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The Oral Health Care System:A State-by-State Analysis

The Oral Health Care System: A State-By-State Analysis

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Table of ContentsCOMMENTARY.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3KEY FINDINGS .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5DATA & METHODS .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

STATE FACT SHEETSALABAMA.. . . . . . . . . . . . . . . . . . . . . . . . . . . 14ALASKA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17ARIZONA. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20ARKANSAS. . . . . . . . . . . . . . . . . . . . . . . . . . 23CALIFORNIA.. . . . . . . . . . . . . . . . . . . . . . . . 26COLORADO. . . . . . . . . . . . . . . . . . . . . . . . . 29CONNECTICUT.. . . . . . . . . . . . . . . . . . . . . . 32DELAWARE.. . . . . . . . . . . . . . . . . . . . . . . . . 35DISTRICT OF COLUMBIA.. . . . . . . . . . . 38FLORIDA.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41GEORGIA.. . . . . . . . . . . . . . . . . . . . . . . . . . . 44HAWAII.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47IDAHO.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50ILLINOIS.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 53INDIANA.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 56IOWA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59KANSAS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62KENTUCKY. . . . . . . . . . . . . . . . . . . . . . . . . . 65LOUISIANA.. . . . . . . . . . . . . . . . . . . . . . . . . 68MAINE.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71MARYLAND.. . . . . . . . . . . . . . . . . . . . . . . . . . 74MASSACHUSETTS.. . . . . . . . . . . . . . . . . . 77MICHIGAN.. . . . . . . . . . . . . . . . . . . . . . . . . . 80MINNESOTA.. . . . . . . . . . . . . . . . . . . . . . . . 83MISSISSIPPI. . . . . . . . . . . . . . . . . . . . . . . . . 86MISSOURI. . . . . . . . . . . . . . . . . . . . . . . . . . . 89

MONTANA.. . . . . . . . . . . . . . . . . . . . . . . . . . . 92NEBRASKA. . . . . . . . . . . . . . . . . . . . . . . . . . 95NEVADA.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 98NEW HAMPSHIRE. . . . . . . . . . . . . . . . . . 101NEW JERSEY.. . . . . . . . . . . . . . . . . . . . . . . 104NEW MEXICO.. . . . . . . . . . . . . . . . . . . . . . 107NEW YORK.. . . . . . . . . . . . . . . . . . . . . . . . . 110NORTH CAROLINA.. . . . . . . . . . . . . . . . 113NORTH DAKOTA.. . . . . . . . . . . . . . . . . . . 116OHIO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119OKLAHOMA.. . . . . . . . . . . . . . . . . . . . . . . 122OREGON.. . . . . . . . . . . . . . . . . . . . . . . . . . . 125PENNSYLVANIA.. . . . . . . . . . . . . . . . . . . . 128RHODE ISLAND.. . . . . . . . . . . . . . . . . . . . 131SOUTH CAROLINA. . . . . . . . . . . . . . . . . 134SOUTH DAKOTA.. . . . . . . . . . . . . . . . . . . 137TENNESSEE.. . . . . . . . . . . . . . . . . . . . . . . . 140TEXAS.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143UTAH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146VERMONT.. . . . . . . . . . . . . . . . . . . . . . . . . 149VIRGINIA. . . . . . . . . . . . . . . . . . . . . . . . . . . 152WASHINGTON.. . . . . . . . . . . . . . . . . . . . . 155WEST VIRGINIA.. . . . . . . . . . . . . . . . . . . . 158WISCONSIN.. . . . . . . . . . . . . . . . . . . . . . . . 161WYOMING.. . . . . . . . . . . . . . . . . . . . . . . . . 164


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Commentary “HEADLINES ARE IMPORTANT, BUT TREND LINES ARE MORE IMPORTANT.” This is how President Bill Clinton began his keynote address at the 154th Annual Meeting of the American Dental Association in 2013. It is not every day that you hear a politician, let alone a former president, emphasize the need to temper rhetoric with facts and to let evidence guide policy.

The American Dental Association’s Health Policy Institute (HPI) has compiled a first-of-its-kind comprehensive analysis of key aspects of the oral health care system in all 50 states and the District of Columbia. This multi-year effort brings together data and analysis in a way that helps inform policy decisions. And when it comes to oral health in America, indeed, many trend lines are important.

Three Major TakeawaysOne major takeaway from this new analysis is that adults view oral health as very important. For example, 95 percent of adults say they value keeping their mouth healthy. Furthermore, routine dental care is seen as a key part of overall wellness, with 93 percent of adults agreeing that regular visits to the dentist “help keep me healthy.”

A second major takeaway is that there have been substantial gains in access to dental care among Medicaid children in recent years. Between 2000 and 2013, all but one state saw an increase in the percentage of Medicaid children who had at least one dental visit within the past year. Nationally, the rate increased from 29 percent to 48 percent, and in states such as Maryland, it increased fivefold. As a result, the gap in dental care use between Medicaid children and children with private dental benefits narrowed significantly over this same timeframe in the vast majority of states. In fact, in Texas, Medicaid children are actually more likely to visit a dentist than their privately insured counterparts.

A third major takeaway is that dental care use trends for adults are very different than the trends for children. Among adults with private dental benefits, dental care use is declining in most states. Additionally, other HPI analysis shows that the gap in dental care use between Medicaid and privately insured adults is much wider than it is for children.

Additional troubling statistics emerge when it comes to oral health among adults. More than one out of three low-income adults say they avoid smiling and 17 percent report difficulty doing usual activities because of the condition of their mouth and teeth. Nearly one out of four low-income adults and 14 percent of all adults report that their oral health issues have led them to reduce participation in social activities.

95% OF ADULTS SAY THEY VALUE KEEPING THEIR MOUTH HEALTHY

BETWEEN 2000 AND 2013, THE PERCENTAGE OF MEDICAID CHILDREN WITH A DENTAL VISIT INCREASED FROM 29% TO 48%

THE GAP IN DENTAL CARE USE BETWEEN MEDICAID AND PRIVATELY INSURED ADULTS IS MUCH WIDER THAN IT IS FOR CHILDREN

≠

ORAL HEALTH IS REALLY IMPORTANT

MORE MEDICAID CHILDREN ACCESSING DENTAL CARE

ADULT TRENDS ARE DIFFERENT


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CommentaryThe facts are the facts. But what should policymakers think about doing to address some of these oral health challenges?

First, policymakers need to continue implementing evidence-based reforms in Medicaid. The states with the largest gains in access to dental care among Medicaid children are those that implemented comprehensive, multi-pronged reforms that work. For example, the experiences in Connecticut, Maryland and Texas have been well documented. The Medicaid programs in these states focused on provider and Medicaid beneficiary outreach, provider reimbursement increases, and streamlining administrative procedures. It is important to note that the remarkable gains in access to dental care in these three states, as well as others, did not involve any major increase in the number of dental care providers. In fact, there is strong evidence that there is significant excess capacity in the dental care system today. According to new HPI research, one out of three dentists in the U.S., and as high as one out of two in states like Florida, report they are not busy enough and can treat more patients. This further suggests that policymakers ought to focus on policies that leverage existing unused capacity rather than increasing the number of dental care providers.

Second, policymakers, and the oral health community more broadly, need to consider reinventing how oral health is defined and measured. The current focus of many government agency data collection efforts is to measure the presence and severity of dental disease and the frequency and type of dental care services people use. There is very little emphasis, in contrast, on measuring the contribution of oral health to physical, social and emotional wellbeing. These are the ultimate outcomes of interest that the oral health care system ought to be designed around. The new measures of oral health status developed by HPI are a significant advancement in this area but are meant to be a starting point for others, including the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality, to build upon. A robust oral health measurement system would also enable a shift toward outcomes-based delivery and reimbursement models, a critical aim of the Affordable Care Act.

Third, policymakers need to rethink how dental care for adults is handled in state and federal health care policy. Research shows that adults, particularly low-income adults, report cost as the number one reason for not visiting the dentist. Current policies are not helping. Under the Affordable Care Act, dental care for adults is not considered “essential” and thus, dental coverage is not part of the individual mandate. Within Medicaid, adult dental benefits are optional and most states provide only basic coverage. Implementing a comprehensive dental benefit for Medicaid adults in states that currently lack one is estimated to cost $1.4 billion to $1.6 billion per year. The estimated state portion of this bill translates to about 1 percent of total Medicaid spending. At the same time, an estimated $1.6 billion is spent each year on hospital emergency room visits for dental conditions, one-third of which is paid for by Medicaid. Additionally, while more and more private medical insurance plans in the health insurance marketplaces established by the Affordable Care Act are covering dental benefits for children, there are far fewer options for adults. This is despite the fact that dental care is a high priority among young adults who are shopping for health insurance.

As stated by a former U.S. surgeon general: “You can’t be healthy without good oral health.” There is emerging evidence that oral health is related to conditions outside of the mouth, like diabetes, pregnancy and even mental health. Health care policy in the United States clearly emphasizes oral health for children. It might be time to reconnect mouth and body for adults. Now there’s a headline.


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Key Findings Oral health is an integral component of whole body health. The American Dental Association’s Health Policy Institute (HPI) analyzed key aspects of the oral health care system in all 50 states and the District of Columbia. Topics include dental care utilization, self-reported oral health status, knowledge and attitude toward oral health, community water fluoridation, provider reimbursement rates and the supply of dentists.

The data sources, methodology, state-level fact sheets, as well as all of the underlying data used in the analysis are available for download at ADA.org/statefacts.

Key findings from the analysis are summarized below.

Dental Care UtilizationNationally, the percentage of Medicaid children who visited a dentist within the past year increased from 29 percent in 2000 to 48 percent in 2013. All but one state saw an increase in dental care utilization among Medicaid children. Dental care utilization among children with private dental benefits increased, as well, from 60 percent in 2005 to 64 percent in 2013. In contrast, utilization among adults with private dental benefits decreased slightly over the same timeframe, with the majority of states experiencing a decline.

In 2013, dental care utilization among children with Medicaid dental benefits was highest in Connecticut, while Massachusetts had the highest utilization rate among children with private dental benefits. Among adults with private dental benefits, dental care utilization was highest in Oregon.

Sealants and Community Water FluoridationIn 2013, 14 percent of Medicaid children ages 6 through 14 in the United States received a dental sealant on a permanent molar. This ranges from 6 percent in Ohio to 24 percent in Massachusetts.

In 2012, approximately 75 percent of Americans on a community water system received fluoridated drinking water. This ranges from 11 percent in Hawaii to 100 percent in the District of Columbia and Kentucky.

Oral Health Status, Knowledge and AttitudeHPI developed a new, innovative composite measure of oral health status based on various self-reported measures. On an index of zero (frequent oral health problems) to ten (no oral health problems), the average oral health status rating for U.S. adults was 7.9 in 2015. This ranges from 7.2 in Alaska to 8.6 in Illinois. High-income adults had an average score of 8.2 compared to 7.2 for low-income adults. The widest gap between high- and low-income adults was in Arizona, while the narrowest gap was in California.

HPI also developed a new, simplified measure of oral health knowledge. Nationally, 50 percent of adults were able to respond correctly to each of the eight general knowledge questions regarding oral health facts. This ranges from 42 percent in

http://www.ada.org/statefacts


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Key Findings New Jersey to 60 percent in Colorado and from 44 percent among low-income adults to 52 percent among high-income adults nationwide.

HPI developed a new index measuring attitude toward oral health, and U.S. adults have a positive attitude overall toward oral health. On a scale of -10 to +10, with zero being neutral, the average score was 5.1 nationally. This ranges from 4.3 in Montana to 5.7 in Arizona.

Reimbursement, Supply of Dentists and Medicaid Participation From 2003 to 2013, Medicaid fee-for-service reimbursement rates for child dental services decreased by 14 percent nationally. This ranges from a decrease of 41 percent in Minnesota to an increase of 82 percent in the District of Columbia. Over the same time period, private dental benefit plan charges increased, on average, by 1.2 percent nationally for child dental services. This ranges from a decrease of 13 percent in Hawaii to an increase of 14 percent in North Dakota. For adult dental services, private dental benefit plan charges decreased by 0.6 percent between 2003 and 2013, ranging from a decrease of 14 percent in Nevada to an increase of 12 percent in North Dakota.

The supply of dentists in the United States increased from 57.3 dentists per 100,000 population in 2001 to 60.5 in 2013. Nationally, 42 percent of dentists participate in Medicaid, with significant variation across states.


