Policy and Position Statements


Oral Health Position Statement

I. ASTHO Supports State and Territorial Efforts to Improve Oral Health

The Association of State and Territorial Health Officials (ASTHO) supports federal and state and territorial health agency efforts to improve the oral health of their population by enhancing state oral health infrastructure, improving access to oral healthcare services, and ensuring that state oral health programs are well integrated in state health departments.

II. Within This Context, ASTHO Recommends:

  • Defining minimum oral health system standards to promote optimal oral health and overall health for all Americans by:

○ Focusing on prevention, access to care, and state and territorial public health infrastructure to address oral health needs, workforce development, and health disparities.
○ Increasing public health infrastructure funding for planning, delivering, and evaluating dental public health activities and services at the local, state, and national level. Enhancing state public health infrastructure is critical to building strong state oral health programs that are equipped to address essential public health services.
○ Promoting and leveraging funding for the promotion and expansion of evidence-based services such as community water fluoridation, school-based sealant programs, the integration of oral health into primary care, oral injury prevention and domestic violence programs. Collaborating with federal, state and territorial, and local resources to support the dental safety net.

  • Using evidence-based public health policies to promote oral health for the entire population with a particular focus on health inequities and disparities.1
  • Using a full array of public health, healthcare, and oral health professionals in a variety of settings to address oral health workforce shortages and increase access to preventive and restorative oral health services.
  • Supporting medical and dental collaborations across the lifespan in all healthcare settings.
  • Prioritizing oral health reforms into health systems transformation initiatives aimed at integrating and improving the delivery of high quality oral health services.
  • Promoting and leveraging funding for the expansion of oral health surveillance measures through the Pregnancy Risk Assessment Monitoring System survey, National Health and Nutrition Examination Survey, Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, National Oral Health Surveillance System oral health indicators, and other emerging state and national data systems.
  • Supporting improvements in oral health literacy efforts that use culturally competent materials at the appropriate literacy level and through relevant communication pathways.
  • Promoting the translation of research into evidence-based practice.
  • Promoting oral health by implementing the 10 Essential Services to Promote Oral Health.2Promoting the use of a health in all policies framework and the integration of oral health with community health and chronic disease programs such as maternal and child health, WIC, Medicaid, injury prevention, domestic violence screenings, aging, water quality, diabetes, asthma, nutrition and obesity, heart disease and stroke, cancer, tobacco, HIV/AIDS, school and adolescent health, minority health and rural health, primary care, etc., and collaborating closely with agencies that administer such programs. For example, oral health programs should collaborate with state water agencies around fluoridation.

III. Background:

ASTHO's members are responsible for the health of the residents in their states or territories. Dental diseases affect not only oral health, but also general health status. Studies show that some association exists between oral infections and cardiovascular disease and stroke, diabetes, respiratory infections, and the birth of premature, low-birth-weight babies.3 Oral health is one of the twelve leading indicators for Healthy People 2020.4

Social determinants of health, including income, education, cultural beliefs, and occupation, are strongly related to both child and adult health and oral health outcomes such as tooth decay, oral cancer, and tooth loss.5 Dental caries, or cavities, which result in tooth decay, are the most common chronic childhood disease and become more prevalent with increasing age. Approximately 51 million school hours are lost each year because of oral disease, which likely affects a child’s readiness to learn at school.6 In addition to having a higher occurrence of dental problems, more than one third of low-income children have untreated tooth decay and are also half as likely to have access to dental services as children whose families have higher incomes.7 While Americans of all ages continue to experience improvements in oral health, children aged 2 to 5 years are seeing an increase in tooth decay in their primary teeth,8 and many are developing early childhood caries (ECC). Early risk assessment and anticipatory guidance and use of evidence-based preventive procedures can help prevent ECC. Children of ethnic minorities and children whose primary caregiver has limited education are less likely to have access to dental services than white children and children whose primary caregivers have had more education.9

Poor oral health also seriously affects adults. Some oral diseases, such as periodontal (gum) disease, may be associated with diabetes and respiratory disease.10 More than 40 percent of low-income adults (20 years and older) have at least one untreated decayed tooth, compared to 16 percent of non-low­income adults.11 Most adults show signs of gum disease, and about 14 percent of adults aged 45 to 54 years are affected with severe gum disease.12 There is a notable social and economic burden associated with inadequate access to oral healthcare, with employed adults losing more than 164 million hours of work each year due to oral diseases and conditions.13

