Three out of five third-graders in Colorado during the 2022-2023 school year had tooth decay, according to the most recent data from the state health department.
Colorado’s finding of a history of tooth decay in 61% of third graders is both in line with the national average and still far too high, said Dr. Karen Foster, a Denver dentist and previous president of the Colorado Dental Association.
Residue from most types of food will weaken teeth over time, but good oral hygiene, community water fluoridation and regular dental care can prevent that damage, she said.
“Teeth that are kept clean, kept from sugar exposure and fluoridated don’t experience decay,” she said.
Water fluoridation has become controversial in recent years because of studies that found negative effects from drinking high levels of fluoride, though dentists and public health experts say that levels used to prevent tooth decay in the U.S. aren’t high enough to harm children.
The Colorado Department of Public Health and Environment reported that some water systems in the state add fluoride, while others have enough of the mineral in their water naturally that they don’t need to. It didn’t post a breakdown of systems’ fluoridation decisions.
According to the Centers for Disease Control and Prevention, 409 of Colorado’s 947 water systems have fluoridated water, though some, such as Colorado Springs, don’t need to add the mineral because the water picks up naturally occurring fluoride from the surrounding environment.
Water in the reservoirs that supply Denver typically has enough natural fluoride to prevent tooth decay, though Denver Water sometimes adds to its treated water if the supply comes in with a lower-than-expected concentration, according to the utility.
Delayed dental visits during the pandemic may have increased the number of kids experiencing cavities, but even in ordinary times, about half of students in that age group had either current tooth decay, or a filling showing they’d had it before.
The rates of kids with tooth decay ranged from a low of 47% during the 2016-2017 school year to 57% in 2003-2004.
The data comes from Colorado’s Basic Screening Survey, which uses a sample of data collected from free dental check-ups offered to public school students in kindergarten and third grade. Kindergarten students were less likely to have had tooth decay than their older peers, but 46% still had a history of cavities or a current one.
About one-quarter of students in both grades had untreated cavities at the time of their screening. Latino and Black students, and those attending schools with more low-income families, were more likely to have both a history of cavities and current untreated tooth decay.
The screeners recommended that students with untreated cavities see a dental provider before their next scheduled appointment. They also noted about 6.5% of kindergarteners and 4.9% of third graders needed “urgent” dental care because of pain or signs of infection.
To protect children’s teeth, Foster said parents should:
- Arrange a dental visit by the child’s first birthday
- Encourage them to drink water, and limit sugar-sweetened beverages
- Take their children for sealants (resin painted on teeth to block bacteria) on their permanent teeth
- Ensure kids brush twice daily and floss once a day, with supervision for younger children
“If they can tie their shoes by themselves, they are potentially ready to take over” their oral hygiene routine, she said.
As of 2023, about 90% of Coloradans 18 and younger had dental insurance, and 83% said they had visited a dentist or hygienist in the previous year, according to the Delta Dental of Colorado Foundation. Both numbers have trended up since 2013.
Coloradans who avoided the dentist in the previous year reported three main reasons: cost, fear of pain and difficulty finding a provider they related to, said D.J. Close, the foundation’s executive director.
Medicaid covers dental care for both adults and children in Colorado, but not everyone knows that, Close said. And of course, some families earn too much for Medicaid, but not enough to buy dental insurance, he said.
The foundation has also made progress on expanding and diversifying the provider workforce by helping fund new schools for dental hygienists and assistants, Close said. Fear of pain is “harder to chip away at,” but the foundation funds programs to send hygienists into schools, to give kids a preview of what visiting the dentist is like in a place that feels safe, he said.
“Education and exposure are the best way to combat fear,” he said.
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