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Data & MethodsPercentage with a Dental Visit in the Past 12 MonthsTo measure dental care utilization among adults and children with private dental benefits, we analyzed data from the Truven MarketScan® Research Database (Truven). Truven is based on a very large sample of enrollees with employer-sponsored health insurance and dental benefits and included 3.8 million individuals with private dental benefits in 2005 and 10.7 million in 2013. Based on the latest data from the 2012 Medical Expenditure Panel Survey (MEPS),1 we estimate that Truven captures about 7.6 percent of individuals with private dental benefits in the U.S.2

In our utilization analysis, we focused on adults and children with at least 90 days of continuous enrollment in a private dental benefit plan. The 2005 Truven database included 2,497,278 adults ages 21 through 64 and 1,086,098 children ages 0 through 20 who were continuously enrolled in a private dental benefit plan for 90 days. The 2013 Truven database included 7,253,702 adults ages 21 through 64 and 2,923,720 children ages 0 through 20 who were continuously enrolled in a private dental benefit plan for 90 days. We substituted 2011 data for Montana as the sample sizes in 2012 and 2013 were not sufficient.

We measured dental care utilization as the proportion of enrolled individuals who have at least one dental claim in a year.

The ADA Health Policy Institute (HPI) has Truven data from 2005 through 2013 and this is the period we chose to study.

To measure dental care utilization among children with Medicaid dental benefits, we analyzed data from the Centers for Medicare and Medicaid Services (CMS) Form 416 (CMS-416). The CMS-416 is a form that each state Medicaid program submits to CMS on an annual basis, and it includes children under age 21 eligible for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services.3 Beginning in 2010, the dental care utilization rate is based on children ages 1 through 20 who had at least 90 days of continuous Medicaid enrollment during the fiscal year. Prior to 2010, the dental care utilization rate was based on children ages 0 through 20 who were enrolled in Medicaid at any time during the fiscal year.4

We measured dental care utilization as the total number of children receiving any dental service (Line 12a) divided by the total number of children enrolled in Medicaid (Line 1b). It is important to note that because CMS changed its reporting methods beginning in 2010, we are not able to construct a consistent time series of dental care utilization. In other words, some component of the change in dental care utilization between 2000 and 2013 in the CMS-416 data will be due to the changes in how Medicaid enrollment is reported. There is no way to adjust for this in our analysis.

HPI has CMS data from 2000 through 2013 and this is the period we chose to study.

Officials from Ohio’s Medicaid office indicated that 2013 CMS-416 data were not reliable. We substituted 2012 data for the 2013 Ohio utilization rate for children with Medicaid dental benefits. Maine’s Medicaid program did not submit CMS-416 data for 2005, so we do not have a utilization rate for children with Medicaid dental benefits for that year.


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Data & MethodsPercentage of Medicaid Children Who Received a Sealant on a Permanent Molar in 2013CMS began collecting data through the CMS-416 on the total number of children ages 6 through 14 receiving a sealant on a permanent molar in 2010. We define the sealant rate as the ratio of the total number of children ages 6 through 14 receiving a dental sealant (Line 12d) to the total number of children ages 6 through 14 enrolled in Medicaid (Line 1b). A dental sealant is an evidence-based service that prevents the onset of caries on healthy tooth surfaces.5

Data are available from 2010 through 2014. We analyze the data for 2013 because it is the most complete year of data available.

Oral Health Status, Knowledge and Attitude Index Among Adults in 2015The HPI team developed a comprehensive index measure for oral health status, oral health knowledge and attitude toward oral health based on various self-reported items among adults. Data were collected through an online survey conducted by Harris Poll on behalf of HPI from June 23, 2015 through August 7, 2015. Harris Poll collected data from a nationally representative sample of 14,962 adults ages 18 and older across all 50 states and the District of Columbia. We analyzed responses to these survey questions by state and household income using appropriate survey weights.

We reported each index for both high-income and low-income adults. We defined high-income as adults with household incomes above 400 percent of the federal poverty level. We defined low-income as adults with household incomes at or below 138 percent of the federal poverty level.

The HPI oral health status index is reported using a 10-point scale where a score of 10 corresponds to excellent oral health (i.e. no oral health problems) and a score of 0 corresponds to poor oral health (i.e. frequent oral health problems). We report this index measure nationally and by state for both high-income and low-income adults.

The HPI oral health knowledge index is reported as the percentage of respondents who were able to answer each of eight general oral health knowledge questions correctly. We report this percentage nationally and by state for both high-income and low-income adults.

The HPI oral health attitude index is reported on a scale of –10 to +10, with negative values indicating negative attitudes toward oral health, zero indicating a neutral attitude, and positive values indicating positive attitudes toward oral health. We report these scores nationally and by state for both high-income and low-income adults.

For more information on these three measures, please see our detailed methodological description.6


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Data & MethodsPercentage of Population on Community Water Systems Receiving Fluoridated Water in 2012Data on water fluoridation rates are from the Centers for Disease Control and Prevention (CDC).7 Estimates are based on data reported by each state to the CDC Water Fluoridation Reporting System as of December 31, 2012. The CDC utilized population estimates for 2012 from the U.S. Census Bureau.

Change in Private Dental Benefit Plan Charges Between 2003 and 2013We drew on previous research to summarize changes in private dental benefit plan charges for adult and child dental services.8 We constructed separate price indices for 2003 and 2013 for each state and the District of Columbia using private dental benefits charges data from the FAIR Health Dental Benchmark Module.9 The full methodology on the construction of these indices is available in an earlier publication.10 In summary, we constructed a weighted average charge rate for a group of common dental procedures and used the Dental Services Consumer Price Index (CPI)11 to convert 2003 levels to 2013 dollars.

Our data source, FAIR Health, contains fees charged by providers before network discounts are applied. It does not contain data on actual reimbursement to providers. Based on anecdotal information, we feel that providers often submit fees they expect to be paid rather than their true non-discounted fees. However, we have no basis to evaluate this data limitation empirically.

HPI has FAIR Health data from 2003 through 2013 and this is the period we chose to study.

Medicaid Fee-for-Service Reimbursement as a Percentage of Private Dental Benefit Plan Charges for Child Dental Services We drew on previous research to summarize changes in Medicaid dental reimbursement rates for child dental services.10 We constructed separate fee indices for each state and the District of Columbia based on fee-for-service (FFS) Medicaid reimbursement schedules for child dental services. These fee schedules were collected from each state’s Medicaid program webpage. We constructed an index that measures FFS reimbursement rates in Medicaid relative to commercial dental benefits charges. We feel this is a useful measure as it takes into account Medicaid reimbursement relative to “market” conditions. The full methodology on the construction of this index is available in an earlier publication.10 We tracked changes over time in inflation-adjusted Medicaid reimbursement using the Dental Services Consumer Price Index (CPI).11


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Data & MethodsOur analysis of reimbursement has important limitations that are outlined in previous work.10 A main limitation is that our Medicaid reimbursement data are based on FFS rates taken from state Medicaid fee schedules while a significant segment of the Medicaid population in many states may receive dental care through a managed care program. Managed care providers are not necessarily subject to established Medicaid FFS schedules and, as a result, our data may not necessarily capture typical fees paid to dental care providers.

Additionally, we were not able to obtain Medicaid reimbursement data for 2003 for six states: Maine, New Jersey, North Dakota, South Dakota, Vermont and Wyoming. For these states, therefore, we were unable to calculate the change in Medicaid reimbursement rates for child dental services between 2003 and 2013.

HPI has Medicaid reimbursement data from 2003 through 2013 and this is the period we chose to study.

Number of Dentists per 100,000 PopulationTo measure the supply of dentists, we analyzed the ADA Masterfile.12 The ADA Masterfile contains the most up-to-date information on dentists in the United States. The Masterfile is a database of all dentists, practicing and non-practicing, ADA members and non-members, and is updated through a variety of methods including reconciliation with state licensure databases, detailed records, various surveys and censuses of dentists carried out by the ADA. We only included professionally active dentists in our calculation (e.g. retirees are not included) and we used U.S. Census Bureau data for population counts.13, 14

HPI has comparable dentist supply data from 2001 through 2013 and this is the period we chose to study.

Percentage of Dentists Participating in Medicaid for Child Dental Services in 2014To calculate the percentage of dentists participating in Medicaid for child dental services, we analyzed data from Insure Kids Now.15 Insure Kids Now is a website containing information about Medicaid and the Children’s Health Insurance Program (CHIP), including covered dental services for children and a dentist locator tool. The dentist locator tool is supported by a database of dental providers that are enrolled in the Medicaid program. It is overseen by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. One of the objectives of Insure Kids Now is to help families locate a dentist that accepts Medicaid and CHIP insurance. Additionally, Insure Kids Now is meant to connect interested organizations with the Connecting Kids to Coverage National Campaign.16

The Health Resources and Services Administration (HRSA) and CMS jointly provided HPI with Insure Kids Now provider rosters for the months of August, October and


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Data & MethodsNovember 2014. We combined these data, removed duplicate observations and then matched the Insure Kids Now data with the ADA’s roster of dentists who were professionally active as of October 30, 2014 based on the ADA Masterfile. Insure Kids Now providers who could not be matched were excluded. In situations where the Insure Kids Now database included an address only but no dentist information, we count all dentists practicing at that address as participating in the state’s Medicaid program. We recognize this could lead to an over-count of participating providers, depending on the extent of large group practices within a particular state. We cross-referenced practice addresses with a cotemporaneous list of Federally Qualified Health Centers (FQHCs) and included all dentists practicing at FQHCs as Medicaid participants irrespective of whether they are listed in the Insure Kids Now database. We count all dentists listed in Insure Kids Now as participating in Medicaid even if they indicated they were not accepting new patients. We divide the number of dentists who are Medicaid providers by the total number of professionally active dentists in each state, yielding our measure of the percentage of dentists participating in Medicaid in each state.

It is important to note that Insure Kids Now is limited to those dentists that treat children and may not accurately capture dentists that treat Medicaid adults.

HPI collaborated with HRSA and CMS to explore the accuracy and the validity of the Insure Kids Now data. HPI undertook two separate analyses in 2014. First, HPI selected a random sample of 398 dental offices included in the Insure Kids Now database and called each office to ascertain whether the dentist listed did in fact practice at that location and whether he or she did in fact accept Medicaid. Second, a random sample of 287 dental offices not included in the Insure Kids Now database were called to ascertain the same information – whether the dentist listed practiced at the location and whether he or she accepted Medicaid. These non-Insure Kids Now dentists were drawn from the ADA Masterfile.

HPI staff obtained responses from 156 of the 398 dental offices contacted (39 percent). Among respondents, the target dentist was reported to work at the office in only 52 percent of cases (81 of 156). During an initial round of calling these offices, when front office staff were asked whether the dentist accepted “Medicaid,” only 44 percent responded affirmatively. HPI staff subsequently re-contacted the offices which responded negatively and asked if the dentist accepted the specific Medicaid plan name listed in the Insure Kids Now database (e.g. Florida Healthy Kids Argus; Delta Dental; or Medicaid and CHIP United Healthcare). The vast majority of those re-surveyed indicated that the dentist did in fact accept the specified Medicaid plan, and the two groups – those initially responding affirmatively and those initially responding negatively but then responding affirmatively at the second call – were combined to yield an overall Medicaid acceptance rate of 95 percent. In other words, 95 percent of dentists who were practicing at the location listed in the Insure Kids Now database actually accepted Medicaid. In our view, this is a very high accuracy rate.


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Data & MethodsHowever, as noted, the Insure Kids Now database is less accurate in placing individual dentists in specific office locations. This could be for many reasons. For example, some large group practices list all dentists at all office locations in the Insure Kids Now database, even though it is unlikely that each dentist actually practices at multiple locations. This may be one reason why only 52 percent of dentists HPI contacted actually practiced at the office location listed in the Insure Kids Now database. We had no way of identifying if other dentists at the specific location we contacted accepted Medicaid. This was not part of our surveying protocol.

HPI also contacted a random sample of 287 dentists not listed in the Insure Kids Now database. We found that 11 percent of these dentists actually accepted Medicaid. Thus, there are dentists who are not listed on the Insure Kids Now roster who accept Medicaid.

Our vetting of the Insure Kids Now data indicated that dentists listed in the roster are often not actually present at the office they are listed under, but if they are, it is extremely likely that they do accept Medicaid patients. We also found, however, that there are dentists who are not included in Insure Kids Now who accept Medicaid patients. We also recognize that other research in this area has found that lists of Medicaid dental care providers often contain inaccuracies.17, 18

In 2015, HPI also worked directly with Medicaid officials in several states to further validate the Insure Kids Now data. Based on discussions with CMS, states administering their Medicaid dental program through managed care automatically include all participating dentists on the Insure Kids Now roster. However, CMS indicated that 18 state Medicaid programs administer the dental program directly. These states have some additional flexibility and may allow dentists to opt-out of being listed on Insure Kids Now, even though they participate in the Medicaid program. HPI contacted Medicaid officials in each of these 18 states to inquire about their opt-out procedures and to further validate the data. We found that four states allow providers to opt-out of being on publicly available lists, including Insure Kids Now: Alabama, New Hampshire, North Carolina and Oklahoma. At HPI’s request, Medicaid officials in these states provided data that included dentists who opted out of being listed in Insure Kids Now but participate in Medicaid and we used these data in our calculations. Medicaid officials in one other state, Maine, approached HPI and indicated the data submitted to CMS in 2014 were inaccurate and they were able to provide supplemental data that corrected inaccuracies. Due to inconsistencies in how data from Maine, New Hampshire and Oklahoma are handled in our data set, these three states are not included in our calculation of the national average.


