Among children in the United States, tooth decay continues to be the single most common chronic disease, despite the fact that the disease is almost entirely preventable. Tooth decay affects more than one-fourth of U.S. children aged 2–5 years and half of those aged 12–15 years.1 About half of all children and two-thirds of adolescents from lower-income families have had tooth decay.2 Children from lower-income families often do not receive timely treatment for tooth decay.2
In 2007, a 12-year-old Maryland boy passed away of complications from an untreated tooth abscess, which caused a bacterial infection that spread to his brain. His death underscored two major issues in Maryland's oral health system: lack of access to dentists for low-income children and the need for simple, literate, public health messages on oral health.3
The Maryland Department of Health and Mental Hygiene worked closely with a number of medical and dental health professional groups from the public and private sectors, as well as representatives from government agencies, child and family advocacy groups, insurance companies, and educational institutions, to convene a Dental Action Committee (DAC) and develop and execute a multi-faceted plan to improve the oral health of the state’s most vulnerable citizens.
This plan revised the state's Medicaid dental program to make it more accessible to users by, among other things, increasing the pool of providers. It also called for expanding the oral health safety net system and providing preventive pediatric oral health training to non-dental providers, such as pediatricians, family physicians, and nurse practitioners as well as institutes an oral health literacy campaign called "Healthy Teeth, Healthy Kids" for the public, among other measures.
To date under this plan, the Maryland Office of Oral Health and Medicaid Program, with funding from the Maryland Governor and help from its state and federal legislators and other DAC partners, have accomplished the following:
- The "Maryland Healthy Smiles" Medicaid dental program, implemented in 2009, actively works to recruit and retain Medicaid dentists, increasing the number of dentists enrolled as Medicaid providers to 1,190 in 2011, from 649 in 2009.
- Maryland has successfully established five new "safety net" dental clinics or programs to serve six previously unserved counties. As a result of this and other efforts, children in every Maryland county can gain access to a dental home through a public health facility.
- Children from low-income families are utilizing the dental system in larger numbers. During 2010, 64 percent of children enrolled in Medicaid for at least 320 days received dental services compared to 54 percent in 2008. In 2007, Maryland children's access to Medicaid dental services in 2007 was 49 percent.
In 2009, the DAC converted to an independent, broader statewide coalition called the Maryland Dental Action Coalition and continues to work closely with the Maryland Office of Oral Health and other state and national stakeholders on oral health issues. The Coalition is currently working on implementing a state oral health plan, which will help improve oral health for the state's most vulnerable populations.
Maryland has gained recognition as an oral health leader across the Nation and earned an "A" grade from the Pew Center on the States4 for its oral health policies in 2011. The Centers for Medicare & Medicaid Services also highlighted Maryland in its report on best state practices for improving access to Medicaid dental services.5
3Maryland Office of Oral Health (2011). "Maryland's 2011 Annual Oral Health Legislative Report." Annual Oral Health Legislative Report. Baltimore, MD, Maryland Department of Health and Mental Hygiene
4The Pew Center on the States (2011). The State of Children's Dental Health: Making Coverage Matter. Washington, DC.
5Centers for Medicare & Medicaid Services (2011). Innovative State Practices for Improving the Provision of Medicaid Dental Services: Summary of Eight State Reports.