Duval, Thomas E

Georgia Health Policy Center

Koskela, Linda

Landers, Glenn M

English

Georgia State University

Georgia State University 
ScholarWorks @ Georgia State University 
GHPC Briefs Georgia Health Policy Center 
5-8-2007 
Children’s Oral Health in Georgia: Progress and Opportunities 
Georgia Health Policy Center 
Glenn M. Landers 
Linda Koskela 
Thomas E. Duval 
Follow this and additional works at: https://scholarworks.gsu.edu/ghpc_briefs 
Recommended Citation 
Georgia Health Policy Center; Landers, Glenn M.; Koskela, Linda; and Duval, Thomas E., "Children’s Oral 
Health in Georgia: Progress and Opportunities" (2007). GHPC Briefs. 82. 
https://scholarworks.gsu.edu/ghpc_briefs/82 
This Article is brought to you for free and open access by the Georgia Health Policy Center at ScholarWorks @ 
Georgia State University. It has been accepted for inclusion in GHPC Briefs by an authorized administrator of 
ScholarWorks @ Georgia State University. For more information, please contact scholarworks@gsu.edu. 
Georgia Health Policy Center  •  (404) 651-3104  •  www.gsu.edu/ghpc
Children’s Oral Health in Georgia: 
Progress and Opportunities
May 2007
IssueBrief
Introduction
There is room for improvement in oral health practice and 
outcomes among Georgia children. According to the U.S. 
Surgeon General, tooth decay affects more than one-fourth 
of all U.S. children age two through fi ve and one-half of 
those age 12 through 15. 
Low-income children are hardest hit: about half of those age 
six to 19 years have untreated decay. Untreated cavities may 
cause pain, dysfunction, absence from school, underweight, 
and poor appearance - problems that can greatly reduce a 
child’s capacity to succeed in life.1
Georgia Survey Research
The Georgia Department of Human Resources, Division of 
Public Health, Oral Health Section seeks to prevent dental 
disease among Georgians.2  A 2005 survey measuring the 
oral health status of Georgia’s third graders found:
•  One in two (56%) have caries experience.
•  One in four (27%) have untreated dental decay.
•  Four in 10 (40%) have dental sealants.
•  One in four (26%) need either early (22%) or urgent 
    (4%) dental care.
•  Children from high socioeconomic status (SES) 
    households are more likely to have good oral health 
    than children from low SES households.
•  Children from Metropolitan Atlanta are more likely to 
    have good oral health than children from other 
    regions, except for dental sealants.
•  Children with access to dental insurance are more 
    likely to have good oral health than children without 
    access to dental insurance.
•  Children who visited a dentist in the last year are more 
    likely to have good oral health than children who had 
    not visited the dentist in the last year.
•  One in eight (13%) could not get dental care when 
    needed.
•  The percent of third grade children in Georgia with 
    caries experience, untreated dental decay, and dental 
    sealants does not meet Healthy People 2010              
    objectives.  
•  Poor oral health is a signifi cant public health problem 
    among children in Georgia.3 
Goal 21-10 of Healthy People 2010 is: “Increase the propor-
tion of children and adults who use the oral health care sys-
tem each year.4”   The Georgia Health Policy Center (Center) 
has worked in partnership with the Oral Health Section for the 
past fi ve years in analyzing Medicaid and PeachCare claims 
data to measure access of Medicaid and PeachCare children 
to dental health services across Georgia. Results from those 
analyses follow.
Georgia Claims Analysis
A 2006 retrospective analysis of claims from calendar years 
(CY) 2000 to 2005 reveals that access to dental health services 
by Medicaid and PeachCare children shows positive 
mprovement.
• Medicaid (M) and PeachCare (PC) enrolled children who 
received any dental service increased from 24 percent in 
CY2000 to 40.7 percent in CY2005.
• The proportion of Medicaid and PeachCare enrolled chil-
dren who received a preventive service rose from 19.4 (M) 
and 34.5 (PC) percent in CY2000 to 33.4 (M) and 50.5 (PC) 
percent in CY2005.
Glenn M. Landers, M.B.A., M.H.A, Linda Koskela, R.D.H., M.P.H., and Thomas 
E. Duval, D.D.S., M.P.H. contibuted to this brief.
Over the past fi ve years, the Georgia Health Policy Center has been in 
partnership with the Division of Public Health, Oral Health Section to provide 
useful information to state and local oral health providers and advocates for 
program planning and decision-making.
 