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Data & Methods1 MedicalExpenditurePanelSurvey(MEPS).MEPSHC-155:2012FullYearConsolidatedDataFile.AgencyforHealthcareResearchandQuality.

September2014.Availablefrom:http://meps.ahrq.gov/mepsweb/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-155.AccessedAugust10,2015.

2 VujicicM,Nasseh,K.GapindentalcareutilizationbetweenMedicaidandprivatelyinsuredchildrennarrows,remainslargeforadults.HealthPolicyInstituteResearchBrief.AmericanDentalAssociation.November2015(Revised).Availablefrom:ADA.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0915_1.ashx.AccessedNovember18,2015.

3 CentersforMedicare&MedicaidServices.InstructionsforcompletingformCMS-416:annualearlyandperiodicscreening,diagnostic,andtreatment(EPSDT)participationreport.November17,2014.Availablefrom:www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/cms-416-instructions.pdf.AccessedAugust27,2015.

4 In2010theCMSForm416instructionsforline12awerechangedasfollows:Entertheunduplicatednumberofindividualsundertheageof21withatleast90continuousdaysofenrollmentduringthefederalfiscalyearfromLine1bwhoreceivedatleastonedentalservicebyorunderthesupervisionofadentist.

5 CentersforMedicare&Medicaid.Dentalsealants:aneffectivestatestrategytopreventdentalcariesinchildren.September19,2013.Availablefrom:www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/learning-lab-slides-5.pdf.AccessedAugust27,2015.

6 YarbroughC,StarkelR,VujicicM,AravamudhanK,MeyerD.MethodologyfordevelopingtheHealthPolicyInstituteindexmeasuresoforalhealthstatus,oralhealthknowledge,andattitudestowardsoralhealth.HealthPolicyInstituteResearchBrief.AmericanDentalAssociation.October2015.Availablefrom:ADA.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPI-Index-Methods.ashx.

7 CentersforDiseaseControlandPrevention.Waterfluoridation.December31,2012.Availablefrom:www.cdc.gov/fluoridation/statistics/2012stats.htm.AccessedAugust27,2015.

8 NassehK,VujicicM.AreMedicaidandprivatedentalinsurancepaymentratesforpediatricdentalserviceskeepingupwithinflation?HealthPolicyInstituteResearchBrief.AmericanDentalAssociation.December2014.Availablefrom:ADA.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1214_2.ashx.AccessedAugust27,2015.

9 FAIRHealth,Inc.StandardProducts.DentalModule.Undated.Availableat:www.fairhealth.org/DataSolution.AccessedSeptember18,2014.

10NassehK,VujicicM,YarbroughC.Aten-year,state-by-state,analysisofMedicaidfee-for-servicereimbursementratesfordentalcareservices.HealthPolicyInstituteResearchBrief.AmericanDentalAssociation.October2014.Availablefrom:ADA.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1014_3.ashx.AccessedNovember17,2014.

11BureauofLaborStatistics,DentalServicesConsumerPriceIndex.November2014.Availablefrom:http://data.bls.gov/cgi-bin/dsrv?cu.AccessedNovember17,2014.

12MunsonB,VujicicM.SupplyofdentistsintheUnitedStatesislikelytogrow.HealthPolicyInstituteResearchBrief.AmericanDentalAssociation.October2014.Availablefrom:ADA.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1014_1.ashx.AccessedSeptember9,2015.

13U.S.CensusBureau.NationalIntercensalEstimates(2000-2010).Availablefrom:www.census.gov/popest/data/intercensal/national/nat2010.html.AccessedSeptember9,2015.

14U.S.CensusBureau.NationalTotals:Vintage2014.Availablefrom:www.census.gov/popest/data/national/totals/2014/index.html.AccessedSeptember9,2015.

15U.S.DepartmentofHealthandHumanServices.InsureKidsNow.Availablefrom:www.insurekidsnow.gov/.AccessedSeptember28,2015.

16U.S.DepartmentofHealthandHumanServices.AboutUs.InsureKidsNow.Availablefrom:www.insurekidsnow.gov/About%20Us/index.html.AccessedSeptember28,2015.

17KarlamanglaS.Medi-Calpatientsmaynothaveadequateaccesstodoctors,auditfinds.LosAngelesTimes.June16,2015.Availablefrom:www.latimes.com/local/lanow/la-me-ln-medi-cal-audit-20150615-story.html.AccessedOctober5,2015.

18BisgaierJ,CuttsD,EdelsteinB,RhodesK.Disparitiesinchildaccesstoemergencycareforacuteoralinjury.Pediatrics.June2011;127(6):1428-35.Availablefrom:http://pediatrics.aappublications.org/content/127/6/e1428.full.AccessedOctober5,2015.

http://meps.ahrq.gov/mepsweb/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-155

http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0915_1.ashx

http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/cms-416-instructions.pdf

http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/learning-lab-slides-5.pdf

http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPI-Index-Methods.ashx

http://www.cdc.gov/fluoridation/statistics/2012stats.htm


http://www.fairhealth.org/DataSolution

http://www.ADA.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1014_3.ashx

http://data.bls.gov/cgi-bin/dsrv?cu


http://www.census.gov/popest/data/intercensal/national/nat2010.html

http://www.census.gov/popest/data/national/totals/2014/index.html

http://www.insurekidsnow.gov/

http://www.insurekidsnow.gov/About%20Us/index.html

http://www.latimes.com/local/lanow/la-me-ln-medi-cal-audit-20150615-story.html

http://pediatrics.aappublications.org/content/127/6/e1428.full

Oral Health Care System:

Alabama

This fact sheet summarizes select data on the oral health care system as of 2015. Topics include dental care utilization; oral health status; attitudes and knowledge of oral health; fluoridation rates; reimbursement rates to providers and the supply of dentists.

For methods and data sources, please visit ADA.org/statefacts.

For more information on the ADA Health Policy Institute, please visit ADA.org/HPI.

Percentage with a Dental Visit in the Past 12 Months

Percentage of Medicaid Children Who Received a Sealant on a Permanent Molar in 2013

OF ALABAMA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

10%

Alabama Alabama AlabamaU.S.

Children with Medicaid Coverage Children with Private Dental Benefits Coverage

Adults with Private Dental Benefits Coverage

U.S. U.S.

20%

40%

60%

80%

100%

0%

Alabama 10%

14% U.S.

5% 10% 15% 20% 25%

23%

39%

54%

29%35%

48%

56%59% 60%

64%60%

53%50%

59%

2000 2005 2013

14

http://ADA.org/statefacts

http://ADA.org/HPI

64%

32%

36%

74%

52%

58%

53%

77%

80%

11%

70%

76%

67%

92%

99%

89%90%

90%

95%92%

55%

96%

88%

91%

100%

94%

96%

78%

58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Alabama

Oral Health Status Index Among Adults in 2015

Oral Health Knowledge Index Among Adults in 2015

Oral Health Attitude Index Among Adults in 2015

Percentage of Population on Community Water Systems Receiving Fluoridated Water in 2012

OF ALABAMA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

78%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%

ANSWERED ALL OF HPI’S ORAL HEALTH KNOWLEDGE SURVEY QUESTIONS CORRECTLY COMPARED TO 52% OF HIGH-INCOME AND 44% OF LOW-INCOME U.S. ADULTS

50%OF HIGH-INCOME ALABAMA ADULTS

45%OF LOW-INCOME

ALABAMA ADULTS

4.0

-5

0

5

10

-10

3.2

High-Income AdultsLow-Income Adults Low-Income Adults

5.95.4


Alabama

U.S.Alabama

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

8.1HIGH-INCOME

ADULTS 6.3LOW-INCOME

ADULTS

7.2LOW-INCOME

ADULTS

78%

15

Number of Dentists per 100,000 Population

40

50

60

70

80

40%

60%

80%

100%

0%

20%

Change in Private Dental Benefit Plan Charges Between 2003 and 2013

Percentage of Dentists Participating in Medicaid for Child Dental Services in 2014

74%

U.S.

Alabama

2013

42.1 44.0

Alabama U.S.

49%54% BETWEEN

2003 AND 2013 REIMBURSEMENT RATES FOR CHILD DENTAL SERVICES IN MEDICAID

decreased 35.2%in Alabama

CHANGE IN PRIVATE DENTAL BENEFIT PLAN CHARGES BETWEEN 2003 AND 2013

CHILD ADULT

ALABAMA -4.9% -5.1%U.S. 1.2% -0.6%

57.3 60.5

-5%

0%

Child Dental Services

Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

2001 2013

Alabama

U.S.


Alabama

Alabama

Medicaid Fee-for-Service Reimbursement as a Percentage of Private Dental Benefit Plan Charges for Child Dental Services

42%U.S.

16


Alaska






OF ALASKA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

22%

Alaska Alaska AlaskaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Alaska 22%

U.S.

5% 10% 15% 20% 25%

36%42%

48%

29%35%

48%

55% 56%60%

64%60%

52% 53%59%

14%

2000 2005 2013

17


http://ADA.org/HPI

High-Income Adults

U.S.Alaska


OF ALASKA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

53%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


67%OF HIGH-INCOME ALASKA ADULTS

42%OF LOW-INCOME ALASKA ADULTS

4.0

-5

0

5

10

-10

4.1


5.96.2


Alaska

U.S.Alaska

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

7.8HIGH-INCOME

ADULTS

7.2LOW-INCOME

ADULTS

7.2LOW-INCOME

ADULTS


64%

32%

36%

74%

52%

58% 77%

80%

11%

70%

76%

67%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

53%



18

40

50

60

70

80

57.3 60.5

2001 2013


40%

60%

80%

100%

0%

20%


AlaskaChange in Private Dental Benefit Plan Charges Between 2003 and 2013

U.S.Alaska2013

Alaska U.S.

49%62% BETWEEN


increased 3.3%in Alaska


CHILD ADULT

ALASKA -0.5% -2.8%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

AlaskaU.S.


43%Alaska

72.178.3

42%U.S.

19


Arizona






OF ARIZONA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

12%

Arizona Arizona ArizonaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Arizona 12%

U.S.

5% 10% 15% 20% 25%

23%

31%

50%

29%35%

48% 49%

63%60%

64%60%

50%

56% 59%

14%

2000 2005 2013

20


http://ADA.org/HPI

64%

32%

36%

74%52%

53%

77%

80%

11%

70%

76%

67%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Arizona


OF ARIZONA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

58%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


59%OF HIGH-INCOME ARIZONA ADULTS

48%OF LOW-INCOME ARIZONA ADULTS

4.0

-5

0

5

10

-10

5.0


5.97.1


Arizona

U.S.Arizona

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

8.8HIGH-INCOME


ADULTS

6.3LOW-INCOME

ADULTS


58%



21

40%

60%

80%

100%

0%

20%


ArizonaChange in Private Dental Benefit Plan Charges Between 2003 and 2013

U.S.Arizona2013

49%55% BETWEEN


decreased 29.6%in Arizona


CHILD ADULT

ARIZONA -6.1% -8.4%U.S. 1.2% -0.6%

-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Arizona


Arizona U.S.


32%Arizona

40

50

60

70

80

45.0

54.557.3 60.5

2001 2013


42%U.S.

22


Arkansas






OF ARKANSAS MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

12%

Arkansas Arkansas ArkansasU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Arkansas 12%

U.S.

5% 10% 15% 20% 25%

22%30%

54%

29%35%

48% 46%

57%60%

64%60%

51% 49%

59%

14%

2000 2005 2013

23


http://ADA.org/HPI


64%

32%

36%

74%52%

53%

77%

80%

11%

70%

76%

58%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Arkansas


OF ARKANSAS’ POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

67%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


45%OF HIGH-INCOME

ARKANSAS ADULTS

40%OF LOW-INCOME

ARKANSAS ADULTS

4.03.9

-5

0

5

10

-10High-Income AdultsLow-Income Adults Low-Income Adults

5.95.2


Arkansas

U.S.Arkansas

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

8.1HIGH-INCOME


ADULTS5.8

LOW-INCOMEADULTS

67%



24

40%

60%

80%

100%

0%

20%


ArkansasChange in Private Dental Benefit Plan Charges Between 2003 and 2013

U.S.Arkansas2013

49%67% BETWEEN


increased 4.0%in Arkansas


CHILD ADULT

ARKANSAS -4.5% -6.3%U.S. 1.2% -0.6%

-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Arkansas


30

40

50

60

70

Arkansas U.S.

