Environmental Public Health Tracking: Oral Health

Oral health is an important part of our overall health and is much more than just healthy teeth. Oral refers to the whole mouth: the teeth, gums, hard and soft palate, lining of the mouth and throat, tongue, lips, salivary glands, chewing muscles, and upper and lower jaws.

Not only does good oral health mean being free of tooth decay and gum disease, but it means being free of oral pain, oral cancer, birth defects such as cleft lip and palate, and other conditions that affect the mouth and throat. Good oral health also includes the ability to carry on the most basic human functions such as chewing, swallowing, speaking, smiling, kissing, and singing. Learn more about oral health from the Oral Health Program.

• Water quality is a critical component of environmental health and communities add fluoride to their public water supply to improve dental health. Drinking fluoridated water reduces tooth decay by about 25%.¹
• Excessive sun exposure is linked to lip cancer.²
• Smoking is strongly linked to oral cancer, and some research suggests there may be a link between secondhand smoke (also known as environmental tobacco smoke) and oral cancers).³ One aim of the National Environmental Public Health Tracking Network is to host data that researchers can use to better understand these potential environmental links to health risks and disease.

Tracking oral health measures gives public health professionals a better understanding of how often oral diseases happen in their county. With Environmental Public Health Tracking, we can monitor how many cases of particular oral diseases occur in a county over time and can use that information to educate our communities and plan prevention efforts.

The source of the data is the Wisconsin Oral Health Program. The Oral Health Program aggregates the data and sends this information to Wisconsin Environmental Public Health Tracking Program.

• Emergency department visits for non-traumatic dental care
• Measures from the Wisconsin survey of third graders, Healthy Smiles, Healthy Growth (PDF)
• Percentage of population with access to fluoridated public water

We will add more measures as the data become available. Sign up for our quarterly newsletter if you would like an update when new data are added to the portal.

Data on fluoride in drinking water are based on samples taken from active public community water systems. The data represent the population on public drinking water that have access to fluoridated water, regardless of whether it is at the recommended level. In other words, a person might have access to some level of fluoridation, but it may not be at levels recommended for optimal health benefits.

• Wisconsin Department of Health Services – Oral Health Program
• Centers for Disease Control and Prevention – Oral Health Basics

Dental licensure

Total population per dentist

These data come from the Oral Health Program in the Wisconsin Department of Health Services. This measure is a representation of the number of licensed dentists in a geographic area. The measure is presented as a ratio of the population to the number of licensed dentists within the same geography. Within the respective geographies, the 2010 Wisconsin census population was used as the numerator and the count of licensed dentists in the queried year was used as the denominator.

Total population per dental hygienist

These data come from the Oral Health Program in the Wisconsin Department of Health Services. This measure is a representation of the number of licensed dental hygienists in a geographic area. The measure is presented as a ratio of the population to the number of licensed dental hygienists within the same geography. Within the respective geographies, the 2010 Wisconsin census population was used as the numerator, and the count of licensed dental hygienists in the queried year was used as the denominator.

Emergency department visits (non-traumatic)

Counts

These data are collected from emergency room visit records. Patient visits with an ICD-9 code of a primary dental diagnosis that was considered preventable and non-traumatic are collected for this measure. This measure includes cases with an ICD-9 code of 520.6, 521.00-521.09, 521.9, 522.0, 522.1, 522.4-522.7, 522.9, 523.00, 523.01, 523.10, 523.11, 523.3-523.6, 523.9, 525.8, 525.9, 528.3, and 528.9. It also includes cases with an ICD-10 code of K00.6, K01.0, K01.1, K02.3, K02.51, K02.61-K02.63, K02.7, K02.9, K03.6, K03.89, K03.9-K04.1, K04.4-K04.7, K04.90, K04.99, K05.00, K05.01, K05.10, K05.11, K05.20-K05.22, K05.30-K05.32, K05.4, K05.6, K08.8, K08.81, K08.82, K08.89, K08.9, K12.2, K13.70, and K13.79. Effective October 1, 2018, the ICD-10 code of K08.8 was deleted and has been replaced by K08.81, K08.82, or K08.89. Please keep this in mind when interpreting the data. Patients with the diagnosis of disturbances in tooth eruption (ICD-9 code 520.6 and ICD-10 codes K00.6, K01.0, and K01.1) were only included if they fell in the 15 to 30 year age range. This permitted those that may seek emergency care due to impacted third molars to be included. Patients who concomitantly had an ICD-9 code or an E-code in the 800 to 900 range or an ICD-10 code or an E-code in the S00-S99 or T07-T88 range associated with their dental diagnosis were excluded. An E-code and ICD-9 code in the 800 to 900 range and an E-code and ICD-10 code in the S00-S99 and T07-T88 range denotes that the patient's diagnosis was associated with an unintentional or intentional injury or poisoning, and since the target population should include only those with non-traumatic dental diagnoses, this group was excluded. Data for counties with fewer than ten visits are suppressed to protect confidentiality. However, counties with zero cases are not suppressed. Please note that counts are a statistically limited way to consider emergency department visits because they do not allow for accurate comparison between counties. Counties with higher populations, such as Milwaukee, will have more emergency department visits simply because they have more people. An age-adjusted rate is a better measure for true comparison between counties.

