Oral Health Needs Assessment

To re-assess the oral health needs of Orange County (OC) residents, the Local Oral Health Program (LOHP) used data and information from the 2018-2022 LOHP Evaluation Report. Prevalence of oral diseases among various age cohorts; gaps in access and use of preventive services; dental provider availability in the Medi-Cal Dental Program; and access to optimum levels of community water fluoridation were analyzed. The following is a summary of data collected and used to develop the current (2023-2027) Orange County Oral Health Needs Assessment. More information on the Oral Health Needs Assessment can be found on the Orange County Oral Health Strategic Plan 2023-2027.

Prevalence of Tooth Decay Among Kindergarten and Grade 3 Children

Based on Centers for Disease Control and Prevention (CDC) reporting, the national rates of tooth decay among children ages 2-5 years are approximately 22%. Data from the 2020 California Smiles Survey reveals that just over 60% of 3rd Grade children experience tooth decay.

Untreated Tooth Decay Among Kindergarten and Grade 3 Children

Untreated tooth decay is a significant problem for low-income children. In OC, approximately 11% have untreated tooth decay. Based on data from the 2020 California Smiles Survey, the rate of untreated tooth decay among 3rd Grade children living in Southern California increased by 7 percentage points.

It should be noted that this data reflects all counties in Southern California (Orange, San Diego, San Bernardino, Riverside, & Imperial) excluding Los Angeles County. During the next grant cycle, LOHP plans to collaborate and coordinate with the Office of Oral Health to obtain OC specific data.

Prevalence of Dental Sealants Among Grade 3 Children

According to California Smile Survey data, 40% of Grade 3 children living in Southern California had at least one dental sealant on a molar tooth.

Despite overall increases in the prevalence of dental sealants among OC’s 3rd Grade children, receipt of dental sealants among OC’s most vulnerable children is decreasing. In 2013, 23% of Medi-Cal enrolled children ages 6-9 received at least one dental sealant. In 2019 and 2020, that rate dropped to 20% and 16% respectively.

Kindergarten Children with Proof of Assessment

Data submitted by 11 of the 27 OC district school health administrators during the 2021-22 school year, demonstrates that just under half of kindergarten parents are providing proof of oral health assessment. This number is down from the 2018-2019 academic year, where approximately 60% either returned the KOHA form or had a school-based dental screening.

To address this, the LOHP is currently collaborating and coordinating with the OC Department of Education (OCDE) and administrators of the System for California Oral Health Reporting (SCOHR) platform to establish a countywide system for improved KOHA data collection and reporting.

Medi-Cal Enrolled Children Who Received a Preventive Dental Visit

In 2019, 54% of OC low-income children received a preventive dental service but then dropped to 44% in 2020. The LOHP met its target; however, access and use of services dropped in 2020 due to COVID-19. It is anticipated that this rate will increase again now that services have become more readily available.

Medi-Cal Enrolled Children Who Received Any Dental Visit

In 2019, 56% of low-income children living in OC visited a dentist, just short of the target of 57%. This increase demonstrates that more low-income children are accessing dental care.

Medi-Cal Enrolled Adults Who Received Any Dental Visit

The rate of dental care utilization among OC Medi-Cal adults jumped from 19% in 2019 to 25% in 2020 respectively, however, OC low-income adults still use services far less than their more affluent counterparts. According to 2019 National Center for Health Statistics, approximately 66% of US Adults with commercial dental insurance visit a dentist each year. The LOHP will continue to promote dental care use among its most vulnerable adults.

Medi-Cal Enrolled Older Adults Who Received Any Dental Visit

Similar to adults (21-64), low-income seniors (65 + years) also realized an increase in dental care services.  According to Medi-Cal data, use of dental services increased from 8% to 25% between 2013 and 2020. This rate represents a seventeen-percentage point increase in care for this population. The LOHP will continue to promote dental care use among its most vulnerable older adults.

Medi-Cal Enrolled Pregnant Individuals Who Received a Preventive Dental Visit

The American Dental Association, American Academy of Pediatric Dentistry and American Collage of Gynecologists and Obstetricians (ACOG), along with the Health Resources and Services Administration Bureau of Maternal and Child Health, recommends that pregnant individuals receive preventive dental care during pregnancy.

Information regarding the use of such services among OC residents is unavailable however, national data demonstrates low-income, and Medicaid eligible pregnant individuals are less likely to receive these services. The LOHP plans to continue its efforts at promoting preventive services for pregnant individuals during the next grant cycle.

Incidence of Oral Pharyngeal Cancer

Oral Pharyngeal Cancer rates in Orange County remained the same between 2014 and 2018. Progress toward this target could not be assessed as no recent data is available. LOHP relies on State data reporting for this measure. The LOHP will work closely with the California Department of Public Health during the next grant cycle to determine and assess rates of Oral Cancer in Orange County.

Rate of Non-traumatic Dental Visits to the Hospital Emergency Department

According to the Office of Statewide Health Planning and Development, non-traumatic dental use of the Emergency Department is a costly and ineffective way of sustaining the oral health of the county population. Updated data is not currently available to report on this measure.

Number of Water Systems Maintaining Optimum Community Water Fluoridation

Healthy People 2030 has set a goal of 77% of the population as the measure of the number of people served by water systems that maintain optimum community water fluoridation (CWF) levels. In California, approximately 50% of the population has access to optimally fluoridated drinking water.

The LOHP has set a goal of 12 water systems maintaining optimum CWF levels. Based on recent activity and data, OC is close to this number. OC will continue to work with water system operators to promote and support the expansion of CWF in OC.

Percentage of Dental Providers Participating in the Medi-Cal Dental Program

Access and utilization of dental care by Medi-Cal beneficiaries is dependent upon an adequate dental workforce. Medicaid dental programs have traditionally struggled to maintain a sufficient dental network due to low reimbursement rates.

According to the California Dental Association in May 2020, 2,441 Orange County dental providers were enrolled in the Medi-Cal dental program. This number represents 66% of the licensed dentists (3,716) practicing in Orange County.

Between January 15, 2018 and June 30, 2018, the Orange County Local Oral Health Program conducted a comprehensive oral health needs assessment.  This included analysis of secondary data, and the collection and analysis of primary data.  Primary data included both quantitative data and qualitative data in the form of key-informant interviews and focus groups. The 2018-2022 oral health needs assessment focused on these key areas:

Prevalence of Dental Disease in Children

Tooth decay is preventable, yet nationally, it is the most common chronic condition affecting children 6-11 years of age.

Utilization of Dental Services by Children

Utilization of dental services is an important indicator of access to dental care and timely receipt of age-appropriate services. 

Oral Health Status during Pregnancy

Pregnancy is characterized by unique and complex physiological changes, which may also adversely affect oral health.

Utilization of Dental Services by Adults

Dental disease can affect individuals across the life span. Early prevention coupled with ongoing care and maintenance through adulthood is necessary.

Older Adults and Individuals with Special Health Care Needs

Older adults have unique oral health care needs and face a myriad of barriers in accessing care and maintaining good oral health. Individuals with intellectual/developmental disabilities and special health care needs are at an elevated risk of tooth decay, gum disease and associated exacerbation of existing health issues.

Dental Workforce Capacity and the Oral Health Care System

Healthcare providers are an integral component of the public health system and assuring competent public and personal health care workforce is an ‘Essential Public Health Service’.

To access a variety of Orange County data and community indicators, please visit the 2023 Orange County Community Health Assessment.