2001 2013

38.9 40.9

57.360.5


61%Arkansas


42%U.S.

25


California






OF CALIFORNIA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

15%

California California CaliforniaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

California 15%

U.S.

5% 10% 15% 20% 25%

32% 33%

45%

29%35%

48%

61%67%

60%64%

60%63% 62%

59%

14%

2000 2005 2013

26


http://ADA.org/HPI


64%

32%

36%

74%52%

53%

77%

80%

11%

70%

76%

67%58%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%

44%94%

71%

97%23%

High-Income Adults

U.S.California


OF CALIFORNIA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

64%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


44%OF HIGH-INCOME

CALIFORNIA ADULTS

45%OF LOW-INCOME

CALIFORNIA ADULTS

4.03.6

-5

0

5

10


5.95.9


California

U.S.California

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS6.8HIGH-INCOME

ADULTS

7.2LOW-INCOME

ADULTS

7.7LOW-INCOME

ADULTS

64%



27

California

40%

60%

80%

100%

0%

20%


CaliforniaChange in Private Dental Benefit Plan Charges Between 2003 and 2013

U.S.2013

49%29%

BETWEEN


decreased 31.6%in California


CHILD ADULT

CALIFORNIA -4.7% -7.7%U.S. 1.2% -0.6%

-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

California


40

50

60

70

80

California U.S.

2001 2013

76.6

57.360.5

65.9


29%California


42%U.S.

28


Colorado






OF COLORADO MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

17%

Colorado Colorado ColoradoU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Colorado 17%

U.S.

5% 10% 15% 20% 25%

38%

46%

54%

29%35%

48%

71% 68%

60%64%

60%

67%62%

59%

14%

2000 2005 2013

29


http://ADA.org/HPI


64%

32%

36%

74%52%

53%

58% 77%

80%

11%

70%

76%

67%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%

64%64%

44% 94%

71%

97%23%

High-Income Adults

U.S.Colorado

OF COLORADO’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

72%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


61%OF HIGH-INCOME

COLORADO ADULTS

47%OF LOW-INCOME

COLORADO ADULTS

4.0

-5

0

5

10

-10

3.4


5.95.7


Colorado

U.S.Colorado

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

8.5HIGH-INCOME

ADULTS7.1

LOW-INCOMEADULTS

7.2LOW-INCOME

ADULTS

72%




30


40%

60%

80%

100%

0%

20%


U.S.Colorado2013

Colorado U.S.

49%45%BETWEEN


decreased 17.7%in Colorado


CHILD ADULT

COLORADO -7.1% -8.3%U.S. 1.2% -0.6%

-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

Colorado

U.S.


Colorado


53%Colorado

40

50

60

70

80

57.3 60.5

2001 2013

68.764.3


42%U.S.

31


Connecticut






OF CONNECTICUT MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

20%

Connecticut Connecticut ConnecticutU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Connecticut 20%

U.S.

5% 10% 15% 20% 25%

33% 32%

64%

29%35%

48%

67%73%

60%64%

60%

67% 68%

59%

14%

2000 2005 2013

32


http://ADA.org/HPI


64%

32%

36%

74%

52%

53%

58% 77%

80%

11%

70%

76%

67%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

15%86%97%

100%

46%

99%

64%64%

44%94%

71%

72%

97%23%

High-Income Adults

U.S.Connecticut

OF CONNECTICUT’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

90%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


54%OF HIGH-INCOME

CONNECTICUT ADULTS

48%OF LOW-INCOME

CONNECTICUT ADULTS

4.0

-5

0

5

10

-10

3.4


5.95.8

U.S.Connecticut

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

9.1HIGH-INCOME


ADULTS

7.2LOW-INCOME

ADULTS


ConnecticutOral Health Status Index Among Adults in 2015



90%

33

40

50

60

70

80


40%

60%

80%

100%

0%

20%


U.S.Connecticut2013

75.4 76.2

Connecticut U.S.

49%BETWEEN


increased 68.6%in Connecticut


CHILD ADULT

CONNECTICUT -2.2% -2.6%U.S. 1.2% -0.6%

57.3 60.5

-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

2001 2013

ConnecticutU.S.


Connecticut

67%


46%Connecticut


42%U.S.

34


Delaware






OF DELAWARE MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

20%

Delaware Delaware DelawareU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Delaware

U.S.

5% 10% 15% 20% 25%

22%30%

49%

29%35%

48%53%

63% 60%64%

60%57%

61%59%

2000 2005 2013

20%

14%

35


http://ADA.org/HPI


64%

32%

36%

74%52%

53%

77%

80%

11%

70%

76%

67%58%

92%

99%

89%90%

95% 92%55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Delaware

OF DELAWARE’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

86%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


45%OF HIGH-INCOME

DELAWARE ADULTS

36%OF LOW-INCOME

DELAWARE ADULTS

4.03.8

-5

0

5

10


5.95.3


Delaware

U.S.Delaware

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

6.5LOW-INCOME

ADULTS




86%

36

40

40%

60%

80%

100%

0%

20%


U.S.Delaware2013

49%81% BETWEEN


decreased 4.3%in Delaware


CHILD ADULT

DELAWARE 0.3% -0.6%U.S. 1.2% -0.6%

-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.Delaware


50

60

70

80

Delaware U.S.

2001 2013

44.2 45.4

57.360.5


Delaware


55%Delaware


42%U.S.

37


District of Columbia






OF DISTRICT OF COLUMBIA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

18%




U.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%


18%

U.S.

5% 10% 15% 20% 25%

25%31%

54%

29%35%

48%

36%

55%60%

64%60%

47%

56% 59%

14%

2000 2005 2013

38


http://ADA.org/HPI


64%

32%

36%

74%52%

53%

77%

80%

11%

70%

76%

67%58%

92%

99%

89%90%

95% 92%55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.District of Columbia

OF DISTRICT OF COLUMBIA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

100%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


49%OF HIGH-INCOME

DISTRICT OF COLUMBIA ADULTS

23%OF LOW-INCOME

DISTRICT OF COLUMBIA ADULTS

4.0

-5

0

5

10


5.93.7

6.3



U.S.District of Columbia

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

7.9HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.1LOW-INCOME

ADULTS




100%

39

2001 2013

40%

60%

80%

100%

0%

20%


U.S.District of Columbia2013

49%58% BETWEEN


increased 82.4%in District of Columbia


CHILD ADULT

DISTRICT OF COLUMBIA 4.4% 3.8%U.S. 1.2% -0.6%

-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

D.C.


District of Columbia U.S.



U.S.

50

60

70

80

90

100

110105.0

89.2

57.360.5


27% 42%U.S.District of Columbia


40


Florida






OF FLORIDA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

10%

Florida Florida FloridaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Florida 10%

U.S.

5% 10% 15% 20% 25%

26% 22%

30% 29%35%

48%

57%61% 60%

64%60%58% 56% 59%

14%

2000 2005 2013

41


http://ADA.org/HPI


64%

32%

36%

74%

52%

58%

53%

77%

80%

11%

70%

76%

67%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Florida

OF FLORIDA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

78%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


51%OF HIGH-INCOME FLORIDA ADULTS

43%OF LOW-INCOME FLORIDA ADULTS

4.0

-5

0

5

10

-10

4.4


5.96.3


Florida

U.S.Florida

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

8.5HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

6.6LOW-INCOME

ADULTS

78%




42

40

50

60

70

80

2001 2013

40%

60%

80%

100%

0%

20%


U.S.Florida2013

49%37%BETWEEN


increased 0.7%in Florida


CHILD ADULT

FLORIDA 1.0% -2.4%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Florida


Florida U.S.

49.9 50.7


Florida


30%Florida

57.3 60.5

42%U.S.

43


Georgia






OF GEORGIA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

11%

Georgia Georgia GeorgiaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Georgia 11%

U.S.

5% 10% 15% 20% 25%

24%

40%

53%

29%35%

48%

58%63%

60%64%

60%58%55%

59%

14%

2000 2005 2013

44


http://ADA.org/HPI


64%

32%

36%

74%52%

58%

53%

77%

80%

11%

70%

76%

67%

92%

99%

89%90%

95%92%

55%

96%

88%

91%100%

90%94%

78%

78%

58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Georgia

OF GEORGIA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

96%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


58%OF HIGH-INCOME GEORGIA ADULTS

47%OF LOW-INCOME GEORGIA ADULTS

4.0

-5

0

5

10

-10

3.6


5.95.8

U.S.Georgia

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

8.5HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

7.5LOW-INCOME

ADULTS


Georgia

96%




45

40

50

60

70

80

40%

60%

80%

100%

0%

20%


U.S.Georgia2013

49% BETWEEN


decreased 32.0%in Georgia


CHILD ADULT

GEORGIA -3.3% -4.0%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Georgia


Georgia U.S.

2001 2013

43.147.0


Georgia

54%


28%Georgia

57.360.5

42%U.S.

46


Hawaii






OF HAWAII MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

10%

Hawaii Hawaii HawaiiU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Hawaii

U.S.

5% 10% 15% 20% 25%

29%

42%

57%

29%35%

48%50% 48%

60%64%

60%

46%41%

59%

10%

14%

2000 2005 2013

47


http://ADA.org/HPI

64%

32%

36%

74%52%

58%

53%

77%

80%

70%

76%

67%

92%

99%

89%90%

95% 92%55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Hawaii

OF HAWAII’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

11%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


47%OF HIGH-INCOME HAWAII ADULTS

35%OF LOW-INCOME HAWAII ADULTS

4.0

-5

0

5

10

-10

3.6


5.96.0


Hawaii

U.S.Hawaii

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.3HIGH-INCOME


ADULTS


11%




48

Hawaii


50

60

70

80

90

40%

60%

80%

100%

0%

20%


U.S.2013

83.475.2

Hawaii U.S.

49%47%BETWEEN


decreased 29.1%in Hawaii


CHILD ADULT

HAWAII -13.2% -14.0%U.S. 1.2% -0.6%


57.3 60.5

-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

2001 2013

Hawaii

U.S.


Hawaii


36%Hawaii

42%U.S.

49


Idaho






OF IDAHO MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

20%

Idaho Idaho IdahoU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Idaho

U.S.

5% 10% 15% 20% 25%

29%

42%

60%

29%35%

48%

64%

71%

60%64%

60%60%65%

59%

20%

14%

2000 2005 2013

50


http://ADA.org/HPI


64%

32%

74%52%

58%

53%

77%

80%

70%

76%

67%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Idaho

OF IDAHO’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

36%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


55%OF HIGH-INCOME

IDAHO ADULTS

54%OF LOW-INCOME

IDAHO ADULTS

4.0

-5

0

5

10

-10

4.4


5.96.1


Idaho

U.S.Idaho

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

7.6HIGH-INCOME

ADULTS6.5

LOW-INCOMEADULTS

11%

36%




51

40

50

60

70

80

40%

60%

80%

100%

0%

20%


U.S.Idaho2013

Idaho U.S.

49% BETWEEN


decreased 25.3%in Idaho


CHILD ADULT

IDAHO -1.9% -5.3%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

Idaho

U.S.


Idaho

45%


2001 2013

52.3


48%Idaho

57.3 57.860.5

42%U.S.

52


Illinois






OF ILLINOIS MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

20%

Illinois Illinois IllinoisU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Illinois

U.S.

5% 10% 15% 20% 25%

34%

55%

29%28%

35%

48%

61%66%

60%64%

60%63% 61%

59%

20%

14%

2000 2005 2013

53


http://ADA.org/HPI


64%

32%

36%

74%

64%52%

53%

77%

80%

11%

70%

76%

67%58%

92%

99%89%

90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

72%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Illinois

OF ILLINOIS’ POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

99%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


50%OF HIGH-INCOME ILLINOIS ADULTS

39%OF LOW-INCOME ILLINOIS ADULTS

4.04.0

-5

0

5

10


5.9


Illinois

U.S.Illinois

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

9.1HIGH-INCOME


ADULTS

7.2LOW-INCOME

ADULTS

5.2

99%




54

Illinois

40%

60%

80%

100%

0%

20%


U.S.2013

49%33%

BETWEEN


decreased 16.8%in Illinois


CHILD ADULT

ILLINOIS 4.0% 1.8%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.Illinois


40

50

60

70

80

Illinois U.S.

2001 2013

57.360.5


Illinois


30%Illinois

66.765.3

42%U.S.

55


Indiana






OF INDIANA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

21%

Indiana Indiana IndianaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Indiana

U.S.

