MONTGOMERY, Ala. — Oral health among Alabama children has declined in recent years in a number of metrics according to a new report published by the Alabama Department of Public Health.
It’s a decline that the state dental director argued was caused by a lack of fluoridated public water systems and access to dental care.
“We have such a hard time retaining dentists in the state,” said Tommy Johnson, Alabama state dental director, during a recent ADPH meeting.
“It’s my hope that what this (report) is going to do is stir interest and get people to realize exactly what it is that we need to do to improve oral health, because that’s directly related to overall health in our state.”
Johnson and other public health experts began research for the report in early 2020 by performing oral health screenings at 52 public schools over a two-year period.
What they found was that 15.1% of children between the ages of 1 and 17 had experienced, or were experiencing oral health problems, up moderately when compared to the national rate of 14.5%. Of those screened, 4.5% indicated they experienced tooth aches, and 12.7% had decayed teeth or cavities, compared to the national rates of 4.4% and 12.2%, respectively.
The amount of younger children experiencing tooth decay that went untreated also rose, from 20% among kindergarteners in 2013 to 22% in 2022, and among 3rd graders, from 21% to 23% during the same time period. For comparison, the national rate of five year old children with untreated tooth decay was 15% between 2011 and 2016.
Johnson said that he and others were quick to note a correlation between areas with higher amounts of children experiencing oral health problems and the lack of fluoridated water.
“If you compare where the highest (tooth) decay that we found in some of those different areas, (and) how it relates to areas of fluoridation in the state, there’s no question there’s a correlation that’s there,” he said.
The practice of water fluoridation in the United States dates back to the 1940s, and is used as a measure to reduce tooth decay. Of Alabama’s 67 counties, only seven have 100% of their public water systems treated with fluoride, though 26 have at least 75% of their drinking water supplies fluoridated.
Four counties – Choctaw, Washington, Bullock and Geneva counties – do not have any water fluoridation, 13 have less than 25% fluoridation, and 27 have less than 50% fluoridation.
The Oral Health Office, which is under ADPH, currently offers a max grant of $25,000 for municipalities to fluoridate their public water systems.
The problem, Johnson said, is that not a single municipality has taken advantage of the grant during his tenure, and that the only change he’s seen regarding fluoridation were municipalities doing away with it.
“In my almost seven years of being here, we have not had one system contact us to initiate fluoridation,” he said. “We have, however, had several that have done away with it, and that’s a huge issue.”
Another correlation the report found was a shrinking access to dental care.
As of 2022, seven Alabama counties – Fayette, Greene, Clay, Coosa, Perry, Lowndes and Wilcox counties – had either no dentists or just one.
Aging dentists were another factor noted in the report, which, for counties with very few dentists, demonstrated a significant risk for loss of dental care. More than half of Alabama counties had either just one or no dentists under 40 years old, and 25 counties had no dentists under 40.
“When people realize the dental desserts that are out there, that’s one of the biggest takeaways you’re going to get from that (report),” Johnson told Alabama Daily News recently.
“We don’t have access to care; we have so many barriers that are there; we don’t have enough dentists, it’s hard for us to retain dentists in this state; we have counties that don’t have dentists, we have counties that may have one dentist that’s over 60 years old.”
Alabama has continually lagged behind other states in its number of dentists, with the disparity continuing to grow.
In 2007, there were 41.24 dentists in Alabama for every 100,000 residents compared to the national rate of 58.47. In 2020, there were 41.27 dentists in Alabama for every 100,000 residents, whereas the national rate grew to 61.04 per 100,000.
While the report did detail specific policy solutions for Alabama’s oral health issues, Johnson told ADN that modifying the scope of dentistry as is defined under the Dental Practice Act could improve things significantly.
“There are things that (lawmakers) can do, a lot of that’s going to have to do with changes when it comes to who is allowed to do what in what areas,” he said.
“We have a huge, robust telehealth program here in this state; well, expand that to dentistry, but there’s (also) going to have to be some changes when it comes to that Dental Practice Act.”
Current law as it relates to dentistry in Alabama, Johnson suggested, was a major factor in limiting the access to dental care in rural areas of the state, areas that typically see worse oral health among its residents.
“The Dental Practice states that in our state, a dentist has to be physically present for anything from a dental standpoint to take place, anything. Every state is different, in some states it’s much more lenient.”