Changes in state policies related to oral health in the United States, 2002-2009

Abstract

Examining state policies in oral health, including changes over time, helps inform the degree to which states fulfill public health dentistry functions and deliver essential services. This study examines changes in state policies affecting oral health in the United States between 2002 and 2009. We reviewed 43 oral health policies in three domains (public dental insurance; workforce capacity; and infrastructure, programs, and surveillance). Data sources included federal, state, and private foundation reports and databases. Fifteen of 43 policies had data available for both time points and were analyzed. We examined national and regional changes over time using McNemar's test and Wilcoxon matched pairs signed ranks test. Between 2002 and 2009, the number of states offering Medicaid reimbursement to nondental professionals increased, more states had 12-month continuous coverage in CHIP, income eligibility for children on Medicaid expanded, and the number of licensed dentists per 10,000 population per state increased. However, the percent of public and private state health expenditures going toward dental services declined. Though nationally no other state policies significantly changed, the proportion of population on public water system with fluoridated water increased in Western states, and administration of needs assessments or oral health surveys decreased in the Northeast. Efforts are needed to systematically track the status of state policies to promote the public's oral health. Further research can determine if changes in state policies have led to improvements in the provision of oral health services and oral health status and reductions in disparities.