5% 10% 15% 20% 25%

40%44%

29%32%

35%

48%

63% 64%60%

64%60%61%

58% 59%

21%

14%

2000 2005 2013

56


http://ADA.org/HPI


64%

32%

36%

74%

64%52%

53%

77%

80%

11%

70%

76%

67%58%

92%

99%

89%

99%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

90% 70%84%

90%15%

86%97%

100%

46%

72%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Indiana

OF INDIANA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

95%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


48%OF HIGH-INCOME INDIANA ADULTS

48%OF LOW-INCOME INDIANA ADULTS

4.04.1

-5

0

5

10


5.9


Indiana

U.S.Indiana

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

8.6HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

6.7LOW-INCOME

ADULTS

5.8

95%




57

Indiana

40%

60%

80%

100%

0%

20%


U.S.2013

49%56% BETWEEN


decreased 30.6%in Indiana


CHILD ADULT

INDIANA 2.9% 1.9%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Indiana


40

50

60

70

80

Indiana U.S.

2001 2013

46.8 47.4


Indiana

57.360.5


50%Indiana

42%U.S.

58


Iowa






OF IOWA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

14%

Iowa Iowa IowaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Iowa 14%

U.S.

5% 10% 15% 20% 25%

35%

44%

54%

29%35%

48%

69%64%

60%64%

60%62%

55%59%

14%

2000 2005 2013

59


http://ADA.org/HPI


64%

32%

36%

74%

52%72%

53%

58% 77%

80%

11%

70%

76%

67%

99%

89%90%

95% 92%55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Iowa

OF IOWA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

92%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


53%OF HIGH-INCOME

IOWA ADULTS

47%OF LOW-INCOME

IOWA ADULTS

4.0

-5

0

5

10

-10

3.8


5.96.4


Iowa

U.S.Iowa

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

8.0HIGH-INCOME

ADULTS7.3

LOW-INCOMEADULTS

7.2LOW-INCOME

ADULTS

92%




60


40%

60%

80%

100%

0%

20%


U.S.Iowa2013

Iowa U.S.

49%42%BETWEEN


decreased 29.2%in Iowa


CHILD ADULT

IOWA 8.7% 6.6%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

2001 2013

Iowa

U.S.


Iowa


86%Iowa

40

50

60

70

80

51.7 51.957.3

60.5

42%U.S.

61


Kansas






OF KANSAS MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

23%

Kansas Kansas KansasU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Kansas

U.S.

5% 10% 15% 20% 25%

22%

37%

49%

29%35%

48%

63%66% 66%

60%62% 64%59%

23%

60%64%

14%

2000 2005 2013

62


http://ADA.org/HPI


64%

32%

36%

74%52%

53%

77%

80%

11%

70%

76%

67%58%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Kansas

OF KANSAS’ POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

64%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


52%OF HIGH-INCOME KANSAS ADULTS

40%OF LOW-INCOME KANSAS ADULTS

4.03.1

-5

0

5

10


5.95.4

U.S.Kansas

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS


Kansas

7.1LOW-INCOME

ADULTS

64%




63

40

50

60

70

80

2001 2013

57.360.5



2013

BETWEEN


decreased 30.7%in Kansas


CHILD ADULT

KANSAS 0.2% -0.4%U.S. 1.2% -0.6%

-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.Kansas


Kansas U.S.

48.6 50.5


Kansas

Kansas

40%

60%

80%

100%

0%

20%

U.S.

49%47%


26%Kansas

42%U.S.

64


Kentucky






OF KENTUCKY MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

11%

Kentucky Kentucky KentuckyU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Kentucky 11%

U.S.

5% 10% 15% 20% 25%

35%

9%

48%

29%35%

48%

64% 62%60%

64%60%61%

53%59%

14%

2000 2005 2013

65


http://ADA.org/HPI


64%

32%

36%

74%

52%72%

53%

58% 77%

80%

11%

70%

76%

67%

99%

92%

89%90%

95%

55%

96%

88%

91%

90%

94%96%

78%

78%58%

43%

72%

79%

92%70%84%

90%15%

86%97%

100%

46%

99%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Kentucky

OF KENTUCKY’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

100%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


44%OF HIGH-INCOME

KENTUCKY ADULTS

64%OF LOW-INCOME

KENTUCKY ADULTS

4.0

-5

0

5

10

-10

3.7


5.9


Kentucky

U.S.Kentucky

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

7.8HIGH-INCOME

ADULTS6.4

LOW-INCOMEADULTS

6.2

100%




56%

66

40

50

60

70

80

2001 2013


40%

60%

80%

100%

0%

20%


U.S.Kentucky2013

Kentucky U.S.

49%44%BETWEEN


decreased 1.1%in Kentucky


CHILD ADULT

KENTUCKY 5.3% 2.6%U.S. 1.2% -0.6%


55.5 56.6

-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

Kentucky

U.S.


Kentucky


39%Kentucky

57.360.5

42%U.S.

67


Louisiana






OF LOUISIANA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

10%

Louisiana Louisiana LouisianaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Louisiana

U.S.

5% 10% 15% 20% 25%

33%

51%

29%28%

35%

48%54% 55%

60%64%

60%

52%47%

59%

10%

14%

2000 2005 2013

68


http://ADA.org/HPI


64%

32%

36%

74%

64%52%

53%

77%

80%

11%

70%

76%

67%58%

92%

99%

89%90%

95%99%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

72%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Louisiana

OF LOUISIANA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

43%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


47%OF HIGH-INCOME

LOUISIANA ADULTS

29%OF LOW-INCOME

LOUISIANA ADULTS

4.04.2

-5

0

5

10


5.9


Louisiana

U.S.Louisiana

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

5.1

7.7HIGH-INCOME

ADULTS6.4

LOW-INCOMEADULTS

43%




69

Louisiana

40%

60%

80%

100%

0%

20%


U.S.2013

49%61% BETWEEN


increased 21.3%in Louisiana


CHILD ADULT

LOUISIANA 2.1% 0.7%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Louisiana


Louisiana U.S.


Louisiana

40

50

60

70

80

2001 2013

46.0 48.057.3

60.5


43%Louisiana

42%U.S.

70


Maine






OF MAINE MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

20%

Maine Maine MaineU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Maine

U.S.

5% 10% 15% 20% 25%

37%43%

29%35%

48%

69% 69%

60%64%

60%64% 63%

59%

20%

14%

2000 2005 2013

71


http://ADA.org/HPI


64%

32%

36%

74%52%

72%

53%

58% 77%

80%

11%

70%

76%

67%

99%

89%

92%

90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

56%

70%84%

90%15%

86%97%

100%

46%

99%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Maine

OF MAINE’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

79%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


48%OF HIGH-INCOME

MAINE ADULTS

42%OF LOW-INCOME

MAINE ADULTS

4.0

-5

0

5

10


5.95.6


Maine

U.S.Maine

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.4HIGH-INCOME

ADULTS6.8

LOW-INCOMEADULTS

3.8

79%




72


40%

60%

80%

100%

0%

20%


U.S.Maine2013

Maine U.S.

49% IN 2013, MEDICAID REIMBURSEMENT RATES FOR CHILD DENTAL SERVICES WERE 44% OF PRIVATE DENTAL BENEFIT PLAN RATES IN MAINE COMPARED TO 49% IN THE U.S.


CHILD ADULT

MAINE 2.3% 1.3%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

Maine

U.S.


Maine

44%

40

50

60

70

80

2001 2013

46.552.2

57.360.5


42%Maine

42%U.S.

73


Maryland






OF MARYLAND MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

21%

Maryland Maryland MarylandU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Maryland

U.S.

5% 10% 15% 20% 25%

12%

33%

58%

29%35%

48%

62%67%

60%64%

60%58% 58% 59%

21%

14%

2000 2005 2013

74


http://ADA.org/HPI


64%

32%

36%

74%

64%52%

53%

77%

80%

11%

70%

76%

67%58%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%79%56%

70%84%

90%15%

86%

100%

46%

99%72%

64%

44%94%

71%

97%23%

High-Income Adults

U.S.Maryland

OF MARYLAND’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

97%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


47%OF HIGH-INCOME

MARYLAND ADULTS

29%OF LOW-INCOME

MARYLAND ADULTS

4.04.7

-5

0

5

10


5.95.9


Maryland

U.S.Maryland

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

6.5LOW-INCOME

ADULTS

8.7HIGH-INCOME

ADULTS

97%




75

Maryland

40%

60%

80%

100%

0%

20%


U.S.2013

49%48%BETWEEN


increased 8.0%in Maryland


CHILD ADULT

MARYLAND 3.4% 1.5%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.Maryland


40

50

60

70

80

Maryland U.S.

2001 2013

57.360.5

73.6


Maryland

71.9


25%Maryland

42%U.S.

76


Massachusetts






OF MASSACHUSETTS MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

24%

Massachusetts Massachusetts MassachusettsU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Massachusetts 24%

U.S.

5% 10% 15% 20% 25%

33%39%

58%

29%35%

48%

71%76%

60%64%

60%

67% 68%

59%

14%

2000 2005 2013

77


http://ADA.org/HPI


64%

32%

36%

74%

52%

53%

58% 77%

80%

11%

70%

76%

67%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

84%

15%86%97%

100%

46%

99%

64%64%

44%94%

71%

72%

97%23%

High-Income Adults

U.S.Massachusetts

OF MASSACHUSETTS’ POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

70%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


56%OF HIGH-INCOME

MASSACHUSETTS ADULTS

35%OF LOW-INCOME

MASSACHUSETTS ADULTS

4.0

-5

0

5

10


5.95.8

U.S.Massachusetts

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.4

LOW-INCOMEADULTS

7.2LOW-INCOME

ADULTS


Massachusetts

8.8HIGH-INCOME

ADULTS

5.2

90%




70%

78

40

50

60

70

80

2001 2013

57.360.5


40%

60%

80%

100%

0%

20%


U.S.Massachusetts2013

76.6 78.0

Massachusetts U.S.

49% BETWEEN


decreased 2.9%in Massachusetts


CHILD ADULT

MASSACHUSETTS 2.4% 0.2%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

Massachusetts


Massachusetts

U.S.

58%


39%Massachusetts

42%U.S.

79


Michigan






OF MICHIGAN MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

10%

Michigan Michigan MichiganU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Michigan

U.S.

5% 10% 15% 20% 25%

29%35%

48%

69% 68%

60%64%

60%

71%68%

59%

22%

32%

41%

10%

14%

2000 2005 2013

80


http://ADA.org/HPI


64%

32%

36%

74%

52%72%

53%

58% 77%

80%

11%

70%

76%

67%

99%

89%

92%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

56%

70%84%

90%15%

86%97%

100%

46%

79%

99%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Michigan

OF MICHIGAN’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

90%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


59%OF HIGH-INCOME

MICHIGAN ADULTS

40%OF LOW-INCOME

MICHIGAN ADULTS

4.0

-5

0

5

10


5.96.8


Michigan

U.S.Michigan

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.9HIGH-INCOME


ADULTS

4.8

90%




81

33%


40%

60%

80%

100%

0%

20%


U.S.Michigan2013

Michigan U.S.

49%


CHILD ADULT

MICHIGAN -3.1% -5.0%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

Michigan

40

50

60

70

80

2001 2013


Michigan

U.S.

BETWEEN


decreased 32.6%in Michigan

60.561.457.3


92%Michigan

57.9

42%U.S.

82


Minnesota






OF MINNESOTA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

13%

Minnesota Minnesota MinnesotaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Minnesota 13%

U.S.

5% 10% 15% 20% 25%

34%37%

43%

29%35%

48%

66%71%

60%64%

60%65% 65%

59%

14%

2000 2005 2013

83


http://ADA.org/HPI


64%

32%

36%

74%

52%

58%

53%

77%

80%

11%

70%

76%

67%

92%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.Minnesota

OF MINNESOTA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

99%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


62%OF HIGH-INCOME

MINNESOTA ADULTS

52%OF LOW-INCOME

MINNESOTA ADULTS

4.0

-5

0

5

10

-10

3.5


5.96.6


Minnesota

U.S.Minnesota

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.8HIGH-INCOME


ADULTS

99%




84

60.5


40%

60%

80%

100%

0%

20%


U.S.Minnesota2013

Minnesota U.S.

49%27%

BETWEEN


decreased 41.3%in Minnesota


CHILD ADULT

MINNESOTA 3.8% 1.2%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

Minnesota

U.S.


Minnesota

40

50

60

70

80

2001 2013

60.657.3


69%Minnesota

57.8

42%U.S.

85


Mississippi






OF MISSISSIPPI MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

17%

Mississippi Mississippi MississippiU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Mississippi

U.S.

5% 10% 15% 20% 25%

28%

67%

52%

29%35%

48%50%

53%

60%64%

60%

52%

45%

59%

17%

14%

2000 2005 2013

86


http://ADA.org/HPI


64%

32%

36%

74%

52%

58%

53%

77%

80%

11%

70%

76%

67%

92%

89%90%

95%92%

55%

96%

88%

91%

100%

90%

94%

96%

78%

78%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%

99%

72%64%

64%

44%94%

71%

97%23%

High-Income Adults

U.S.Mississippi

OF MISSISSIPPI’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

58%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


45%OF HIGH-INCOME

MISSISSIPPI ADULTS

44%OF LOW-INCOME

MISSISSIPPI ADULTS

4.0

-5

0

5

10

-10

3.6


5.93.8


Mississippi

U.S.Mississippi

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.0HIGH-INCOME

ADULTS6.7

LOW-INCOMEADULTS

58%




87


40%

60%

80%

100%

0%

20%


U.S.Mississippi2013

Mississippi U.S.

