PHE 425 Module 3 Milestone One Example

A Quarter of Third Graders: Untreated Tooth Decay and the Children a Sealant Program Should Reach First

[Student Name]

Southern New Hampshire University

PHE 425: Programming Planning in Public Health

Final Project Milestone One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

A Quarter of Third Graders: Untreated Tooth Decay and the Children a Sealant Program Should Reach First

No chronic condition is more common among American children than tooth decay, and in rural counties with few dentists it often goes untreated. This milestone defines untreated decay among grade-school children in a composite plateau county in Tennessee, home to roughly 24,000 residents, as the health issue for a public health program, describes its size and consequences, identifies the population the program should reach first and states the program's goal.

The Health Issue

Decay starts when bacteria feeding on sugars produce acid that dissolves tooth enamel. Left untreated, a cavity grows until it reaches the nerve, causing pain, infection and sometimes the loss of the tooth. In children, the chewing surfaces of the permanent molars, which erupt around ages 6 and 12, are especially vulnerable because food and bacteria lodge in their deep grooves. Decay is almost entirely preventable through fluoride, sealants, diet and regular care, which makes its persistence a sign of gaps in access rather than in knowledge.

Significance Nationally

Crall and Vujicic (2020) described real progress in children's oral health over two decades, with more children in Medicaid seeing a dentist, but also stubborn differences in untreated decay by family income. CDC's analysis of national survey data found that only 38.7% of low-income children aged 6 to 11 had a sealant, about nine points fewer than children from higher-income families, and judged that millions of children in low-income homes stand to gain from sealants delivered at school (Griffin et al., 2016).

Significance Locally

County data point to a larger problem than the national picture. Table 1 brings the local figures together.

Table 1. County indicators of children's oral health

Note. County figures are composite but realistic for the region.

The sealant rate is about ten points below the national figure for low-income children, and nearly one in four third graders already has a cavity that needs treatment. Emergency visits for dental pain are especially telling, because an emergency department can treat pain and infection but rarely the tooth itself.

Consequences

Untreated decay hurts children in ways that reach beyond the mouth. School nurses report children sent home with toothaches, and teachers describe students who cannot concentrate or who will not smile. Parents lose wages driving to distant appointments. Emergency visits are costly and seldom end the problem. Over time, a child whose first molars decay may need fillings, crowns or extractions that a sealant costing far less could have prevented.

Differences Within the County

The county average hides differences between schools. The two schools farthest from the county seat, each more than twenty miles from the one Medicaid dentist, had untreated decay in about a third of screened third graders, while the school in town had about one in six. The outlying schools also had the lowest return of forms in last year's pilot. Any program that serves schools in the order easiest to reach would leave the children at greatest risk for last, so the outlying schools should be visited first.

Current Services and Gaps

Some help already exists. The health department offers fluoride varnish at its clinic, the school nurse keeps a list of dentists and the one Medicaid dentist sees children two days a week. A mobile dental van from a regional nonprofit visits twice a year but serves mainly adults. None of these brings sealants to children where they spend their days, and none follows up on the decay found at school screenings. The gap is not a lack of willing people but a lack of a system that connects screening, prevention and treatment.

Stakeholders

The people with a stake in the problem include parents, teachers and principals, the school nurse, the health department's hygienist, the county's Medicaid dentist, the hospital, which bears the cost of emergency visits, and the county commission, which has shown interest in children's teeth. Their views will be gathered in the needs assessment.

Priority Population

The program will focus on second and sixth graders in the county's six elementary schools, about 300 children in each grade. These grades are chosen because first permanent molars come in around age six and second molars around age twelve, and sealants protect best when placed soon after eruption. Gooch et al. (2009) noted that school programs focus on newly erupted permanent molars in schools serving low-income children, which describes all six of the county's schools. Children in these grades are also old enough to sit for a short procedure. Families in the county are mostly white and rural, many work in manufacturing, logging or health care, and about three in four children qualify for free or reduced-price meals. Many parents are wary of paperwork that asks for insurance details, a concern that shapes how the program will ask for consent.

Why Sealants Fit the Problem

Pooling dozens of randomized trials, Ahovuo-Saloranta et al. (2017) concluded that children whose molars received resin sealants developed fewer cavities on those biting surfaces than children left unsealed. Because most of the county's children lack a regular dentist, bringing sealants to school removes the barrier of distance and missed work. Other measures, such as fluoride varnish and referral for treatment, can be added to the same visits.

Program Goal

In one sentence, the program sets out to cut untreated tooth decay among the county's elementary children by bringing preventive dental care into every elementary school. Measurable objectives will follow from the needs assessment in the next milestone.

Conclusion

Untreated decay among the county's children is common, painful and largely preventable. Second and sixth graders are the right first audience, and the schools are the right setting. The next milestone will test these choices against what parents, teachers, the school nurse and the county's one Medicaid dentist say about the barriers.

Should those voices point to a different barrier, the sealant idea gives way.

References

Ahovuo-Saloranta, A., Forss, H., Walsh, T., Nordblad, A., Mäkelä, M., & Worthington, H. V. (2017). Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database of Systematic Reviews, 2017(7), Article CD001830. https://doi.org/10.1002/14651858.CD001830.pub5

Crall, J. J., & Vujicic, M. (2020). Children's oral health: Progress, policy development, and priorities for continued improvement. Health Affairs, 39(10), 1762-1769. https://doi.org/10.1377/hlthaff.2020.00799

Gooch, B. F., Griffin, S. O., Gray, S. K., Kohn, W. G., Rozier, R. G., Siegal, M., Fontana, M., Brunson, D., Carter, N., Curtis, D. K., Donly, K. J., Haering, H., Hill, L. F., Hinson, H. P., Kumar, J., Lampiris, L., Mallatt, M., Meyer, D. M., Miller, W. R., . . . Zero, D. T. (2009). Preventing dental caries through school-based sealant programs: Updated recommendations and reviews of evidence. Journal of the American Dental Association, 140(11), 1356-1365. https://doi.org/10.14219/jada.archive.2009.0070

Griffin, S. O., Wei, L., Gooch, B. F., Weno, K., & Espinoza, L. (2016). Vital signs: Dental sealant use and untreated tooth decay among U.S. school-aged children. MMWR Morbidity and Mortality Weekly Report, 65(41), 1141-1145. https://doi.org/10.15585/mmwr.mm6541e1