The saying, “an ounce of prevention is worth a pound of cure” is so true when we talk about oral diseases, such as dental caries (tooth decay) and periodontal (gum) disease.
Most oral diseases can be prevented. The Oral Health Program (OHP) supports community-based oral disease prevention programs—programs that prevent oral diseases in large groups of people.
About Dental Sealants
Dental sealants prevent the most common type of tooth decay seen in school-aged children today. A dental sealant is a thin, plastic coating that is painted on the chewing surface of a back tooth to prevent tooth decay. As seen in the picture below, the chewing surfaces of back teeth have pits and narrow grooves that can't be cleaned well with a toothbrush, making them prone to cavities. Once a sealant is applied, it blocks food and decay-causing germs from going into these areas.
Recent studies show that about 50 percent of third grade schoolchildren in Ohio have one or more sealants on their permanent (adult) teeth. The Ohio Department of Health (ODH) promotes the use of sealants through grant funds that support school-based dental sealant programs and by sharing the most current guidelines on the use of sealants.
Ohio's School-based Sealant Programs (SBSPs) During the COVID-19 Pandemic
The OHP remains committed to supporting its funded SBSPs in providing dental sealants to children from lower income families who are at higher risk for tooth decay or have limited access to dental care. This preventive procedure remains an important strategy that contributes to the overall health of students.
The Oral Health Program (OHP) created an ad hoc workgroup to develop interim guidance for providing the SBSP in schools during the COVID-19 pandemic. The workgroup is comprised of dentists, dental hygienists, and dental assistants who work with SBSPs, school nurses and a parent advocate. Relying on recommendations made by the U.S. Centers for Disease Control and Prevention and other federal agencies and national organizations, the workgroup has focused on how to safely provide this important health service. OHP and SBSP staff are working closely with schools to safely restart SBSPs.
The OHP developed a fact sheet that schools may share with parents with questions and answers on SBSPs and the COVID-19 pandemic. This fact sheet can be modified by individual schools.
More Details about Ohio's SBSPs
Ohio's SBSPs are targeted to schools where 40 percent or more of the students are eligible for the state's Free and Reduced Price Meals Program. Currently, ODH is providing grant funds to 11 SBSPs. A map of these ODH- and locally-funded sealant programs shows that there are many programs in the southern and southeastern areas of Ohio and in Ohio’s major cities. These areas are more likely to have children from low-income families who have trouble getting dental care.
Dental sealants are placed on children’s teeth and parents are told if other dental care is needed. Sometimes school staff help families find a regular dentist. Students are checked the next school year to make sure that the sealants placed the previous year are intact, and to put sealants on teeth that have just erupted.
To learn more about Ohio's program, please view:
- a two-page fact sheet
- SBSP brochure
- frequently asked questions
- selecting a school-based oral health care program
Resources for School-based Sealant Programs
The Ohio Department of Health has created a School-based Sealant Program (SBSP) Reference Guide for Tooth Surface Assessment and Selection.
The School-based Dental Sealant Program Manual provides information and standards for SBSPs funded by the ODH. ODH-funded SBSPs must comply with the requirements in this manual.
Seal America: The Prevention Invention, 3rd Edition is an online manual that provides practical guidance for new programs, and may help existing programs that want to improve their operations.
The Maternal and Child Oral Health Resource Center offers a free continuing education course for dentists and dental hygienists on SBSPs.
The U.S. Centers for Disease Control and Prevention convened an expert workgroup to update guidelines for the use of sealants in SBSPs. These were published in the November 2009 issue of the Journal of the American Dental Association.
Community Water Fluoridation
About Community Water Fluoridation in Ohio
Did you know that the Centers for Disease Control and Prevention (CDC) says that community water fluoridation is “one of the 10 great public health achievements of the 20th century”? More than nine out of 10 people living in Ohio who are served by public water supplies have fluoridated water. This is almost 11 million people.
Fluoride is naturally present in all water. Community water fluoridation is simply adjusting the natural fluoride level in public water systems to a level that is best to prevent tooth decay. Learn more about water fluoridation by reading this fact sheet. You can also visit the Life is Better with Teeth website for more information about fluoridation.
