Oral health survey brings
no smiles to isle officials

Hawaii's high ranking does not reflect its
rate of tooth decay, says the state dental chief

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By Helen Altonn
haltonn@starbulletin.com

A high grade for Hawaii on a national report card on oral health does not reflect the state's high rate of dental disease, state health officials say.

One of four states getting the top grade of B-, Hawaii ranked first in an overall cumulative oral health score. Sharing that grade were Connecticut, Iowa and Utah.

Oral Health America, the advocacy group that released the study, gave the United States overall a C on the 22 measures scored.

State Health Director Bruce Anderson said Hawaii's good showing "is a testament to the hard work of public and private sectors working together to improve oral health in our community."

However, he said, more work must be done to increase use of cost-effective prevention programs and ensure that more people receive regular dental care.

"Hawaii continues to have a very high rate of tooth decay, which is costly for families and our taxpayers who support programs like Medicaid, which pay for dental care for about 10 percent of Hawaii residents," Anderson said.

Dr. Mark H.K. Greer, chief of the Dental Health Division, said the department does not disagree with anything in the report but that it needs to be qualified.

"It is reflective of certain indicators, but it is not representative of oral health as a whole," he said.

He said it does not reflect Hawaii's access-to-care problems and extremely high rates of tooth decay. Most states do not collect data on dental disease, so comparisons cannot be made in that area, he said.

For the most part, the report looked at the commitments and political structure in states to address oral health problems, he said.

"It's a snapshot of the status of oral health in states relative to each other. We happen to score very well in a lot of areas."

Hawaii's worst grade was an F for fluoridation. It is among 10 states where less than half of residents drink fluoridated water. Only 13 percent of island residents have access to fluoridated water.

It scored D's in prevention and use of dental sealants to protect children's teeth from decay.

Better grades -- A's and B's -- were given to Hawaii for access to care, oral health leadership and oral health status.

Hawaii has a high proportion of adults with dental insurance and relatively good access for children under Medicaid, but Medicaid coverage for adults is a problem, Greer said.

Medicaid and QUEST provide only emergency dental services to adults. Legislation has been proposed to close that gap.

Hawaii has one of the highest concentrations of dentists in the country, following Washington, D.C., and New York with the highest ratio of dentists per patient, Greer said. In Hawaii there is one dentist for every 1,287 residents.

The state ranked sixth in access to care for Medicaid-eligible children (33.3 percent) and fifth in dental care use the past year (74.7 percent).

Hawaii was lowest in the nation in use of smokeless tobacco (3.8 percent) and in the percentage (15.9 percent) of adults who lost all their teeth.

"Given our high rates of tooth decay," Anderson said, "we're fortunate to also have a large dentist population in Hawaii. However, we'd rather prevent tooth decay than continue to focus on treating the disease.

"Bringing fluoridation to Hawaii would significantly lower the need and expense of dental treatment for the whole community," he said.