In this endeavor, the Center welcomes the support and interest of public of-
fi cials and philanthropic benefactors, and invites inquiries from policymakers, 
communities, and organizations working to promote better health.
Nationally, there are 0.6 licensed dentists per 1,000 in urban 
areas and 0.4 licensed dentists per 1,000 in rural areas.6  In 
Georgia, the total ratio of licensed dentists statewide per 
1,000 is 0.46, and only in the Augusta, Cobb, DeKalb, and 
Fulton Public Health Districts does it meet or exceed 0.6 
licensed dentists per 1,000.  Eleven of Georgia’s 18 Public 
Health Districts do not meet the national rural average of 
0.4 licensed dentists per 1,000.
Conclusion
Poor oral health is a signifi cant public health problem 
among children in Georgia.  Children with access to den-
tal insurance and children from higher income families are 
more likely to have good oral health than children without 
access to dental insurance or from lower income families.  
Georgia’s Medicaid and PeachCare programs have played a 
role in improving access to dental care among lower income 
children.  Between 2000 and 2005, the percent of Medicaid 
and PeachCare enrolled children receiving preventive or 
restorative dental services increased, as did the number of 
licensed dentists “participating” and “active” in Medicaid 
and PeachCare.
Despite these advances, dental access challenges still 
remain. The percentages of third grade children with caries 
experience, untreated dental decay, and dental sealants 
remain below Healthy People 2010 objectives.  Dentists per 
1,000 Georgians are below the national average, and some 
Georgia counties still do not have a dentist that accepts 
Medicaid or PeachCare. Georgia’s Medicaid and PeachCare 
programs play an important role in maintaining and improv-
ing dental access for Georgia’s children.
   1 Carmona, R. “Oral Health Problems: Painful, Costly, and Preventable”; http://www.
cdc.gov/nccdphp/publications/aag/oh.htm. Retrieved from the World Wide Web 
January 23, 2007.
 2 Oral Health Section services include: dental health prevention services to eligible 
children in school-based prevention programs, public health nutritionist training in 
promoting the prevention of early childhood caries, public health and school nurse 
training on providing oral screenings for dental disease, and promoting the  use of 
fl uoridated water through monitoring and surveillance of community water systems.
  
  3 Falb M, Kanny D, Duval T, Koskela L. “Oral Health of Georgia’s Children: 
Results from the 2005 Georgia Third Grade Oral Health Survey”. Georgia De-
partment of Human Resources, Division of Public Health, April 2006.  Publica-
tion Number: DPH06.028HW. http://health.state.ga.us/pdfs/familyhealth/oral/
2005GeorgiaThirdGradeSurveyApril2006.pdf
  4 CDC, HIS, NIH. “Healthy People 2010”; http://www.healthypeople.gov/Document/
HTML/Volume2/21Oral.htm. Retrieved from the World Wide Web January 23, 2007.
  5 Participating means the dentist saw at least one child in a calendar year, while active 
means the dentist saw at least one child per week.
  6 Gamm, L. et al eds. (2003). “Rural Healthy People 2010: A Companion Document 
to Healthy People 2010. Volume 1”. College Station, Texas: The Texas A&M University 
Health Sciences Center, School of Rural Public Health, Southwest Rural Health Re-
search Center.
Georgia Health Policy Center  •  (404) 651-3104  •  www.gsu.edu/ghpc ANDREW YOUNG SCHOOL
 O F  P O L I C Y  S T U D I E S
Figure 1
Percent of Medicaid and PeachCare Enrolled Children under Age 19 
Who Received Preventive Services CY2000, CY2001, CY2002, 
CY2003, CY2004, CY2005 by Statewide Totals
.
In spite of these positive signs of progress, the data also 
reveal challenges.
The proportion of Medicaid and PeachCare enrolled chil-
dren who received a restorative service peaked in CY2002 
to 10.8 (M) and 18.4 (PC) percent and fell to 8.9 (M) and 
11.2 (PC) percent in CY2005 – a decline of 21 percent for 
Medicaid children and 64 percent for PeachCare children.
Figure 2
Percent of Medicaid and PeachCare Enrolled Children under Age 19 Who 
Received Restorative Services CY2000, CY2001, CY2002, CY2003, CY2004, 
CY2005 by Statewide Totals
The decline in restorative visits cannot be attributed to any 
known policy change. Because the need for restorative ser-
vices is often identifi ed during preventive visits, one might 
expect restorative services to increase along with preven-
tive visits as caries are identifi ed. 
The number of Georgia dentists “participating” and “ac-
tive”  statewide in the Medicaid and PeachCare programs 
increased 53 and 76 percent, respectively, from CY2000 to 
CY2005.   Although this analysis demonstrates an overall 
increase statewide, several counties still do not have dental 
providers that accept Medicaid or PeachCare reimburse-
ments or that see at least one M/PC client each week5.  
There is still a need for providers who will serve this popula-
tion.
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0.16
0.18
0.2
2000 2001 2002 2003 2004 2005
Medicaid P eachCare
0
0.1
0.2
0.3
0.4
0.5
0.6
2000 2001 2002 2003 2004 2005
Medicaid P eachCare


