Hawaii Leads Nation in Pediatric Tooth Decay



While pediatric tooth decay appears to be reaching epidemic proportions across the United States, the children of the Aloha State are suffering the worst. The Hawaii State Department of Health reports that third graders there have the highest prevalence of caries in the nation.

The department based its report on data collected from more than 3,000 students in 67 public elementary schools during the 2014 to 2015 school year. Third graders were chosen because they are the same target population of national oral health surveillance surveys and provided a basis of comparison with national statistics.

For example, tooth decay affects 71% of third graders, which is higher than the national average of 52%. Also, about 7% of third graders need urgent dental care because of pain or infection. But there are great disparities within this population based on income and ethnicity.  

About 31% of third graders eligible for the National School Lunch Program have untreated tooth decay, compared to 13% of those who aren’t eligible. Also, 12% of these low-income third graders need urgent dental care, while only 2% of their higher-income peers require it.

Meanwhile, about 56% of Micronesian and 41% of other Pacific Islander children have untreated decay, compared to 13% of white children and 11% of Japanese children. Furthermore, 30% of Micronesian and 23% of other Pacific Islander children have dental pain and/or infection, while 3% of white and 2% of Japanese children have it.

“With support from principals and their staff at elementary schools within the Department of Education, we now have solid data on which to build our programs,” said Virginia Pressler, MD, PhD, director of the Hawaii State Department of Health.

“We can now begin to fill in the gaps in oral health for children by joining with various partners in the community and harnessing the latest technological tools available,” Pressler said. “Our goal is to make quality oral healthcare more accessible for all Hawaii children by offering culturally appropriate, community-based prevention programs, screening and referrals services, and restorative dental care.” 

The survey also showed that more than 60% of third graders don’t have protective dental sealants, which cost-effectively prevents tooth decay in molars. The Hawaii Dental Service (HDS) Foundation, the charitable arm of the HDS, has provided funding to the state Department of Health for sealant and fluoride varnishing programs.

“We recognize that everyone has an important role in improving and promoting oral health for children,” said Mark Yamakawa, president and chief executive officer of the HDS, which also provided funding to underwrite the cost of the survey. The US Centers for Disease Control and Prevention, the Department of Health and Human Services, and the Kaiser Foundation also helped fund the survey.

“We are now partnering with the Department of Health and other nonprofit community organizations to improve the oral health of keiki [children] in our community,” Yamakawa said.

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