Crude rate (per 10,000 population)

These data are collected from emergency room visit records. Patient visits with an ICD-9 code of a primary dental diagnosis that was considered preventable and non-traumatic are collected for this measure. This measure includes cases with an ICD-9 code of 520.6, 521.00-521.09, 521.9, 522.0, 522.1, 522.4-522.7, 522.9, 523.00, 523.01, 523.10, 523.11, 523.3-523.6, 523.9, 525.8, 525.9, 528.3, and 528.9. It also includes cases with an ICD-10 code of K00.6, K01.0, K01.1, K02.3, K02.51, K02.61-K02.63, K02.7, K02.9, K03.6, K03.89, K03.9-K04.1, K04.4-K04.7, K04.90, K04.99, K05.00, K05.01, K05.10, K05.11, K05.20-K05.22, K0.5.30-K05.32, K05.4, K05.6, K08.8, K08.81, K08.82, K08.89, K08.9, K12.2, K13.70, and K13.79. Effective October 1, 2018, the ICD-10 code of K08.8 was deleted and has been replaced by K08.81, K08.82, or K08.89. Please keep this in mind when interpreting the data. Patients with the diagnosis of disturbances in tooth eruption (ICD-9 code 520.6 and ICD-10 codes K00.6, K01.0, and K01.1) were only included if they fell in the 15 to 30 year age range. This permitted those that may seek emergency care due to impacted third molars to be included. Patients who concomitantly had an ICD-9 code or an E-code in the 800 to 900 range or an ICD-10 code or an E-code in the S00-S99 and T07-T88 range associated with their dental diagnosis were excluded. An E-code and ICD-9 code in the 800 to 900 range and an E-code and ICD-10 code in the S00-99 and T07-T88 range denotes that the patient's diagnosis was associated with an unintentional or intentional injury or poisoning, and since the target population should include only those with non-traumatic dental diagnoses, this group was excluded. Data for counties with fewer than ten visits per 10,000 are suppressed to protect confidentiality. However, counties with zero cases are not suppressed. The crude rate is the number of emergency department visits divided by the total number of people in the area of interest (for example, a county). This is expressed as a number per unit population such as "per 10,000 population." The crude rate does not take into account the differences in age distributions across counties and is therefore subject to bias.

Medicaid

Percent of Medicaid members with any utilization

These data come from the Division of Medicaid Services and Oral Health Program in the Wisconsin Department of Health Services. The percent of Medicaid members receiving a dental service (any utilization) within a given year is obtained by dividing the number of continuously enrolled Medicaid members who received any dental service in a given age category (indicated by at least one of the codes D0100 to D9999) by the total number of Medicaid members in that age category who have been continuously enrolled for 90 days within the reporting period in a full benefit plan. The percent of Medicaid members is separated into the following age categories: 0-2 years, 3-20 years, 21-64 years, 65+ years, and all ages. If the percent is based on a denominator less than or equal to five, it is suppressed. The county represents the Medicaid member’s county of residence. Counties classified as “other” (which includes tribal areas) were included in the statewide estimate but not as separate counties.

Percent of Medicaid members seeking preventive care

These data come from the Division of Medicaid Services and Oral Health Program in the Wisconsin Department of Health Services. The percent of Medicaid members receiving a preventive dental service within the given year is obtained by dividing the number of continuously enrolled Medicaid members who received preventive care in a given age category (indicated by at least one of the codes D0100 to D1999) by the total number of Medicaid members in that age category who have been continuously enrolled for 90 days within the reporting period in a full benefit plan. The percent of Medicaid members is separated into the following age categories: 0-2 years, 3-20 years, 21-64 years, 65+ years, and all ages. If the percent is based on a denominator less than or equal to five, it is suppressed. The county represents the Medicaid member’s county of residence. Counties classified as “other” (which includes tribal areas) were included in the statewide estimate but not as separate counties.