How Do I Find Out How Much Fluoride is in My Water?
If you receive your tap water from a public water system, you can find out the water's fluoride content by calling your local government office. Request the phone number of the water plant and call the water plant to ask about the fluoride content of the water. Or, visit your community's government website and look under the section on "Utilities". Often the phone number of the water plant will be listed.
If you receive your tap water from a well or other private water source, a laboratory will need to test a sample to determine the fluoride content. The test should be done by a lab certified by the Ohio Environmental Protection Agency. You will be charged a fee for every sample tested. Please contact the specific lab for the cost. All labs provide sample bottles and instructions.
The lab will send a report that tells you the fluoride level of the water sample, but won’t interpret the findings. You should talk to your doctor, dentist or the Oral Health Program for an explanation of the results, so that you can decide what preventive measures are advised based on the amount of fluoride in the water sample.
Currently, the optimum recommended level of fluoride in drinking water in Ohio to prevent tooth decay is 1.0 part per million (ppm) or 1.0 mg/L. Fluoride is naturally found in almost all water, and there are many communities in Ohio that naturally have enough fluoride in the water to protect teeth from tooth decay. Many other communities adjust the amount of fluoride in the water to provide this protection.
Overall, more than nine out of 10 people living in Ohio who are served by public water systems have fluoridated water. This is almost 11 million people.
Ohio's Fluoridation Law
In 1969, the Ohio General Assembly was convinced that community water fluoridation could greatly improve the dental health of people in Ohio. The General Assembly passed a law that required public water systems that serve more than 5,000 persons to fluoridate. The law gave communities served by these systems the option to be exempt from the law through a special vote held within 240 days of the law’s passage.
Thirty Ohio cities held a special vote in 1970 and were exempted from the law. Since then, nine of those cities have reversed their decision. Athens, Bellefontaine, Bellevue, Fairborn, Lebanon, Middletown, Delaware and Tipp City are now fluoridated. In November 2016, voters in Wilmington voted to fluoridate their drinking water. However, 21 cities remain exempt from fluoridation.
Communities with water systems that serve fewer than 5,000 persons can choose to start fluoridating. If your community wants to start fluoridating, contact the Ohio Department of Health and the Ohio Environmental Protection Agency (Ohio EPA) to learn how to start providing this valuable public health measure to your residents. The Ohio EPA regulates the fluoridation of public water systems.
Fluoridation Assistance Program
Making fluoridated water available to Ohioans is the single most important step a community can take to improve the dental health of its residents. This effective, economical, legal and safe public health measure can be implemented at minimal cost through the Ohio Department of Health’s (ODH) Fluoridation Assistance Program (FAP). This program is funded through the generous support of the Delta Dental Foundation.
The purpose of the FAP is to provide financial and technical assistance to communities, enabling them to fluoridate their water systems to the optimum level necessary to prevent dental disease. The FAP assists public water supply systems by reimbursing a portion of the cost to purchase new or replacement fluoridation equipment and/or supplies.
Assistance will be provided to water plants in the following order, subject to availability of funds:
- Newly fluoridating systems
- Replacement equipment for small systems (1,000-15,000 consumers)
- Replacement equipment for medium-sized systems (15,000-50,000 consumers)
- Replacement equipment for large systems (over 50,000 consumers)
The Fluoridation Assistance Program will not provide reimbursement for capital costs; taxes; freight, shipping and handling; or redundant systems (i.e., back-up equipment).
To apply, submit a letter requesting financial assistance accompanied by detailed quotes/ estimates from suppliers. After review, applicants will receive a letter from the ODH indicating the level and dollar amount of available assistance. Following equipment purchase and installation, invoices must be submitted to initiate payment. Interested communities should review the complete packet containing program guidelines and application materials. If you have any further questions, please contact Barbara Carnahan, Oral Health Program, at 614/728-2838 or via email at Barbara.Carnahan@odh.ohio.gov.