49% BETWEEN


decreased 10.5%in Mississippi


CHILD ADULT

MISSISSIPPI 2.6% 0.7%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Mississippi


Mississippi

48%

30

40

50

60

70

57.3 60.5

2001 2013


55%Mississippi

39.242.6

42%U.S.

88


Missouri






OF MISSOURI MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

12%

Missouri Missouri MissouriU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Missouri

U.S.

5% 10% 15% 20% 25%

20%23%

39%

29%35%

48%

56%62%

60%64%

60%57% 58% 59%

12%

14%

2000 2005 2013

89


http://ADA.org/HPI


64%

32%

36%

74%

52%

58%

53%

77%

80%

11%

70%67%

92%

89%90%

95% 92%55%

96%

88%

91%

100%

90%

94%96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%

99%

72%64%

64%

44%94%

71%

97%23%

High-Income Adults

U.S.Missouri

OF MISSOURI’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

76%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


56%OF HIGH-INCOME MISSOURI ADULTS

49%OF LOW-INCOME

MISSOURI ADULTS

4.0

-5

0

5

10

-10

4.0


5.9


Missouri

U.S.Missouri

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.6HIGH-INCOME

ADULTS7.4

LOW-INCOMEADULTS

6.0

76%




90

Missouri


40%

60%

80%

100%

0%

20%


U.S.2013

Missouri U.S.

49% BETWEEN


decreased 16.6%in Missouri


CHILD ADULT

MISSOURI 5.0% 2.5%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.Missouri

40%

40

50

60

70

80

46.7 48.0

57.3 60.5

2001 2013


Missouri


23%Missouri

42%U.S.

91


Montana






OF MONTANA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

16%

Montana Montana MontanaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Montana

U.S.

5% 10% 15% 20% 25%

26% 25%

53%

29%35%

48%

32%

59% 60%64%

60%

49%

56%59%

16%

14%

2000 2005 2011 2013

92


http://ADA.org/HPI


64%

36%

74%

52%

58%

53%

77%

80%

11%

70%67%

92%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%

99%

72%64%

64%

44%94%

71%

76%

97%23%

High-Income Adults

U.S.Montana

OF MONTANA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

32%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


42%OF HIGH-INCOME

MONTANA ADULTS

47%OF LOW-INCOME

MONTANA ADULTS

4.0

-5

0

5

10


5.9


Montana

U.S.Montana

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

7.0HIGH-INCOME

ADULTS

6.8LOW-INCOME

ADULTS

3.94.6

32%




93

Montana


40%

60%

80%

100%

0%

20%


U.S.2013

Montana U.S.

49% BETWEEN


decreased 14.7%in Montana


CHILD ADULT

MONTANA 2.3% -0.7%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Montana

53%

40

50

60

70

80

56.3 58.957.3 60.5

2001 2013


Montana


72%Montana

42%U.S.

94


Nebraska






OF NEBRASKA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

21%

Nebraska Nebraska NebraskaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Nebraska

U.S.

5% 10% 15% 20% 25%

41%47%

56%

29%35%

48%

58%

67%

60%64%

60%55%

59% 59%

21%

14%

2000 2005 2013

95


http://ADA.org/HPI


64%

36%

32%

74%

52%

58%

53%

77%

80%

11%

70%67%

92%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%

99%

72%64%64%

44%

94%

76%

97%23%

High-Income Adults

U.S.Nebraska

OF NEBRASKA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

71%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


61%OF HIGH-INCOME

NEBRASKA ADULTS

44%OF LOW-INCOME

NEBRASKA ADULTS

4.0

-5

0

5

10


5.9


Nebraska

U.S.Nebraska

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.5HIGH-INCOME


ADULTS

5.93.9

71%




96

Nebraska


40%

60%

80%

100%

0%

20%


U.S.2013

Nebraska U.S.

49% BETWEEN


decreased 24.1%in Nebraska


CHILD ADULT

NEBRASKA 6.3% 4.0%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Nebraska

43%

40

50

60

70

80

57.3 60.5

2001 2013


Nebraska

64.464.1


61%Nebraska

42%U.S.

97


Nevada






OF NEVADA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

20%

Nevada Nevada NevadaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Nevada

U.S.

5% 10% 15% 20% 25%

20% 19%

46%

29%35%

48%44%

56%60%

64%60%

49%53%

59%

20%

14%

2000 2005 2013

98


http://ADA.org/HPI


64%

36%

32%

52%

58%

53%

77%

80%

11%

70%67%

92%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%

99%

72%64%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.Nevada

OF NEVADA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

74%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


56%OF HIGH-INCOME NEVADA ADULTS

41%OF LOW-INCOME NEVADA ADULTS

4.0

-5

0

5

10


5.9


Nevada

U.S.Nevada

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

7.9HIGH-INCOME

ADULTS

7.6LOW-INCOME

ADULTS

3.05.8

74%




99

Nevada


40%

60%

80%

100%

0%

20%


U.S.2013

Nevada U.S.

49% BETWEEN


decreased 26.7%in Nevada


CHILD ADULT

NEVADA -11.1% -14.3%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Nevada


Nevada

40

50

60

70

80

40.3

51.957.3 60.5

2001 2013


42%Nevada

48%

42%U.S.

100


New Hampshire






OF NEW HAMPSHIRE MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

18%

New Hampshire New Hampshire New HampshireU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

New Hampshire

U.S.

5% 10% 15% 20% 25%

33%

42%

60%

29%35%

48%

71%75%

60%64%

60%

67%67%

59%

14%

18%

2000 2005 2013

101


http://ADA.org/HPI


64%

36%

32%

52%

58%

53%

77%

74%

80%

11%

70%67%

92%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%

56%

70%84%

90%15%

86%97%

100%

99%

99%

72%64%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.New Hampshire

OF NEW HAMPSHIRE’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

46%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


42%OF HIGH-INCOME

NEW HAMPSHIRE ADULTS

46%OF LOW-INCOME

NEW HAMPSHIRE ADULTS

4.04.6

-5

0

5

10


5.9


New Hampshire

U.S.New Hampshire

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.3HIGH-INCOME

ADULTS7.5

LOW-INCOMEADULTS

5.6

46%




102

New Hampshire


40%

60%

80%

100%

0%

20%


U.S.2013

New Hampshire U.S.

49% BETWEEN


decreased 24.5%in New Hampshire


CHILD ADULT

NEW HAMPSHIRE 4.4% 2.9%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

New Hampshire

40

50

60

70

80

2001 2013


New Hampshire

40%

58.564.0

60.557.3


45%New Hampshire

42%U.S.

103


New Jersey






OF NEW JERSEY MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

13%

New Jersey New Jersey New JerseyU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

New Jersey

U.S.

5% 10% 15% 20% 25%

18%

25%

50%

29%35%

48%

64%70%

60%64%

60%63%62%

59%

14%

13%

2000 2005 2013

104


http://ADA.org/HPI

64%

36%

32%

52%

58%

53%

77%

74%

80%

11%

70%67%

92%

89%90%

95% 92%55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%

56%

70%46%

84%90%

86%97%

100%

99%

99%

72%64%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.New Jersey

OF NEW JERSEY’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

15%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


46%OF HIGH-INCOME

NEW JERSEY ADULTS

35%OF LOW-INCOME

NEW JERSEY ADULTS

4.0

-5

0

5

10


5.9


New Jersey

U.S.New Jersey

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.8HIGH-INCOME


ADULTS

6.33.6


15%




105

New Jersey


40%

60%

80%

100%

0%

20%


U.S.2013

New Jersey U.S.

49%


CHILD ADULT

NEW JERSEY -0.8% -3.4%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

New Jersey

40

50

60

70

80

2001 2013

69%

71.3

81.2

60.557.3


New Jersey

U.S.


24%New Jersey

IN 2013, MEDICAID REIMBURSEMENT RATES FOR CHILD DENTAL SERVICES WERE 69% OF PRIVATE DENTAL BENEFIT PLAN RATES IN NEW JERSEY COMPARED TO 49% IN THE U.S.

42%U.S.

106


New Mexico






OF NEW MEXICO MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

15%

New Mexico New Mexico New MexicoU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

New Mexico

U.S.

5% 10% 15% 20% 25%

24%

32%

55%

29%35%

48%51%

64%60%

64%60%

57%53%

59%

14%

15%

2000 2005 2013

107


http://ADA.org/HPI

64%

36%

32%

52%

58%

53%

74%

80%

11%

70%67%

92%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%46%

84%90%

86%15%

97%

100%

99%

99%

72%64%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.New Mexico

OF NEW MEXICO’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

77%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


59%OF HIGH-INCOME

NEW MEXICO ADULTS

52%OF LOW-INCOME

NEW MEXICO ADULTS

4.0

-5

0

5

10


5.9


New Mexico

U.S.New Mexico

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS


77%




8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

5.44.1

108

New Mexico


40%

60%

80%

100%

0%

20%


U.S.2013

New Mexico U.S.

49%49%


CHILD ADULT

NEW MEXICO 1.7% 0.6%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

New Mexico

U.S.

BETWEEN


decreased 24.9%in New Mexico


New Mexico


53%New Mexico

40

50

60

70

80

2001 2013

44.450.9

60.557.3

42%U.S.

109


New York






OF NEW YORK MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

11%

New York New York New YorkU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

New York

U.S.

5% 10% 15% 20% 25%

27%32%

43%

29%35%

48%

65%62% 60%

64%60%61%

58% 59%

14%

11%

2000 2005 2013

110


http://ADA.org/HPI


64%

32%

36%

74%

52%

58%

53%

77%

80%

11%

70%

76%

67%

92%

99%

89%90%

95%92%

55%

96%

88%

91%

100%

90%94%

96%78%

78%

58%

43%

79%56%

70%84%

90%15%

86%97%

100%

46%

99%72%

64%64%

44%94%

71%

97%23%

High-Income Adults

U.S.New York

OF NEW YORK’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

72%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


50%OF HIGH-INCOME

NEW YORK ADULTS

43%OF LOW-INCOME

NEW YORK ADULTS

4.0

-5

0

5

10

-10

4.1


5.9


New York

U.S.New York

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

72%




7.9HIGH-INCOME

ADULTS

7.6LOW-INCOME

ADULTS

5.8

111

40

50

60

70

80

2001 2013

60.557.3

75.0

40%

60%

80%

100%

0%

20%


U.S.New York2013

49%37%BETWEEN


decreased 33.9%in New York


CHILD ADULT

NEW YORK 5.4% 3.8%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

New York


New York U.S.


38%New York


New York

73.5

42%U.S.

112


North Carolina






OF NORTH CAROLINA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

16%

North Carolina North Carolina North CarolinaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

North Carolina

U.S.

5% 10% 15% 20% 25%

24%

40%

52%

29%35%

48%

56%

65%60%

64%60%59%58% 59%

14%

16%

2000 2005 2013

113


http://ADA.org/HPI

64%

36%

32%

52%

58%

53%

74%

80%

11%

70%67%

92%

89%90%

95%92%

55%

91%

100%

90%

94%

96%

78%

78%58%

43%

72%

79%56%

70%46%

84%90%

86%15%

97%

96%100%

99%

99%

72%

77%

64%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.North Carolina

OF NORTH CAROLINA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

88%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


55%OF HIGH-INCOME

NORTH CAROLINA ADULTS

31%OF LOW-INCOME

NORTH CAROLINA ADULTS

4.0

-5

0

5

10


5.9


North Carolina

U.S.North Carolina

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS


88%




8.5HIGH-INCOME

ADULTS7.3

LOW-INCOMEADULTS

3.76.2

114

40

50

60

70

80

2001 2013

27%

North Carolina


40%

60%

80%

100%

0%

20%


U.S.2013

North Carolina U.S.

49%


CHILD ADULT

NORTH CAROLINA 1.9% 0.5%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

North Carolina

U.S.

BETWEEN


decreased 22.1%in North Carolina

42.347.9


North Carolina


North Carolina

48%

60.557.3

42%U.S.

115


North Dakota






OF NORTH DAKOTA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

11%

North Dakota North Dakota North DakotaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

North Dakota

U.S.

