The Oral Health of Vermont

While Vermont has made great strides in oral health, there is much to do…

  • Of all Vermont children in grades 1-3, 34% have a history of caries (dental decay).[i]
  • 11.2 % of children in grades 1-3 have active decay.[ii]
  • Among adults ages 65-74 in Vermont, 14.7% have lost all of their natural teeth.[iii]

…and there are immense socio-economic oral health disparities

  • Nearly 45% of Medicaid eligible children have tooth decay, and 16% have untreated decay.[iv]
  • While roughly 95% of children had a dental visit at least annually, 50% of those children who never visited the dentist or visited the dentist less than once a year are primarily Medicaid eligible.[v]
  • Of all uninsured children aged 0-17, 20.2% did not receive dental care, including check-ups, because they could not afford it, compared to 2.9 % of children who were insured.[vi]
  • 34.5% of uninsured adults aged 18-64 did not seek dental care, including check-ups, because they could not afford it compared to 13.1 % of those with insurance.[vii]
  • Of adults aged 65 and older with less than a high school education, 54% have no teeth; 46.4% percent of adults aged 65 and older with less than $15,000 income level had no teeth.[viii]

The high cost of dental care impacts everyone

  • 60% of dental services are paid out-of-pocket while only 14% of health care services are paid out of pocket.[ix]
  • In 2009, Medicaid paid $2,210,131.00 to treat Vermont children aged 0 to 5 years who suffered from severe tooth decay.[x]
  • Medicaid was a primary payer for 55.7% of the visits to emergency departments due to dental problems and self-pay was listed for 25.8.[xi]

Community water fluoridation

  • Community water fluoridation effectively prevents tooth decay and is one of very few public health prevention measures that offer significant cost savings to almost all communities.[xii]
  • It has been estimated that about every $1 invested in community water fluoridation saves approximately $38 in averted costs.
  • Only 57% of the Vermont population with community water systems receives optimally fluoridated water. [xiii]
  • In 1952, the City of Burlington became the first Vermont community to provide fluoridated water to its residents. Since then, public water systems throughout Vermont have been providing this important community dental health measure.
  • Of 458 community water systems in Vermont, 68 systems currently fluoridate their drinking water and another 23 systems are eligible to participate in community water fluoridation.

School-based dental care

  • In communities that do not have fluoridated water, additional fluoride may be needed. The School-based Fluoride Mouth Rinse Program provides weekly fluoride mouth rinse to children in Vermont schools in communities without water fluoridation. Each year, over 90 percent of eligible Vermont schools participate in the program. [xiv]
  • Vermont’s school-linked dental sealant program, Tooth Tutor Dental Access Program (TTDAP),  connects children with local dental homes where they receive comprehensive dental care, including sealants. There are approximately 35 hygienists working as Tooth Tutors in 120 elementary schools as well as all Vermont Head Start programs throughout the state.[xv]

However, fluoridated water is the most cost-effective and equitable way to provide fluoride.

Annually, the per-person cost of fluoride supplements is more than 70 times higher than fluoridated water.  [xvi]

The Burden of Oral Health Disease in Vermont

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[i] Vermont Department of Health. Oral Healthy Survey. 2009-2010.  Available at

[ii] Ibid.

[iii] Ibid.

[iv] Ibid.

[v] Ibid.

[vi] Vermont Department of Financial Regulation. 2009. Vermont Household Health Insurance Survey: Comprehensive Report. Available at


[vii] Ibid.

[viii] Vermont Department of Health, Division of Health Surveillance. 2011 BRFSS

brief. Available at

[ix] Green Mountain Care Board. 2010 Vermont Health Care Expenditure Report. March 2012.

Available at

[x] Oral Health Survey.

[xi] Vermont Department of Health.1998-2009. Vermont Uniform Hospital Discharge Data Set. Available at

[xii] Griffin SO, Jones K, Tomar SL. An economic evaluation of community water fluoridation. J

Public Health Dent 2001;61(2):78–86. Abstract available at

[xiii] BRFSS.

[xiv] Vermont Department of Health, Division of Health Surveillance. 2007, 2009, 2011 Vermont

Dentist Survey (summary report). Available at

[xv] Oral Health Survey.

[xvi] Recommendations for Using Fluoride to Prevent and Control Dental Caries in the  United States,” Morbidity and Mortality Weekly Report, Centers for Disease Control and  Prevention, (August 17, 2001), Vol. 50 1-42,