Percent of Medicaid members seeking post-ED visit follow-up care

These data come from the Division of Medicaid Services and Oral Health Program in the Wisconsin Department of Health Services. The values represent the percent of Medicaid members who had a dental visit within 30 days of a non-traumatic dental-related emergency department visit. It is obtained by dividing the number of continuously enrolled Medicaid members who visited a dental provider within 30 days of a dental-related emergency department visit by the total number of Medicaid members continuously enrolled for 90 days within the reporting period in a full benefit plan who had a dental-related emergency department visit. If the percent is based on a denominator less than or equal to five, it is suppressed. The county represents the Medicaid member’s county of residence. Counties classified as “other” (which includes tribal areas) were included in the statewide estimate but not as separate counties.

Enrolled dentist counts by Medicaid members served

These data come from the Division of Medicaid Services and Oral Health Program in the Wisconsin Department of Health Services. The values represent the number of Medicaid continuously enrolled dentists by the number of Medicaid members they served (0 members, 1-49 members, 50-100 members, and 100+ members) as well as a total count of all Medicaid continuously enrolled dentists during the given year. The county represents the dentist’s county of practice. Due to the different ways these counts are obtained and limitations in geocoding, there may be a discrepancy between the number of Medicaid continuously enrolled dentists in a given county and the total number of licensed dentists (available in the licensure data under the Oral Health topic) in that county.

Percent of enrolled dentists seeing Medicaid members

These data come from the Division of Medicaid Services and Oral Health Program in the Wisconsin Department of Health Services. The values represent the percent of dentists continuously enrolled during the reporting period who saw at least one Medicaid member within the given year. This figure is obtained by adding the number of dentists who saw 1-49 members, 50-100 members, and 100+ members together and dividing it by the total number of Medicaid continuously enrolled dentists. The county represents the dentist’s county of practice.

Enrolled hygienist counts by Medicaid members served

These data come from the Division of Medicaid Services and Oral Health Program in the Wisconsin Department of Health Services. The values represent the number of Medicaid continuously enrolled hygienists by the number of Medicaid members they served (0 members, 1-49 members, 50-100 members, and 100+ members) as well as a total count of all Medicaid continuously enrolled hygienists during the given year. The county represents the hygienist’s county of practice. Due to the different ways these counts are obtained and limitations in geocoding, there may be a discrepancy between the number of Medicaid continuously enrolled hygienists in a given county and the total number of licensed hygienists (available in the licensure data under the Oral Health topic) in that county.

Percent of enrolled hygienists seeing Medicaid members

These data come from the Division of Medicaid Services and Oral Health Program in the Wisconsin Department of Health Services. The values represent the percent of hygienists continuously enrolled during the reporting period who saw at least one Medicaid recipient within the given year. This figure is obtained by adding the number of hygienists who saw 1-49 members, 50-100 members, and 100+ members together and dividing it by the total number of Medicaid continuously enrolled hygienists. The county represents the hygienists’ county of practice.

Population on fluoridated public water system

Percent of population

These data are collected from the Water Fluoridation Reporting System (WFRS). Data are based on samples taken from active public water systems and do not reflect data from private wells. The data represent the percent of the population on public drinking water that have access to fluoridated water, regardless of whether it is at the recommended level.

Third grade survey

Percent of children who experience caries

These data are from the "Healthy Smiles, Healthy Growth" statewide survey administered by the Wisconsin Department of Health Services. Data are collected during the school year (e.g., 2000-01). The survey included a representative sample of third grade students in Wisconsin public schools. The caries experienced measure captures children with either treated decay, untreated decay, or both.

Percent of children who need treatment

These data are from the "Healthy Smiles, Healthy Growth" statewide survey administered by the Wisconsin Department of Health Services. Data are collected during the school year (e.g., 2000-01). The survey included a representative sample of third grade students in Wisconsin public schools. The need treatment measure captures children that exhibited a dental condition that needed to be addressed by a dentist.

Percent of children with sealants

These data are from the "Healthy Smiles, Healthy Growth" statewide survey administered by the Wisconsin Department of Health Services. Data are collected during the school year (e.g., 2000-01). The survey included a representative sample of third grade students in Wisconsin public schools. The sealants measure captures children with the presence of at least one sealant on a permanent molar tooth.

Percent of children with untreated decay

These data are from the "Healthy Smiles, Healthy Growth" statewide survey administered by the Wisconsin Department of Health Services. Data are collected during the school year (e.g., 2000-01). The survey included a representative sample of third grade students in Wisconsin public schools. The untreated decay measure captures children with the presence of a dental cavity where the breakdown of the enamel surface is readily observed.

Explore definitions and explanations of terminology found on the portal, like age-adjusted rate and confidence intervals.