Sep 16, 2015

Oral Health in the First Years

Michelle Fay, MPA is Associate Director of Voices for Vermont’s Children, the state's independent advocacy voice for children and youth. She is a lifelong advocate for women and families, and a former State Representative. She lives in St. Johnsbury with her family.

Oral Health and Early Development

Oral health care in the early years is an important part of healthy development for our youngest children. National standards set by dental and pediatric organizations call for children to visit a dentist every six months and establish a dental home (the dental office where they will get ongoing care) by age one. Yet, nearly 40% of Vermont children and teens with Dr. Dynasaur coverage did not get dental care in 2012.1

While Vermont has made great strides in extending health insurance to low and middle-income Vermonters, eligibility does not always translate into access—especially when it comes to dental care. Affordable dental care for children is out of reach for many Vermont families, as relatively few dentists accept new Medicaid patients, and the majority of general dentists don’t treat young children at all. A parent from Shaftsbury shared this typical story about trying to find routine dental care for her young son:

“We called every [dentist] within an hour and a half of us and were turned away because the office no longer served Medicaid patients under the age of 5 or sometimes 8. We finally found a [pediatric dentist] in Burlington. I wish we didn't have to travel 3 hours twice a year to see him, but it's our best chance of receiving the treatment that is appropriate, not just the most convenient or ‘stop gap’ measure that people often have to resort to due to lack of access to private insurance or cash on hand.”

Poor oral health can have cascading effects for children, impacting their nutrition, overall health and school performance. Besides causing excruciating pain, infected teeth are a source of bacteria that can flood the body and cause other illnesses, including ear and sinus infections. The pain from untreated dental disease can be an obstacle to good nutrition by making chewing and swallowing difficult, and can interfere with sleep.2 These negative impacts add up to poor concentration in class and school absences, with one study finding that children in poor oral health experienced poor school performance at a rate 40% higher than their peers without oral health problems.3 

To address the lack of access to dental care, legislation has been passed in more than 50 countries around the world and in the states of Minnesota and Alaska to establish a midlevel provider known in some areas—such as Minnesota—as a dental therapist. Dental therapists are licensed dental hygienists with advanced practice training in preventive and routine restorative procedures, allowing dentists to focus on the more complex procedures that only they are educated to do.

By playing a role similar to nurse practitioners in medical practices, dental therapists can expand the reach of their supervising dentist. To maximize their effect on access, dental therapists can work in rural health centers, schools, WIC clinics and other settings where they are most likely to reach those who struggle to get care. This expanded workforce model can make it financially feasible—and in some cases profitable—for private-practice dentists to serve more low-income patients. In Minnesota, where dental therapists have been practicing since 2011, early data show that it only costs about $.30 to employ a dental therapist for every $1 in revenue they generate.4

The Vermont Oral Health Care for All Coalition is a group in Vermont made up of organizations including consumer groups, children’s advocates, health providers, organized labor, senior advocates, health clinics and other organizations who work with Vermonters suffering from the lack of access to affordable dental care. Its mission is to build a statewide consumer voice for oral health care and raise public awareness of the need for greater access to affordable dental care. To learn more about the coalition's work, check out the website at or contact Michelle Fay at Voices for Vermont's Children (802-229-6377).

1 Annie E. Casey Foundation Kids Count Data Center. Retrieved from,868,867,133,38/any/17151

2 Vermont Department of Health. 2013-2014 Keep Smiling Vermont

3 Blumenshine, S. L., Vann, W. F., Gizlice, Z. and Lee, J. Y. (2008), Children's School Performance: Impact of General and Oral Health. Journal of Public Health Dentistry, 68: 82–87. doi: 10.1111/j.1752-7325.2007.00062.x

4 Kim, F.M. (2013). Economic Viability of Dental Therapists. Community Catalyst.

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