Improving oral health for children in Medicaid, NC Health Choice

July 2013

Post Author

Berkeley Yorkery is a project director at the North Carolina Institute of Medicine ( 

Tooth decay is the most common chronic disease among children ages 5 to 19, affecting approximately 1 in 5 children. In North Carolina, 14 percent of children in kindergarten (ages 5-6) have untreated dental decay in at least one primary tooth. A number of factors put some children at greater risk of developing dental cavities, particularly low socioeconomic status and minority race/ethnicity. With proper dental care and dietary choices, dental cavities and decay could almost be eliminated among children. While North Carolina has made tremendous improvements in dental service utilization by children enrolled in Medicaid and NC Health Choice over the past decade, there is still room for improvement. Only 45 percent of children enrolled in Medicaid and 49 percent of the children enrolled in NC Health Choice received at least one preventive service from a dentist in FFY 2012.

In response to low utilization rates nationally, the Centers for Medicare and Medicaid Services asked all states to develop plans to improve utilization of preventive dental services. The North Carolina Institute of Medicine Task Force on Children’s Preventive Oral Health Services, in partnership with the North Carolina Division of Medical Assistance and others, studied the issue of how to increase utilization of preventive dental services by children enrolled in Medicaid and NC Health Choice and developed a series of policy recommendations:

  • Increase preventive care utilization through education and outreach to enrolled families and provider incentives.
  • Promote usage of sealants, which are effective in reducing cavities by approximately 60 percent among children ages 6-17. In North Carolina, fewer than 20 percent of children enrolled in either Medicaid or NC Health Choice received a sealant.
  • Increase education of primary care providers about the importance of oral health and strengthen collaboration between primary care providers and dentists.
  • Provide additional funding for public dental health hygienists who can provide preventive oral health services in schools.
  • Pilot private dental practice school-based programs in which practices would provide screenings, preventive services and sealants in schools.

The Task Force’s full report and recommendations are available at: