Oral health affects our ability to speak, smile, eat, and show emotions. It also affects self-esteem, school performance, and attendance at work and school. According to the Centers for Disease Control and Prevention (CDC), oral diseases—which range from cavities to gum disease to oral cancer—cause pain and disability for millions of Americans. They also cost taxpayers billions of dollars each year. Additionally, oral health has been linked with other chronic diseases, like diabetes and heart disease. It is also linked with risk behaviors like using tobacco and eating and drinking foods and beverages high in sugar.


Public health strategies—notably community water fluoridation—have been proven to save money and prevent cavities.

This is a priority because…

  • Community water fluoridation (CWF) is a cost-effective way to prevent and reduce tooth decay.
  • There were 9,853 emergency department visits for dental problems in 2018.
  • 19% of older Iowans have untreated tooth decay and 15% need periodontal care.

A public health approach to improving oral health in Iowa would touch on the priorities of increasing access to fluoridated water for citizens through community water fluoridation (CWF), while also increasing access to the spectrum of oral care for those in at-risk groups including older adults and those without the financial resources to obtain adequate care.

In 2017, the Iowa Department of Public Health could verify that only 63.7 percent of Iowans served by a community water system were receiving optimally fluoridated water. While this is trending up, more can be done. CWF is a cost-effective way to prevent and reduce tooth decay. Studies show the CWF provides a reduction of tooth decay by at least 25 percent throughout a person’s lifetime, regardless of age, income or education.

In regard to access, it is vital that the Dental Wellness Plan, implemented as part of the Medicaid expansion in 2014 is maintained. This ensures that those aged 19-64 with a household income between 0 and 133% of the federal poverty level receive comprehensive dental benefits. Emergency department visits for oral health concerns have declined each year since the Dental Wellness Plan was implemented, greatly reducing the cost and resources required to serve this population. 

Additionally, oral disease is a common problem for older adults, leading to pain and issues with eating and speaking. Only 1 in 3 older Iowans report having dental insurance and just 1 in 6 of those 80 years or older reported having dental insurance. According to the IDPH, only half of older Iowans have reported seeing a dentist in the past year, despite significant numbers of them having untreated tooth decay (19%) and needing periodontal care (15%).

Increased access to oral health services for older adults has the potential to save money for the treatment of advanced oral disease, while improving quality of life for those 60 and older.