By Olga Ensz
“He hides his smile in every school photo,” Jayden’s mother told me, holding up a picture of her 6-year-old son.
I first met Jayden – not his real name – as a patient at the University of Florida community dental outreach program in Gainesville, Florida. Jayden had visible cavities on his front teeth – dark spots that had become the target of teasing and bullying by classmates. The pain had become so severe that he began missing school. His family, living in a rural part of north Florida, had spent months trying to find a dentist who accepted Medicaid.
In the meantime, Jayden stopped smiling.
As a dental public health professional working in community dental outreach settings, I’ve seen firsthand how children across the state face significant barriers to achieving good oral health. Despite being largely preventable, tooth decay remains the most common chronic disease among children in the U.S., and Florida is no exception.
Pediatric dental health in Florida
Untreated dental problems can lead to pain, infection, difficulty eating or sleeping, and even affect a child’s ability to concentrate and learn. Poor oral health has also been linked to broader health issues such as heart disease.
According to the most recent data available from the Florida Department of Health, nearly 1 in 3 third graders in the Sunshine State had untreated tooth decay – that is, cavities – during the 2021–2022 school year. That’s almost double the national average of 17% of children ages 6-9 with untreated tooth decay and underscores the severity of the issue in Florida.
In addition, only 37% of Florida third graders had dental sealants. These thin coatings applied to the chewing surfaces of molars are proven to prevent up to 80% of cavities. Nationwide, 51.4% of kids have this cost-effective treatment.
The most recent data available from the 2017-2018 school year shows that 24% of children ages 3-6 in Florida’s Head Start program, which provides free health and education for low-income families with young children, had untreated tooth decay. By comparison, the U.S. Centers for Disease Control and Prevention found that 11% of U.S. children ages 2-5 had untreated decay.
These numbers represent children like Jayden, whose pain and missed school days are preventable.
A 2023 report found that Florida children are increasingly visiting emergency rooms for nontraumatic dental conditions. Besides being costly and stressful for families, these visits generally provide only temporary relief. Emergency departments simply aren’t equipped to offer dental care that addresses the root problem.
Slipping through the cracks
Florida ranks among the worst states in the U.S. for dental care access, with over 5.9 million residents living in dental care health professional shortage areas. In fact, 65 of Florida’s 67 counties face shortages of dental professionals, with some areas reporting just 6.6 dentists per 100,000 people – far below the national average of 60.4.
This lack of access to care is compounded by poverty and insurance limitations.
More than 2 million Florida children are enrolled in Medicaid, but only 18% of Florida dentists – about 2,500 in total – accept it. And even families with private insurance often face high out-of-pocket costs, making essential dental care unaffordable for some. Delaying routine dental visits can allow minor issues to worsen over time, ultimately requiring more complex and costly treatment.
As a result, Florida ranks 43rd out of 50 states in the percentage of children receiving dental care in the past year.
Lack of awareness is also a problem. Research shows that many parents don’t realize their children should see a dentist by their first birthday, and that baby teeth matter just as much as adult teeth.
Prevention works
Historically, community water fluoridation has been one of the most effective public health strategies to reduce children’s tooth decay. While fluoridation is not meant to be a standalone prevention method, multiple studies have shown that it helps to prevent cavities in both children and adults. As recently as May 2024, the CDC supported the safety of this strategy.
However, a new Florida law, signed by Gov. Ron DeSantis in May 2025 and going into effect on July 1, now prohibits local governments from adding fluoride to public drinking water. This makes other preventive treatments even more essential.
Fluoride varnish, recommended by pediatric and dental associations, is a topical treatment that should be applied every 3-6 months to reduce the risk of tooth decay.
When a child has just the beginnings of a cavity, silver diamine fluoride is a noninvasive liquid treatment that can stop it from progressing. This is especially beneficial for young children or those with limited access to care.
These highly effective, evidence-based treatments are safe and cost-effective, and they can be delivered in schools, medical offices and clinics.