Children’s Oral Health in Georgia: Progress and Opportunities

ScholarWorks @ Georgia State University

Georgia State University ScholarWorks @ Georgia State University GHPC Briefs Georgia Health Policy Center 5-8-2007 Children’s Oral Health in Georgia: Progress and Opportunities Georgia Health Policy Center Glenn M. Landers Linda Koskela Thomas E. Duval Follow this and additional works at: https://scholarworks.gsu.edu/ghpc_briefs Recommended Citation Georgia Health Policy Center; Landers, Glenn M.; Koskela, Linda; and Duval, Thomas E., "Children’s Oral Health in Georgia: Progress and Opportunities" (2007). GHPC Briefs. 82. https://scholarworks.gsu.edu/ghpc_briefs/82 This Article is brought to you for free and open access by the Georgia Health Policy Center at ScholarWorks @ Georgia State University. It has been accepted for inclusion in GHPC Briefs by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact scholarworks@gsu.edu. Georgia Health Policy Center  •  (404) 651-3104  •  www.gsu.edu/ghpcChildren’s Oral Health in Georgia: Progress and OpportunitiesMay 2007IssueBriefIntroductionThere is room for improvement in oral health practice and outcomes among Georgia children. According to the U.S. Surgeon General, tooth decay affects more than one-fourth of all U.S. children age two through fi ve and one-half of those age 12 through 15. Low-income children are hardest hit: about half of those age six to 19 years have untreated decay. Untreated cavities may cause pain, dysfunction, absence from school, underweight, and poor appearance - problems that can greatly reduce a child’s capacity to succeed in life.1Georgia Survey ResearchThe Georgia Department of Human Resources, Division of Public Health, Oral Health Section seeks to prevent dental disease among Georgians.2  A 2005 survey measuring the oral health status of Georgia’s third graders found:•  One in two (56%) have caries experience.•  One in four (27%) have untreated dental decay.•  Four in 10 (40%) have dental sealants.•  One in four (26%) need either early (22%) or urgent     (4%) dental care.•  Children from high socioeconomic status (SES)     households are more likely to have good oral health     than children from low SES households.•  Children from Metropolitan Atlanta are more likely to     have good oral health than children from other     regions, except for dental sealants.•  Children with access to dental insurance are more     likely to have good oral health than children without     access to dental insurance.•  Children who visited a dentist in the last year are more     likely to have good oral health than children who had     not visited the dentist in the last year.•  One in eight (13%) could not get dental care when     needed.•  The percent of third grade children in Georgia with     caries experience, untreated dental decay, and dental     sealants does not meet Healthy People 2010                  objectives.  •  Poor oral health is a signifi cant public health problem     among children in Georgia.3 Goal 21-10 of Healthy People 2010 is: “Increase the propor-tion of children and adults who use the oral health care sys-tem each year.4”   The Georgia Health Policy Center (Center) has worked in partnership with the Oral Health Section for the past fi ve years in analyzing Medicaid and PeachCare claims data to measure access of Medicaid and PeachCare children to dental health services across Georgia. Results from those analyses follow.Georgia Claims AnalysisA 2006 retrospective analysis of claims from calendar years (CY) 2000 to 2005 reveals that access to dental health services by Medicaid and PeachCare children shows positive mprovement.• Medicaid (M) and PeachCare (PC) enrolled children who received any dental service increased from 24 percent in CY2000 to 40.7 percent in CY2005.• The proportion of Medicaid and PeachCare enrolled chil-dren who received a preventive service rose from 19.4 (M) and 34.5 (PC) percent in CY2000 to 33.4 (M) and 50.5 (PC) percent in CY2005.Glenn M. Landers, M.B.A., M.H.A, Linda Koskela, R.D.H., M.P.H., and Thomas E. Duval, D.D.S., M.P.H. contibuted to this brief.Over the past fi ve years, the Georgia Health Policy Center has been in partnership with the Division of Public Health, Oral Health Section to provide useful information to state and local oral health providers and advocates for program planning and decision-making. In this endeavor, the Center welcomes the support and interest of public of-fi cials and philanthropic benefactors, and invites inquiries from policymakers, communities, and organizations working to promote better health.Nationally, there are 0.6 licensed dentists per 1,000 in urban areas and 0.4 licensed dentists per 1,000 in rural areas.6  In Georgia, the total ratio of licensed dentists statewide per 1,000 is 0.46, and only in the Augusta, Cobb, DeKalb, and Fulton Public Health Districts does it meet or exceed 0.6 licensed dentists per 1,000.  