New CDC Study Highlights Income Divide Behind Lack of Dental Sealants

A new Centers for Disease Control and Prevention (CDC) Vital Signs report highlights the need to expand access to dental sealants of the back teeth for children of low-income families, pointing to school-based sealant programs (SBSPs) as a way of addressing the issue.

Painless and effective, sealants can prevent up to 80% of cavities in school children, the report says. However, according to the CDC, while overall prevalence of the use of sealants has increased, nearly 60% of school children ages 6-11 do not receive them.

“Many children with untreated cavities will have difficulty eating, speaking, and learning,” said CDC Director Tom Frieden, MD, MPH. “Dental sealants can be an effective and inexpensive way to prevent cavities, yet only 1 in 3 low-income children currently receive them. School-based sealant programs are an effective way to get sealants to children.”

Data paint a stark portrait of the severity of this issue. According to the report, by age 19, 1 in 5 children are showing signs of untreated tooth decay. Additionally, children who fall below the poverty line are 27% more likely to have untreated tooth decay than children whose family income is more than 200% of the federal poverty level.

SBSPs address this issue by expanding access to at-risk children. Typically, SBSPs will use the number of students who are eligible for free or reduced-cost lunch within a district as a barometer to gauge the level of care required. This puts the procedure within reach for at-risk children who are less likely to receive adequate dental care, the CDC reports.

Studies have shown that while 43% of 6- to 11-year-olds have had dental sealants, children from low-income families are about 20% less likely to receive them. And clinical results do not bode well for children without sealants: school-age children without them typically have three times as many cavities, the report says.

Data support the efficacy of sealants as an intervention. Studies have shown that sealants can prevent 80% of cavities for 2 years after they are applied. But, the benefits don’t stop after that: sealants have been shown to stop 50% of cavities for up to 4 years after application.

The expansion of SBSPs could result in treatment cost savings, the report says. The CDC projects that providing access to sealants for the approximately 7 million low-income children who do not have them could result in a treatment cost savings of about $300 million.

To that end, the CDC is funding 21 state public health departments to establish sealant programs to low-income children and those lack access to care, for geographic reasons.

In the Vital Signs study, the CDC evaluated National Health and Nutrition Examination Survey data from 2011-2014 to establish an estimate of the current prevalence of sealant use, as well as untreated tooth decay, among low- and high-income children, ages 6 to 11 years. This data was then compared to 1999-2004 NHANES data. Researchers then estimated the mean number of decayed and filled first molars (DFFM) for children who had and had not received sealants. They also estimated the prevention of tooth decay from increased sealant use. The differences were determined to be statistically significant at p<.05.