PeopleImages/iStock via Getty Images Plus
Keeping your kids’ teeth healthy
Here are some steps parents can take right now to protect their child’s dental health:
- Schedule regular dental visits, starting by age 1. Children should see a dentist by their first birthday or within six months of their first tooth. After that, annual visits help catch problems early, when treatment is easier and less expensive.
- For families in areas with few dental providers, parents can ask their child’s pediatrician for referrals, check state Medicaid websites or use the American Association of Pediatric Dentists’ “Find a Pediatric Dentist” tool. Some communities also offer care through federally qualified health centers, dental schools or mobile clinics at low or no cost.
- As soon as their teeth come in, children need to brush twice a day with fluoridated toothpaste. Use a smear of toothpaste about the size of a grain of rice for children under age 3, and a pea-sized amount for ages 3–5.
- Make brushing a fun and supported routine. Help your child brush until they can do it well on their own, usually around age 7 or 8. Play a favorite song or video to make brushing time enjoyable.
- Limit sugary snacks and drinks. Offer water and healthy snacks like fruits and vegetables. Avoid letting infants fall asleep with bottles of milk or juice, and limit sticky, sugary foods like candy, chips and cookies.
- Ask your dentist about sealants and fluoride varnish. These treatments are especially important for children at higher risk for cavities, such as those with limited access to dental care, a family history of tooth decay, visible plaque or the habit of frequent snacking.
Olga Ensz is a Clinical Assistant Professor of Community Dentistry at the University of Florida.
JimboXYZ says
All that flouride added to the water & children still get cavities, even leave them untreated. Maybe oral hygiene is the real culprit here and flouride does little or nothing for tooth decay & gingivitis ? Once a cavity forms, that tooth is on the clock. Very few people end up with their original pearly whites. Is it processed sugar ? What other habits and addictions do humans have for food, that here isn’t a lobby of sorts that isn’t behind ? Tobacco for the longest time, & still is legal, damages teeth. Any of us probably get more flouride with a toothpaste than what would be added to tap water ? I don’t know what the solution is, but flouride in tap water hasn’t worked either. Because more folks have cavities, healthcare is crappier for routine dental visits.
Deborah Coffey says
When did Republicans become so pathetic? To sum up the Trump era, no one wants to be a child, a pregnant woman, an LGBTQ, Black, Latino, immigrant, poor, or non-Christian in America anymore. And, they call our current condition making America great again? God save our country from these greedy, self absorbed, power hungry people rulers and open the eyes of those that voted for them.
Dennis C Rathsam says
Parents need to take thier kids to the dentist period! You start when they are, 3 or 4. Find a dentist that specializes in children. My daughter has a great dentist for my 3 grand kids, they never complain, they think its fun. She takes her time with them, & is very caring.
Pogo says
@Smile
…the toof fairwee wuvs woo.
Laurel says
Limit sugary snacks? How about getting rid of sugary snacks altogether? How about reading labels of the foods you’re buying them? How about not buying processed foods? How about not voting for people who want to reduce Medicaid to give billionaires more unnecessary tax break bonanzas? How about not criticizing Michelle Obama for trying to interest children in whole foods, and especially vegetables?
I am suspicious of anyone who promotes a waste product of fertilizer added to our drinking water, though most of us will not benefit from it. Someone’s making money off it though.
My thoughts says
Maybe someday Florida authorities will care about the welfare of it citizens including its children.
BillC says
Don’t worry. RFK Jr. is a pediatric dental expert. He probably thinks cavities are normal and good for children since he believes vaccines are bad for them.
YankeeExPat says
Pres Donald Trump ..Covid, 19, ….. suggesting research into whether coronavirus might be treated by injecting disinfectant into the body. “ingesting Lysol Shooters ”
Robert F. Kennedy Jr. Secretary of Health and Human Services.. conspiracy theorist, and anti-vaccine activist , whale head collector. He has promoted the consumption of raw milk, despite warnings from the FDA and CDC about the risks of dangerous bacteria it may contain.