Eleven of Georgia’s 18 Public Health Districts do not meet the national rural average of 0.4 licensed dentists per 1,000.ConclusionPoor oral health is a signifi cant public health problem among children in Georgia.  Children with access to den-tal insurance and children from higher income families are more likely to have good oral health than children without access to dental insurance or from lower income families.  Georgia’s Medicaid and PeachCare programs have played a role in improving access to dental care among lower income children.  Between 2000 and 2005, the percent of Medicaid and PeachCare enrolled children receiving preventive or restorative dental services increased, as did the number of licensed dentists “participating” and “active” in Medicaid and PeachCare.Despite these advances, dental access challenges still remain. The percentages of third grade children with caries experience, untreated dental decay, and dental sealants remain below Healthy People 2010 objectives.  Dentists per 1,000 Georgians are below the national average, and some Georgia counties still do not have a dentist that accepts Medicaid or PeachCare. Georgia’s Medicaid and PeachCare programs play an important role in maintaining and improv-ing dental access for Georgia’s children.   1 Carmona, R. “Oral Health Problems: Painful, Costly, and Preventable”; http://www.cdc.gov/nccdphp/publications/aag/oh.htm. Retrieved from the World Wide Web January 23, 2007. 2 Oral Health Section services include: dental health prevention services to eligible children in school-based prevention programs, public health nutritionist training in promoting the prevention of early childhood caries, public health and school nurse training on providing oral screenings for dental disease, and promoting the  use of fl uoridated water through monitoring and surveillance of community water systems.    3 Falb M, Kanny D, Duval T, Koskela L. “Oral Health of Georgia’s Children: Results from the 2005 Georgia Third Grade Oral Health Survey”. Georgia De-partment of Human Resources, Division of Public Health, April 2006.  Publica-tion Number: DPH06.028HW. http://health.state.ga.us/pdfs/familyhealth/oral/2005GeorgiaThirdGradeSurveyApril2006.pdf  4 CDC, HIS, NIH. “Healthy People 2010”; http://www.healthypeople.gov/Document/HTML/Volume2/21Oral.htm. Retrieved from the World Wide Web January 23, 2007.  5 Participating means the dentist saw at least one child in a calendar year, while active means the dentist saw at least one child per week.  6 Gamm, L. et al eds. (2003). “Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 1”. College Station, Texas: The Texas A&M University Health Sciences Center, School of Rural Public Health, Southwest Rural Health Re-search Center.Georgia Health Policy Center  •  (404) 651-3104  •  www.gsu.edu/ghpc ANDREW YOUNG SCHOOL O F  P O L I C Y  S T U D I E SFigure 1Percent of Medicaid and PeachCare Enrolled Children under Age 19 Who Received Preventive Services CY2000, CY2001, CY2002, CY2003, CY2004, CY2005 by Statewide Totals.In spite of these positive signs of progress, the data also reveal challenges.The proportion of Medicaid and PeachCare enrolled chil-dren who received a restorative service peaked in CY2002 to 10.8 (M) and 18.4 (PC) percent and fell to 8.9 (M) and 11.2 (PC) percent in CY2005 – a decline of 21 percent for Medicaid children and 64 percent for PeachCare children.Figure 2Percent of Medicaid and PeachCare Enrolled Children under Age 19 Who Received Restorative Services CY2000, CY2001, CY2002, CY2003, CY2004, CY2005 by Statewide TotalsThe decline in restorative visits cannot be attributed to any known policy change. Because the need for restorative ser-vices is often identifi ed during preventive visits, one might expect restorative services to increase along with preven-tive visits as caries are identifi ed. The number of Georgia dentists “participating” and “ac-tive”  statewide in the Medicaid and PeachCare programs increased 53 and 76 percent, respectively, from CY2000 to CY2005.   Although this analysis demonstrates an overall increase statewide, several counties still do not have dental providers that accept Medicaid or PeachCare reimburse-ments or that see at least one M/PC client each week5.  There is still a need for providers who will serve this popula-tion.00.020.040.060.080.10.120.140.160.180.22000 2001 2002 2003 2004 2005Medicaid P eachCare00.10.20.30.40.50.62000 2001 2002 2003 2004 2005Medicaid P eachCare

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Children’s Oral Health in Georgia: Progress and Opportunities

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