such as the dental sealants or other topical products.

Just as important as prevention is the identification of children with active decay that needs to be treated. School-based programs should have the ability to not only prevent decay, but also to stop the decay from progressing. This treatment to stop the decay can be provided at the school. This strategy seems to be more efficient and a better use of scarce resources. Schools are an ideal place to provide dental services because dental providers go where the children are, removing transportation and access barriers.

How can dental health care be made more affordable?

There are different strategies that could make dental care more affordable, from actions at the individual level to system and policy actions. Innovation is happening in several States from introduction of new products to new workforce and practice arrangements to new policies. All with the main goal to increase not only dental care access, but also quality and affordability. I wouldn’t point out one single strategy, as its effectiveness may depend on the context and needs of the community.

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

Dental care is part of overall care, and should be part of standard health insurance. Historically, there are reasons for this to not be the current case. However, in my view, oral health as part of overall health should be included in standard health insurance. Medicaid does cover dental care in certain circumstances. Every public health professional and dental provider should support the expansion of Medicaid.

Joanna Douglass Associate Professor of Craniofacial Sciences at the University of Connecticut School of Dental Medicine Joanna Douglass

What tips do you have for a person that wishes to maintain dental health without breaking the bank?

The most important thing to achieve good dental health is good home care. Brush your teeth and gums two times a day with a fluoride-containing toothpaste, and floss once a day. Make sure that the snacks and drinks that you consume between meals do not contain sugar. It is the frequency of sugar ingestion that is most highly connected to the development of cavities, so restricting how often we have sugar-containing drinks and foods is key to preventing cavities forming.

If you do not have dental insurance or a lot of money, try to get to the dentist at least once a year for a check-up. Ideally, twice a year is great, but for most people, once a year can work. This helps detect cavities or gum disease before they become a big problem, and you can more economically get them fixed. If you do not go regularly, cavities can go undetected and grow significantly before you are aware of them. This can become a costly problem.

Beyond brushing and flossing, what are the most important habits and behaviors to teach children to ensure they have good dental hygiene?

These are the same habits and behaviors as for adults. Make sure that foods and drinks consumed between meals do not contain sugar. Also, try to restrict snacks to only one time between meals. Constant grazing, even if there is no obvious sugar in the food, can contribute to the formation of cavities.

Should cities and towns add fluoride to drinking water to improve dental health? What are the pros and cons?

Towns absolutely should add fluoride to their drinking water to improve dental health. Fluoride in the drinking water has been heralded as one of the top ten public health measures of the last 100 years. It remains the most effective way to decrease people’s levels of cavities. Fluoride has been studied extensively for decades and has been found to be completely safe.

Should school sealant programs be extended more aggressively, especially in low-income areas in order to better prevent tooth decay in the school-age population?

Sealants are an effective way to protect permanent molar teeth from developing cavities. These are very cost-effective, especially if employed in populations with high levels of cavities, such as children living in low-income areas. Yet, they should be extended to reach more school children.

How can dental health care be made more affordable?

The best way to make dental health care more affordable is to take good care of our teeth at home, by following the simple steps we discussed above. Additionally, getting good prevention, such as fluoridated water, using fluoridated toothpaste, and going to the dentist for regular check-ups, and for children for sealants and topical fluoride applications, are very important steps to preventing expensive dental health care bills. Dental disease in the very large part is preventable, it is not an inevitable disease.

Should dental coverage be included as part of standard health insurance or covered by Medicaid?

Dental coverage for children is already included under Medicaid, and should be included under Affordable Care Act health plans (although this is a rather complicated picture that does not always happen in practice). Adults, on the other hand, do not get coverage in Medicaid automatically. A limited number of states provide comprehensive dental coverage, but they are definitely in the minority. Unmet dental treatment is a huge problem for people, leading to lost workdays, problems with overall health (dental health and overall health are linked), and aesthetic problems which can lead to trouble getting jobs. Getting people timely dental treatment results in decreased emergency room visits and costs, and help.

Methodology

In order to determine the places with the best dental health in the U.S., WalletHub compared the 50 states and the District of Columbia across two key dimensions, Dental Habits & Health and Oral Health.

We examined those dimensions using 25 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the most favorable conditions for dental health.

We then determined each state and the District’s weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order our sample.

  • Share of Adolescents Who Visited a Dentist in the Past Year: Full Weight (~2.78 Points)
  • Share of Adults Who Visited a Dentist in the Past Year: Full Weight (~2.78 Points)
  • Dental Treatment Costs: Double Weight (~5.56 Points)
  • Reduced Dentist Visits Due to Costs: Full Weight (~2.78 Points)
  • Dentists per Capita: Full Weight (~2.78 Points)
  • Dental Professionals per Capita: Full Weight (~2.78 Points)
  • Share of Population Living in Dental HPSAs (Health Professional Shortage Areas): Full Weight (~2.78 Points)
  • Dentists Supply-Demand Ratio by 2025: Full Weight (~2.78 Points)
  • Sugar-Sweetened Beverage Consumption Full Weight (~2.78 Points)
  • Share of Adult Smokers: Full Weight (~2.78 Points)
  • Share of People Who Receive Fluoridated Water Through PWSs (Public Water Systems): Full Weight (~2.78 Points)
  • Presence of State Oral Health Plan: Full Weight (~2.78 Points)
  • Presence of School-Based Dental Sealant Programs: Full Weight (~2.78 Points)
  • Medicaid Dental Benefits for Adults: Full Weight (~2.78 Points)
  • Presence of State Dental Periodicity Schedule: Full Weight (~2.78 Points)
  • Status of Older Adult Basic Screening Survey: Full Weight (~2.78 Points)
  • Oral Health Knowledge Index: Full Weight (~2.78 Points)
  • Poor or Fair Oral Condition: Double Weight (~10.00 Points)
  • Share of Elderly Population with No Natural Teeth: Full Weight (~5.00 Points)
  • Pain Due to Oral Condition: Double Weight (~10.00 Points)
  • Dry Mouth Due to Oral Condition: Full Weight (~5.00 Points)
  • Sleeping Problems Due to Oral Condition: Full Weight (~5.00 Points)
  • Reduced Life Satisfaction Due to Oral Condition: Full Weight (~5.00 Points)
  • Reduced Social Participation Due to Oral Condition: Full Weight (~5.00 Points)
  • Work Absence Due to Oral Condition: Full Weight (~5.00 Points)

 

Sources: Data used to create this ranking were collected from U.S. Census Bureau, Bureau of Labor Statistics, Centers for Disease Control and Prevention, Healthy Grid, American Dental Association, Health Resources & Services Administration, United Health Foundation, Kaiser Family Foundation, American Academy of Pediatric Dentistry and Oral Health America.



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