Dental sealants and community water fluoridation are proven methods to prevent dental caries.14 Dental sealants can reduce dental caries by 87 percent after 12 months.15 State Medicaid programs have seen cost savings if sealants are appropriately used for high-risk children. However, research has shown that sealants are underutilized.16

The oral health workforce environment is changing as states are developing and implementing new and innovative workforce models and effective programs to remove barriers and expand access to oral health services. Expanding the scope of practice to allow dental professionals to practice to the full extent of their education and training can expand service delivery. States and territories must develop effective infrastructure that meets oral health needs of all populations and effectively integrates oral health into overall health. Public programs must be adequately funded to allow equitable access to oral health services.17

Oral health surveillance systems funded by state and federal dollars support state and territory efforts to collect and disseminate accurate data about the health of their residents. These systems contain qualitative and quantitative data that allow health officials to identify successes and areas for improvement. Unfortunately, a high percentage of states do not have an ongoing and coordinated oral health surveillance system that allows them to (1) monitor the oral health of their residents, (2) document and monitor disparities, or (3) evaluate programs. In 2013/2014, 59 percent of states had minimal or no oral health epidemiology capacity and 45 percent did not have a written oral health surveillance plan, key components of any surveillance system.18 Healthy People 2020 identifies building public health surveillance systems as a national goal. State health jurisdictions should develop, implement, and maintain a robust, state-based oral health surveillance system that monitors oral health outcomes, access to dental care, individual risk factors and risk determinants, availability of interventions, workforce issues, public health infrastructure, and public policies.19

Approval History

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate policy committees and approved by the ASTHO Executive Committee. Position statements are not voted on by the full ASTHO membership.

Access Policy Committee Review and Approval: July 2015.
Board of Directors review and approval: September 2015.
Policy Expires: September 2018.


  1. Anderson LM, Brownson RC, Fullilove MT, Teutsch SM, Novick LF, Fielding J, Lane GH. “Evidence-based public health policy and practice: promises and limits.” American Journal of Preventive Medicine. 2005. Jun;28(5S);226-30.
  2. Association of State and Territorial Dental Directors. Guidelines for State and Territorial Oral Health Programs. Sparks, NV: Association of State and Territorial Dental Directors. Revised 2010. http://www.astdd.org/state-guidelines/. Accessed 12- 30-2014.
  3. Academy of General Dentistry. Position Paper on Increasing Access to and Use of Oral Health Care Services. Available at http://agd.org/media/54365/7025accesstocarewhitepaper7_31_08.pdf. Accessed 7-31-2015.
  4. Healthy People 2020. "Leading Health Indicators." http://www.healthypeople.gov/2020/Leading-Health-Indicators. Accessed 7-31-2015
  5. Anderson LM, Brownson RC, Fullilove MT, Teutsch SM, Novick LF, Fielding J, Lane GH. “Evidence-based public health policy and practice: promises and limits.” American Journal of Preventive Medicine. 2005. Jun; 28(5S);226-30.
  6. HHS. National Call to Action to Promote Oral Health. Rockville, MD: National Institute of Dental and Craniofacial Research. 2003.
  7. Kenney GM, McFeeters JR, Yee JY. “Preventive Dental Care and Unmet Dental Needs Among Low-Income Children.” American Journal of Public Health. 2005; 95(8):1360-1366. doi:10.2105/AJPH.2004.056523.
  8. Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital Health Stat 11. 2007(248):1-92.
  9. Stanton MW, Rutherford MK. Dental care: improving access and quality. Rockville, MD: Agency for Healthcare Research and Quality. 2003. Research in Action, No.13.
  10. Institute of Medicine. Advancing Oral Health in America. Washington, DC: The National Academies Press. 2011
  11. Center for Disease Control. "Fact Sheet: Oral Health for Adults." Available at http://www.cdc.gov/oralhealth/publications/factsheets/adult_oral_health/adults.htm. Accessed 7-31-2015.
  12. Ibid.
  13. Ibid.
  14. Institute of Medicine. Advancing Oral Health in America. Washington, DC: The National Academies Press. 2011.
  15. Ibid.
  16. Center for Disease Control. "Preventing Chronic Diseases: Investing Wisely in Health. Preventing Dental Caries with Cornmunity Programs." Available at http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/oh.pdf. Accessed 02-25-2012.
  17. Institute of Medicine and National Research Council. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press.
  18. Association of State and Territorial Dental Directors. Synopses of State Dental Public Health Programs, Data for FY 2012-2013. July 2014.
  19. Council of State and Territorial Epidemiologists. Epidemiology Capacity Assessment for Chronic Disease, Maternal and Child Health and Oral Health. 2014 (in press).