Supporting Water Fluoridation
The U.S. Centers for Disease Control and Prevention (CDC) has identified community water fluoridation as one of the 10 great public health achievements of the 20th century. More than 70 years of research and community experience have shown that fluoridation works.
The American Dental Association has compiled a list of statements from some of the leading health organizations in the U.S. about the benefits of community water fluoridation. You can also visit the Life is Better with Teeth website to learn more about the safety and benefits of water fluoridation.
The Oral Health Program provides technical assistance to communities considering water fluoridation and offers limited funds for the start-up and maintenance of community water fluoridation. Communities of any size can request funds for equipment used in the fluoridation feed system, fluoride compounds (limited) and fluoride testing equipment used in the water treatment laboratory. Program guidelines and application materials can be found by visiting the Fluoridation Assistance Program section of this Web page.
Applying fluoride varnish to the teeth is one of the easiest ways to prevent tooth decay and keep small cavities from getting bigger. Fluoride varnish is painted on the teeth and hardens as soon as saliva touches it. Babies and young children can get fluoride varnish at the dental or doctor's office during routine check-ups. It can be applied as soon as the first teeth erupt. Learn more about fluoride varnish by viewing this fact sheet.
Physicians and other primary care providers are encouraged to learn about fluoride varnish by viewing Smiles for Life, a Web-based, self-study oral health curriculum developed by the Society of Teachers of Family Medicine. It includes a module on the use of fluoride varnish, including application techniques. Continuing education credits are available. A physician may delegate the application of fluoride varnish to staff within their scope of practice (e.g., nurses, physician assistants and medical assistants).
Reimbursement to Medical Providers for the Application of Fluoride Varnish for Children Enrolled in Medicaid
In Ohio, the Medicaid program will reimburse for the application of fluoride varnish for children up to six years of age. This service is reimbursable by Medicaid ($15.00) when provided in addition to a well or sick child visit, but cannot be the sole reason for the visit. In order to be reimbursed, primary care providers must submit current dental terminology (CDT) code D1206 on a physician claim form.
Coverage for fluoride varnish application is limited to one application every one hundred and eighty days. The reimbursement code includes three components, each of which must be performed: 1) oral assessment; 2) varnish application; and 3) referral to a dentist, as necessary. Medical providers with questions on Medicaid billing can contact the Ohio Department of Medicaid Provider Call Center at 1-800-686-1516, or visit the Provider Assistance Web page.
Dietary Fluoride Supplements
Dietary fluoride supplements help prevent tooth decay. Doctors and dentists prescribe them for infants and children who do not drink water with enough fluoride in it. The supplements come in two forms: drops for infants more than six months of age and chewable tablets for children and teens.
This chart shows the dosage for supplements. The dose depends on the age of the child and how much fluoride is naturally in their drinking water:
Dietary Fluoride Supplement Schedule
Fluoride ion level in drinking water (ppm)*
Birth - 6 months
6 months -3 years
3 - 6 years
6 - 16 years
* 1.0 part per million (ppm) = 1 milligram/liter (mg/L)
** 2.2 mg sodium fluoride contains 1 mg fluoride ion.
Dietary Fluoride Supplement Schedule, 1994, approved by the American Dental Association, the American Academy of Pediatrics and the American Academy of Pediatric Dentistry
Important Information for Doctors and Dentists
Consider the following factors to determine the proper dosage of fluoride supplements:
- Take a thorough fluoride history. Determine how much fluoride the child gets from drinking water at home, daycare and school; from other beverages and foods; and from topical fluorides such as toothpaste with fluoride.
- If the fluoride level of the child’s drinking water is unknown, you must test the water for its fluoride content before supplements are prescribed. For more information, please see How Do I Find Out How Much Fluoride is in My Water? in the Community Water Fluoridation section of this Web page.
- The benefits of fluoride supplements are derived from long-term compliance on a daily basis. For this reason, not every child is a good candidate for supplements.
