Close to Home: Curing a ‘silent epidemic’ of dental disease

With our political parties at loggerheads over the future of health care, we still have plenty of room to maneuver at the local level to expand access and meaningfully respond to our most pressing health needs. One that cries out for more attention is dental disease, a silent epidemic within our capacity to meet and beat.

The seriousness of the problem was confirmed in 2009, when a survey of 1,500 kindergartners and third-graders revealed a disturbing picture. We learned that nearly 50 percent of 5-year-olds started school with cavities - and 16 percent had untreated cavities. Many students exhibited serious conditions - abscesses, inflammation and pain. The problem was especially pronounced among Latino youth and at schools serving low-income students. The findings were affirmed with a follow-up survey in 2014 and remain consistent when dental assessments are performed in kindergarten classrooms.

While many health providers are investing to improve dental health, childhood tooth decay and dental disease remain the leading edge of approximately 450,000 new cavities annually among all age groups in Sonoma County - with associated treatment costs of $127 million a year. Poor dental health is directly linked to chronic medical conditions, including cancer, diabetes, heart disease and stroke.

That's the bad news. The good news is tooth decay and dental disease are preventable. The roadmap is in a new strategic plan adopted last fall by the Sonoma County Dental Health Network. With an objective of 75 percent cavity-free 5-year-olds by 2020, the Dental Health Network, a coalition of care providers and policy experts, has endorsed five evidence-based strategies: more community education; greater access to care; wider use of fluoride varnish; introduction of dental sealant programs; and community water fluoridation.

For the most part, we are executing on the first four strategies. But if we are serious about dental health and closing the dental health-equity gap, we need to get serious about extending water fluoridation beyond the city of Healdsburg to the rest of Sonoma County. Cost shouldn't be a deterrent to protecting the teeth of the 600,000 people in Sonoma and Marin counties served by the Sonoma County Water Agency. A preliminary engineering report prepared in 2014 estimated startup capital needs of $4.5 million, plus $581,000 in annual operating expenses. Science and economics tell us the payoff would be well worth it. Every $1 invested in this preventive measure yields approximately $38 savings in treatment costs.

Public opinion is on the side of action, too. An extensive survey commissioned in early 2016 by the county Health Services Department found strong public support for stepped-up action. According to the survey, residents believe access to dental care is unequal in the county. Importantly, 85 percent said they agree - with 59 percent saying they agree strongly - that local government should do more to expand access to dental care. The surest and most cost-effective way to do this is community water fluoridation.

Now is the time to act on that support. On May 9, the Board of Supervisors, which also serves as the governing board of the county Water Agency, voted to accept and authorize expenditures under a new $3.5 million state grant to the county Health Services dental health program. Initial outlays will be used to embed new dental health workers at community health clinics serving Medi-Cal eligible residents.

That's a smart, worthy initiative. Let's make it just the start of a comprehensive, sustained, countywide response, one that includes community water fluoridation. Sources of funding can be found if we have the political will. One could be Proposition 56, the voter-approved tobacco tax projected to raise $30 million a year for state dental health programs. Dental disease is a serious public health issue in Sonoma County. Strategies to tackle it have been identified and vetted. Now is the time for Sonoma County to work on all fronts to close the gap and achieve dental health equity.

Rita Scardaci is a former director of the Sonoma County Department of Health Services. She led the department from 2010 to 2015.