5% 10% 15% 20% 25%

13%

27%33%

29%35%

48% 50% 51%

60%64%

60%

50%49%

59%

14%

11%

2000 2005 2013

116


http://ADA.org/HPI

64%

36%

32%

52%

58%

53%

77%

74%

80%

11%

70%67%

92%

89%90%

95%92%

55%

96%

88%

91%

100%

90%

94%96%

78%

78%58%

43%

72%

79%56%

70%46%

84%90%

15%86%97%

100%

99%

99%

72%64%

71%

64%

44%94%

76%

23%

High-Income Adults

U.S.North Dakota

OF NORTH DAKOTA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

97%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


51%OF HIGH-INCOME

NORTH DAKOTA ADULTS

40%OF LOW-INCOME

NORTH DAKOTA ADULTS

4.0

-5

0

5

10


5.9


North Dakota

U.S.North Dakota

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS


97%




8.4HIGH-INCOME

ADULTS7.5

LOW-INCOMEADULTS

5.43.8

117

40

50

60

70

80

2001 2013

North Dakota


40%

60%

80%

100%

0%

20%


U.S.

North Dakota U.S.

2013

49%


CHILD ADULT

NORTH DAKOTA 13.6% 11.7%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

North Dakota

63%

U.S.


83%North Dakota

47.754.457.3 60.5


North Dakota

IN 2013, MEDICAID REIMBURSEMENT RATES FOR CHILD DENTAL SERVICES WERE 63% OF PRIVATE DENTAL BENEFIT PLAN RATES IN NORTH DAKOTA COMPARED TO 49% IN THE U.S.

42%U.S.

118


Ohio






OF OHIO MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

6%

Ohio Ohio OhioU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Ohio

U.S.

5% 10% 15% 20% 25%

42%36%

42%

29%35%

48%

62% 62% 60%64%

60%61%57% 59%

2000 2005 2012 2013

6%

14%

119


http://ADA.org/HPI


64%

36%

32%

52%

58%

53%

77%

80%

11%

70%67%

92%

89%

95%

55%

96%

88%

91%

100%

90%94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%

90%

15%86%97%

100%

46%

99%

99%

72%

74%

64%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.Ohio

OF OHIO’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

92%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


55%OF HIGH-INCOME

OHIO ADULTS

43%OF LOW-INCOME

OHIO ADULTS

4.0

-5

0

5

10


5.9

U.S.Ohio

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

8.0LOW-INCOME

ADULTS

6.5

92%





Ohio

8.6HIGH-INCOME

ADULTS

4.3

120

Ohio


40%

60%

80%

100%

0%

20%


U.S.2013

Ohio U.S.

49% BETWEEN


decreased 32.3%in Ohio


CHILD ADULT

OHIO -0.9% -1.2%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.Ohio


20%Ohio

41%


Ohio

40

50

60

70

80

52.1 51.957.3 60.5

2001 2013

42%U.S.

121


Oklahoma






OF OKLAHOMA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

9%

Oklahoma Oklahoma OklahomaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Oklahoma

U.S.

5% 10% 15% 20% 25%

18%

36%

51%

29%35%

48%

55% 57%60%

64%60%

56%51%

59%

9%

14%

2000 2005 2013

122


http://ADA.org/HPI


64%

36%

32%

52%

58%

53%

77%

80%

11%

67%

92%

89%

95%

55%

96%

88%

91%92%

100%

90%

94%96%

78%

78%58%

43%

72%

79%56%

70%84%

90%90%

15%86%97%

100%

46%

99%

99%

72%

74%

64%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.Oklahoma

OF OKLAHOMA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

70%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


44%OF HIGH-INCOME

OKLAHOMA ADULTS

48%OF LOW-INCOME

OKLAHOMA ADULTS

4.0

-5

0

5

10


5.9

U.S.Oklahoma

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

70%





Oklahoma

8.4HIGH-INCOME

ADULTS7.1

LOW-INCOMEADULTS

3.15.7

123

Oklahoma


40%

60%

80%

100%

0%

20%


U.S.2013

Oklahoma U.S.

49% BETWEEN


decreased 18.2%in Oklahoma


CHILD ADULT

OKLAHOMA 5.1% 2.8%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Oklahoma


Oklahoma

40

50

60

70

80

48.0 50.457.3 60.5

2001 2013


Oklahoma

55%

52% 42%U.S.

124


Oregon






OF OREGON MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

13%

Oregon Oregon OregonU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Oregon

U.S.

5% 10% 15% 20% 25%

28%32%

45%

29%35%

48%

60%

71%

60%64%

60%61%

69%

59%

2000 2005 2013

14%

13%

125


http://ADA.org/HPI


64%

36%

32%

52%

58%

53%

77%

80%

11%

67%

92%

89%

95%

55%

96%

88%

91%

92%

100%

90%

94%

96%

78%

78%58%

43%

72%

79%56%

70%84%

90%90%

15%86%97%

100%

46%

99%

99%

72%

74%

64%

70%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.Oregon

OF OREGON’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

23%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


56%OF HIGH-INCOME OREGON ADULTS

52%OF LOW-INCOME OREGON ADULTS

4.0

-5

0

5

10


5.9

U.S.Oregon

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

23%





Oregon

4.25.3

8.8HIGH-INCOME


ADULTS

126

Oregon


40%

60%

80%

100%

0%

20%


U.S.2013

Oregon U.S.

49% BETWEEN


decreased 27.8%in Oregon


CHILD ADULT

OREGON -0.4% -3.3%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.Oregon


Oregon

40

50

60

70

80

57.3 60.5

2001 2013

39%


Oregon

33%

68.963.4

42%U.S.

127


Pennsylvania






OF PENNSYLVANIA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

13%

Pennsylvania Pennsylvania PennsylvaniaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Pennsylvania

U.S.

5% 10% 15% 20% 25%

22%

29%

45%

29%35%

48%

71%71%

60%64%

60%66%

62%59%

14%

13%

2000 2005 2013

128


http://ADA.org/HPI


64%

36%

32%

52%

58%

53%

77%

80%

11%

67%

92%

89%

95%

96%

88%

91%92%

100%

90%94%

96%

78%

78%58%

43%

79%56%72%

70%84%

90%90%

15%86%97%

100%

46%

99%

99%

72%

74%

64%

70%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.Pennsylvania

OF PENNSYLVANIA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

55%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


58%OF HIGH-INCOME

PENNSYLVANIA ADULTS

50%OF LOW-INCOME

PENNSYLVANIA ADULTS

4.0

-5

0

5

10


5.9

U.S.Pennsylvania

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

55%





Pennsylvania

8.9HIGH-INCOME

ADULTS7.5

LOW-INCOMEADULTS

6.53.8

129

43%

Pennsylvania


40%

60%

80%

100%

0%

20%


U.S.2013

Pennsylvania U.S.

49% BETWEEN


decreased 19.3%in Pennsylvania


CHILD ADULT

PENNSYLVANIA 1.6% 0.4%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Pennsylvania


Pennsylvania

40

50

60

70

80

57.3 60.5

2001 2013

68%60.261.8


Pennsylvania

42%U.S.

130


Rhode Island






OF RHODE ISLAND MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

10%

Rhode Island Rhode Island Rhode IslandU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Rhode Island

U.S.

5% 10% 15% 20% 25%

36% 38%

47%

29%35%

48%

72%

62% 60%64%

60%58%

67%

59%

14%

10%

2000 2005 2013

131


http://ADA.org/HPI


64%

36%

32%

52%

58%

53%

77%

80%

11%

67%

92%

89%

95%

96%

88%

91%

92%

100%

90%94%

96%

78%

78%58%

43%

79%

56%

72%

55%

70%

90%90%

15%86%97%

100%

46%

99%

99%

72%

74%

64%

70%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.Rhode Island

OF RHODE ISLAND’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

84%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


45%OF HIGH-INCOME

RHODE ISLAND ADULTS

52%OF LOW-INCOME

RHODE ISLAND ADULTS

4.0

-5

0

5

10


5.9

U.S.Rhode Island

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS





Rhode Island

7.7LOW-INCOME

ADULTS

8.4HIGH-INCOME

ADULTS

5.5 4.4

84%

132

28%

Rhode Island


40%

60%

80%

100%

0%

20%


U.S.2013

Rhode Island U.S.

49% BETWEEN


decreased 32.3%in Rhode Island


CHILD ADULT

RHODE ISLAND -6.4% -5.9%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Rhode Island


Rhode Island

40

50

60

70

80

2001 2013

53.755.6


Rhode Island

60.557.3

45% 42%U.S.

133


South Carolina






OF SOUTH CAROLINA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

14%

South Carolina South Carolina South CarolinaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

South Carolina

U.S.

5% 10% 15% 20% 25%

30%

46%

53%

29%35%

48%

61%

54%60%

64%60%

55% 53%59%

14%

14%

2000 2005 2013

134


http://ADA.org/HPI


64%

36%

32%

52%

58%

53%

77%

80%

11%

67%

92%

89%

95%96%

88%

91%92%

100%

90%

96%

78%

78%58%

43%

79%56%

72%

55%

70%

90%90%

15%86%97%

100%

46%

99%

99%

72%

74%

64%

70%

71%

64%

44%94%

76%

97%23%

High-Income Adults

U.S.South Carolina

OF SOUTH CAROLINA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

94%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


70%OF HIGH-INCOME

SOUTH CAROLINA ADULTS

35%OF LOW-INCOME

SOUTH CAROLINA ADULTS

4.0

-5

0

5

10


5.9

U.S.South Carolina

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

7.2LOW-INCOME

ADULTS





South Carolina

8.6HIGH-INCOME

ADULTS

3.66.7

84%

94%

135

South Carolina


40%

60%

80%

100%

0%

20%


U.S.2013

South Carolina U.S.

49% BETWEEN


decreased 27.6%in South Carolina


CHILD ADULT

SOUTH CAROLINA 2.2% 1.5%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

South Carolina


South Carolina

40

50

60

70

80

2001 2013

48%


South Carolina

53%

45.2 47.9

60.557.3

42%U.S.

136


South Dakota






OF SOUTH DAKOTA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

11%

South Dakota South Dakota South DakotaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

South Dakota

U.S.

5% 10% 15% 20% 25%

26%

36%

45%

29%35%

48%

60%59% 60%64%

60%54% 53%

59%

14%

11%

2000 2005 2013

137


http://ADA.org/HPI


64%

36%

32%

52%

58%

53%

77%

80%

11%

67%

92%

89%

95%

96%

88%

91%

92%

100%

90%

96%

78%

78%58%

43%

79%56%

72%

55%

70%

90%90%

15%86%97%

100%

46%

99%

99%

72%

74%

64%

70%

71%

64%

44%

94%

76%

97%

23%

High-Income Adults

U.S.South Dakota

OF SOUTH DAKOTA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

94%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


61%OF HIGH-INCOME

SOUTH DAKOTA ADULTS

46%OF LOW-INCOME

SOUTH DAKOTA ADULTS

4.0

-5

0

5

10


5.9

U.S.South Dakota

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS





South Dakota

4.4

84%

94%

7.3LOW-INCOME

ADULTS

7.7HIGH-INCOME

ADULTS

4.1

138

South Dakota


40%

60%

80%

100%

0%

20%


U.S.2013

South Dakota U.S.

49%


CHILD ADULT

SOUTH DAKOTA 10.7% 7.7%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

South Dakota


South Dakota

40

50

60

70

80

2001 2013

57.3

65%

51%

45.954.1


South Dakota

60.5

IN 2013, MEDICAID REIMBURSEMENT RATES FOR CHILD DENTAL SERVICES WERE 51% OF PRIVATE DENTAL BENEFIT PLAN RATES IN SOUTH DAKOTA COMPARED TO 49% IN THE U.S.

42%U.S.

139


Tennessee






OF TENNESSEE MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

15%

Tennessee Tennessee TennesseeU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

29%

40%

53%

29%35%

48%

58%55%

60%64%

60%57%

53%59%

Tennessee 15%

U.S.

5% 10% 15% 20% 25%

14%

2000 2005 2013

140


http://ADA.org/HPI


64%

36%

32%

52%

58%

53%

77%

80%

11%

67%

92%

89%

95%

96%

88%

91%

92%

96%

78%

78%58%

43%

79%56%

72%

55%

70%

90%90%

15%86%97%

100%

100%

46%

99%

99%

72%

74%

64%

70%

71%

64%

44%

94%

94%

76%

97%23%

High-Income Adults

U.S.Tennessee

OF TENNESSEE’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

90%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


42%OF HIGH-INCOME

TENNESSEE ADULTS

50%OF LOW-INCOME

TENNESSEE ADULTS

4.0

-5

0

5

10


5.9

U.S.Tennessee

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS





Tennessee

84%

90%

4.8

7.9HIGH-INCOME

ADULTS

7.5LOW-INCOME

ADULTS

6.2

141

54%

Tennessee


40%

60%

80%

100%

0%

20%


U.S.2013

Tennessee U.S.

49%


CHILD ADULT

TENNESSEE 2.0% 0.7%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Tennessee


Tennessee

40

50

60

70

80

2001 2013

35%50.6 50.0

60.5


Tennessee

BETWEEN


decreased 37.5%in Tennessee

57.3

42%U.S.