- Getting fluoride from many sources can make proper prescribing complex. Ingestion of higher than recommended amounts of fluoride by young children may lead to dental fluorosis in developing, unerupted teeth. Most commonly, dental fluorosis appears as faint white, opaque spots or areas on the teeth. These spots are usually not noticeable except to a dental professional examining the teeth.
Preventing Periodontal Diseases
Periodontal diseases (diseases of the gums and bone around the teeth) are very common. The Centers for Disease Control and Prevention estimates that about half of all adults show signs of gum disease, and nine percent have severe gum disease that can lead to tooth loss.
Periodontal disease is an infection that starts from a buildup of plaque. Plaque is a sticky film of bacteria. Plaques irritates the gums, causing them to get red, tender and bleed while brushing. This condition is caused gingivitis.
If not removed daily, plaque can harden into calculus (tarter). Once it's formed, calculus cannot be removed by brushing or flossing, but only by a dental hygienist or dentist.
If left untreated, gingivitis can progress to periodontitis. Periodontitis is an infection of the gum tissues and bone that keep the teeth in place. As the disease gets worse, so much of the gum tissues and bone are destroyed that the teeth become loose.
Several factors can cause a person to be more likely to develop periodontal diseases. These include:
- not brushing and flossing every day.
- using tobacco products, which make the gums less able to heal themselves.
- illnesses such as diabetes. People with diabetes are more likely to develop periodontal diseases, especially if their blood sugar levels are not well-controlled. Periodontal diseases can also make it harder for a person with diabetes to keep their blood sugar at a healthy level.
- hormonal changes, such as during pregnancy or puberty, can cause the gums to swell, making it harder to remove plaque.
- some medications.
Much research is currently underway to study the links between periodontal diseases and other conditions such as cardiovascular (heart) disease, stroke, and pneumonia.
The most important way to prevent periodontal diseases is to carefully remove plaque from the teeth everyday through toothbrushing and flossing. Toothbrushing can remove plaque on the front, back and top of each tooth, but not from between teeth. Only flossing can do that. So if you don't floss, the sides of the teeth will not get cleaned. Some mouth rinses are also helpful in reducing the number of bacteria in the mouth that cause periodontal diseases.
A good rule to follow is to brush the teeth for 2 minutes, 2 times a day.
Preventing Oral Cancer
Oral cancer is cancer that occurs in the mouth or throat. It is most common among people who are 55 years old and older, especially if they use tobacco products (including cigarettes, cigars, pipes and smokeless tobacco) or are heavy drinkers. Using a combination of tobacco and alcohol increases the risk even more.
Recent data show that 1,700 Ohioans are diagnosed with oral cancer each year. While less common than many other cancers, oral cancer is particularly serious because most is found only after the cancer has spread. A person may not feel any pain with oral cancer, and most people don't check their mouth regularly, allowing the cancer to spread to other areas of the body before it is found.
Oral cancer can occur on the:
- cheek inside the mouth
- floor of the mouth (under the tongue) and
- hard and soft palate.
Oral Cancer and HPV
Oral cancer can also occur on the oropharynx (the part of the throat behind the mouth and nasal cavity). This cancer is most likely caused by the human papillomavirus (HPV). HPV is so common that almost all people who are sexually active will acquire HPV at some point in their lives. There are about 200 strains of HPV and most do not cause any problems. People infected with these “low-risk” strains of HPV do not notice any symptoms and the infection will go away on its own without treatment.
However, there is a small number of strains that are considered “high-risk” because they are known to cause cancer in different areas of the body, including the oropharynx. HPV16 is the only strain known to be strongly linked cervical, penile, anal and oropharyngeal cancer. Oropharyngeal cancer can take many years to develop after a person has been infected with HPV.
There is no approved test for oral HPV and no visible signs of oral HPV infection. But because HPV infection is so common and it's difficult to predict who will acquire a “high-risk” strain, the Centers for Disease Control and Prevention recommends vaccination, particularly for children before sexual activity begins.
You can prevent oral cancer by:
- not using tobacco products.
- using alcohol in moderation.
- getting the HPV vaccine.
- seeing you dental hygienist or dentist regularly for an oral cancer screening.
- shielding your lips from the sun.