142


Texas






OF TEXAS MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

19%

Texas Texas TexasU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Texas

U.S.

5% 10% 15% 20% 25%

42%47%

64%

29%35%

48%

61%

54%60%

64%60%

54% 53%59%

14%

19%

2000 2005 2013

143


http://ADA.org/HPI


64%

36%

32%

58%

53%

77%

11%

67%

92%

89%

95%

96%

88%

91%

92%

96%

78%

78%58%

43%

79%56%

72%

55%

70%

90%90%

90%

15%86%97%

100%100%

46%

99%

99%

72%52%

74%

64%

70%

71%

64%

44%

94%

94%

76%

97%23%

High-Income Adults

U.S.Texas

OF TEXAS’ POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

80%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


53%OF HIGH-INCOME

TEXAS ADULTS

50%OF LOW-INCOME

TEXAS ADULTS

4.0

-5

0

5

10


5.9

U.S.Texas

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

7.2LOW-INCOME

ADULTS





Texas

84%

80%

7.3HIGH-INCOME

ADULTS

4.24.9

144

48%

60%

Texas


40%

60%

80%

100%

0%

20%


U.S.2013

Texas U.S.

49%


CHILD ADULT

TEXAS -1.1% -3.2%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Texas


Texas

40

50

60

70

80

2001 2013

BETWEEN


increased 33.8%in Texas


Texas

50.545.2

60.557.3

42%U.S.

145


Utah






OF UTAH MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

18%

Utah Utah UtahU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

Utah

U.S.

5% 10% 15% 20% 25%

33%38%

53%

29%35%

48%

66%65%60%

64%60%61% 60% 59%

14%

2000 2005 2013

18%

146


http://ADA.org/HPI


64%

36%

32%

58%

53%

77%

80%

11%

67%

92%

89%

95%

96%

88%

91%

92%

96%

78%

78%58%

43%

79%56%

72%

55%

70%

90%90%

90%

15%86%97%

100%100%

46%

99%

99%

72%

74%

64%

70%

71%

64%

44%

94%

94%

76%

97%23%

High-Income Adults

U.S.Utah

OF UTAH’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

52%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


48%OF HIGH-INCOME

UTAH ADULTS

55%OF LOW-INCOME

UTAH ADULTS

4.0

-5

0

5

10


5.9

U.S.Utah

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS





Utah

84%52%

8.0HIGH-INCOME

ADULTS7.0

LOW-INCOMEADULTS

4.75.4

147

43%

Utah


40%

60%

80%

100%

0%

20%


U.S.2013

Utah U.S.

49%


CHILD ADULT

UTAH -4.1% -6.3%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Utah


Utah

40

50

60

70

80

2001 2013

60%60.5

BETWEEN


decreased 4.8%in Utah

57.3


Utah

65.261.7

42%U.S.

148


Vermont






OF VERMONT MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

15%

Vermont Vermont VermontU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

48%52%

60%

29%35%

48%

72%70%

60%64%

60%63%

66%

59%

Vermont 15%

U.S.

5% 10% 15% 20% 25%

14%

2000 2005 2013

149


http://ADA.org/HPI


64%

36%

32%

58%

53%

77%

11%

67%

80%

92%

89%

95%

96%

88%

91%

92%

96%

78%

78%58%

43%

79%

72%

55%

70%

90%90%

90%

15%86%97%

100%100%

46%

99%

99%

72%52%

74%

64%

70%

71%

64%

44%

94%

94%

76%

97%23%

High-Income Adults

U.S.Vermont

OF VERMONT’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

56%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


53%OF HIGH-INCOME VERMONT ADULTS

50%OF LOW-INCOME

VERMONT ADULTS

4.0

-5

0

5

10


5.9

U.S.Vermont

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS





Vermont

84%

56%

8.5HIGH-INCOME


ADULTS

6.04.5

150

50%

Vermont


40%

60%

80%

100%

0%

20%


U.S.2013

Vermont U.S.

49%


CHILD ADULT

VERMONT 5.9% 4.8%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Vermont


Vermont

40

50

60

70

80

2001 2013

57.3


Vermont

58.2 60.557.8

IN 2013, MEDICAID REIMBURSEMENT RATES FOR CHILD DENTAL SERVICES WERE 50% OF PRIVATE DENTAL BENEFIT PLAN RATES IN VERMONT COMPARED TO 49% IN THE U.S.

42%76%U.S.

151


Virginia






OF VIRGINIA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

14%

Virginia Virginia VirginiaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

21%26%

52%

29%35%

48%

68%62% 60%

64%60%62% 62%

59%

Virginia

U.S.

5% 10% 15% 20% 25%

14%

14%

2000 2005 2013

152


http://ADA.org/HPI


64%

36%

32%

58%

53%

77%

11%

67%

80%

92%

89%

95%

88%

91%

92%

96%

78%

78%58%

43%

79%

72%

55%

70%

90%90%

90%

15%86%97%

100%100%

46%

56%

99%

99%

72%52%

74%

64%

70%

71%

64%

44%

94%

94%

76%

97%23%

High-Income Adults

U.S.Virginia

OF VIRGINIA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

96%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


52%OF HIGH-INCOME VIRGINIA ADULTS

40%OF LOW-INCOME VIRGINIA ADULTS

4.0

-5

0

5

10


5.9

U.S.Virginia

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

7.2LOW-INCOME

ADULTS





Virginia

84%

96%

8.8HIGH-INCOME

ADULTS

4.06.4

153

Virginia


40%

60%

80%

100%

0%

20%

U.S.2013

Virginia U.S.

49%


CHILD ADULT

VIRGINIA 8.6% 6.8%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Virginia


Virginia

40

50

60

70

80

2001 2013

57.3 60.5


Virginia

47%BETWEEN


decreased 5.7%in Virginia

31%58.2

62.8


42%U.S.

154


Washington






OF WASHINGTON MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

18%

Washington Washington WashingtonU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

46%44%

59%

29%35%

48%

71%

63%60%

64%60%62%

67%

59%

Washington

U.S.

5% 10% 15% 20% 25%

14%

18%

2000 2005 2013

155


http://ADA.org/HPI


36%

32%

58%

53%

77%

11%

67%

80%

92%

89%

95%

88%

96%91%

92%

96%

78%

78%58%

43%

79%

72%

55%

70%

90%90%

90%

15%86%97%

100%100%

46%

56%

99%

99%

72%52%

74%

64%

70%

71%

64%

44%

94%

94%

76%

97%23%

High-Income Adults

U.S.Washington

OF WASHINGTON’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

64%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


60%OF HIGH-INCOME

WASHINGTON ADULTS

44%OF LOW-INCOME

WASHINGTON ADULTS

4.0

-5

0

5

10


5.9

U.S.Washington

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS





Washington

84%

64%

6.3

6.8LOW-INCOME

ADULTS

8.6HIGH-INCOME

ADULTS

4.5

156

41%

Washington


40%

60%

80%

100%

0%

20%

U.S.2013

Washington U.S.

49%


CHILD ADULT

WASHINGTON -8.1% -10.3%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Washington


Washington

40

50

60

70

80

2001 2013

57.3 60.5

BETWEEN


decreased 23.7%in Washington


Washington

66.171.0

29%


42%U.S.

157


West Virginia






OF WEST VIRGINIA MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

15%

West Virginia West Virginia West VirginiaU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

34%

44%

52%

29%35%

48%

57%59% 60%64%

60%

51% 51%

59%

West Virginia

U.S.

5% 10% 15% 20% 25%

14%

15%

2000 2005 2013

158


http://ADA.org/HPI


36%

64%

32%

58%

53%

77%

11%

67%

80%

92%

89%

95%

88%

96%

92%

96%

78%

78%58%

43%

79%

72%

55%

70%

90%90%

90%

15%86%97%

100%100%

46%

56%

99%

99%

72%52%

74%

64%

70%

71%

64%

44%

94%

94%

76%

97%23%

High-Income Adults

U.S.West Virginia

OF WEST VIRGINIA’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

91%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


53%OF HIGH-INCOME

WEST VIRGINIA ADULTS

50%OF LOW-INCOME

WEST VIRGINIA ADULTS

4.0

-5

0

5

10


5.9

U.S.West Virginia

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS





West Virginia

84%91%

6.3

3.1

7.9HIGH-INCOME

ADULTS6.4

LOW-INCOMEADULTS

159

70%

West Virginia


40%

60%

80%

100%

0%

20%


U.S.2013

West Virginia U.S.

49%


CHILD ADULT

WEST VIRGINIA 5.7% 4.1%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

West Virginia


West Virginia

40

50

60

70

80

2001 2013

BETWEEN


decreased 0.4%in West Virginia

47.9 48.0

71%


West Virginia

57.3 60.5

42%U.S.

160


Wisconsin






OF WISCONSIN MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

11%

Wisconsin Wisconsin WisconsinU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

22% 22%28% 29%

35%

48%

67%68%

60%64%

60%

68%63%

59%

Wisconsin

U.S.

5% 10% 15% 20% 25%

14%

11%

2000 2005 2013

161


http://ADA.org/HPI


36%

64%

32%

58%

53%

77%

11%

67%

80%

92%

91%95%

88%

96%

92%

96%

78%

78%58%

43%

79%

72%

55%

70%

90%90%

90%

15%86%97%

100%100%

46%

56%

99%

99%

72%52%

74%

64%

70%

71%

64%

44%

94%

94%

76%

97%23%

High-Income Adults

U.S.Wisconsin

OF WISCONSIN’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

89%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


53%OF HIGH-INCOME

WISCONSIN ADULTS

52%OF LOW-INCOME

WISCONSIN ADULTS

4.0

-5

0

5

10


5.9

U.S.Wisconsin

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS





Wisconsin

84%

89%

8.6HIGH-INCOME

ADULTS7.1

LOW-INCOMEADULTS

5.93.6

162

32%

Wisconsin


40%

60%

80%

100%

0%

20%


U.S.2013

Wisconsin U.S.

49%


CHILD ADULT

WISCONSIN 10.0% 7.7%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Wisconsin


40

50

60

70

80

2001 2013

BETWEEN


decreased 31.7%in Wisconsin

56.8 56.057.3 60.5


Wisconsin

42%U.S.

36%Wisconsin

163


Wyoming






OF WYOMING MEDICAID CHILDREN 6 THROUGH 14 YEARS OLD RECEIVED A SEALANT ON A PERMANENT MOLAR IN 2013, COMPARED TO 14% NATIONALLY

14%

Wyoming Wyoming WyomingU.S.



U.S. U.S.

20%

40%

60%

80%

100%

0%

33% 35%

45%

29%35%

48%54%52%

60%64%

60%

50% 51%

59%

2000 2005 2013

Wyoming

U.S.

5% 10% 15% 20% 25%

14%

14%

164


http://ADA.org/HPI


36%

64%

32%

58%

53%

77%

11%

67%

80%

92%

89%

95%

88%

96%

92%

91%

96%

78%

78%58%

43%

79%

72%

55%

70%

90%90%

90%

15%86%97%

100%100%

46%

56%

99%

99%

72%52%

74%

64%

70%

71%

64%

94%

94%

76%

97%23%

High-Income Adults

U.S.Wyoming

OF WYOMING’S POPULATION ON COMMUNITY WATER SYSTEMS RECEIVE FLUORIDATED WATER

44%

Positive

Negative

Neutral

0-25%

26-50%

51-75%

76-100%


56%OF HIGH-INCOME

WYOMING ADULTS

44%OF LOW-INCOME

WYOMING ADULTS

4.0

-5

0

5

10


5.9

U.S.Wyoming

Exce

llent

O

ral H

ealth

Poor

O

ral H

ealth

2

10

4

6

8

0

8.2HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS





Wyoming

84%

44%

3.5

7.9HIGH-INCOME

ADULTS7.2

LOW-INCOMEADULTS

5.4

165

Wyoming

61%


40%

60%

80%

100%

0%

20%


U.S.2013

Wyoming U.S.

49%


CHILD ADULT

WYOMING 12.5% 7.9%U.S. 1.2% -0.6%


-5%

0%


Adul

t Den

tal S

ervi

ces

5% 10% 15%-10%-15% -5%

0%

5%

10%

15%

-15%

-10%

U.S.

Wyoming


Wyoming

40

50

60

70

80

2001 2013

53.8 53.0

73%57.3 60.5


Wyoming

IN 2013, MEDICAID REIMBURSEMENT RATES FOR CHILD DENTAL SERVICES WERE 61% OF PRIVATE DENTAL BENEFIT PLAN RATES IN WYOMING COMPARED TO 49% IN THE U.S.

42%U.S.

166

Documents

ADA.org: HPI's The Oral Health Care System: A State-by ... › ~ › media › ADA › Science and... · models, a critical aim of the Affordable Care Act. Third, policymakers need