Gov. Ron, the Grim Reaper DeSantis. . 89,075 Covid-19 deaths in Florida
Joseph Ladapo Surgeon General of Florida known for his opposition to COVID-19 mitigation measures, and promotion of COVID-19 misinformation.
No Fluoride in water ?,….. despite No Clinical or Scientific evidence of harm only reduction in tooth decay ?
What does one come to expect from the Quackery Council ?
I submit my remaining time to Forest Gump…”STUPID IS AS STUPID DOES “
DaleL says
There is still fluoride in the drinking water of those communities in Florida that draw their water from the Florida Aquifer. The Florida Aquifer, as is normal for well water, contains fluoride which leaches from limestone of the aquifer.
This is a quote from the Jacksonville JEA website: “The range of fluoride in the JEA water supply was recently tested to be between 0.385 mg/L and 1.22 mg/L, depending on the location of the water treatment plant. JEA does not and has never added fluoride to our drinking water.” As a point of reference, the recommended level by Health and Human Services is 0.7 mg/L.
https://www.jea.com/About/Water_Supply/Constituents/
Ignorance is bliss.
Laurel says
Look, I am not a fan of RFK, but that does not mean I will not listen, and will turn my back on all that’s said. If he wants to get rid of dyes and chemicals in food that are known to be harmful, I’m all for it. Europe is much fussier about their foods than we are. Our corporations intentionally put poor ingredients in our foods to addict us to their garbage. Sugar is in nearly everything you can imagine, even salt. Many products that are known to cause cancer are placed in our foods by big corporations to increase their profit. Many of these products are banned in Europe for health reasons. Our big corporations do not care about us. You know, the ones that just got a big tax break.
Is RFK an expert (in anything)? No. Should we keep a close eye on him? Yes. Should we battle the illogical things he promotes? Yes. BUT, we should promote the things that make sense, that he may actually push through that others have not. Don’t throw out the baby with the bathwater, right?
As for fluoride, go to the dollar store and buy a tube of fluoridated toothpaste for a buck twenty-five.
Concerned Citizen says
Natural Fluoride has been shown to help with cavities and can be found to occur in higher levels in Jacksonville and other areas as well as some foods.
The Fluoride being added to the water and to toothpaste is synthetic. Studies have shown it can be dangerous especially to infants and small children in high doses, and harmful to everyone “if swallowed” (check the back of your toothpaste). We all drink water, bathe in water, make food in water so it stands to reason we all consume tap water at different levels. Infants on formula in lower class families may possibly be consuming every bottle with tap water – that may be a much higher dose of Fluoride than intended for an infant if Fluoride is in the water. Especially since synthetic Fluoride has been shown to cross the blood brain barrier.
Kids under age six can’t have toothpaste with Fluoride because it’s been known for a very long time that Fluoride can mineralize their teeth and make them weaker. That’s why little kid toothpaste has no Fluoride) There are more recent studies of brain development issues in infants and cancers in all ages from ingestion. Not asking you take my word for it, do your own research.
It is a problem that dental care is not a priority. Not only for welfare recipients, but also working class. Dental insurance is a joke, dental care outrageously expensive.
Sugar may not be the only problem, acidic foods and the lie to brush after every meal. Turns out that advice will strip your teeth of protective enamel and cost a fortune. (Wish my dentist told me before I taught my kids wrong too) Swish with plain water after every meal and before you brush to remove the acid – then use a soft brush only and floss of course.
We still need to fix dental care costs.
JimboXYZ says
Most of what any of us have problems in life are Dental & Vision related. I think if I had to do it all over again for a lifetime. I’d use just enough toothpaste to dilute & swish around my mouth. The toothbrush would be used to to massage the gums for anything gingivitis prevention. Toothpaste will clean the brown oxidated haze off your car’s headlight, imagine what that’s doing to your tooth’s enamel with a 3X a day scrubbing ? Like I commented earlier, very few end up with all their teeth in excellent condition over a lifetime ? Fillings & crowns go so far, then the dentists got a new procedure, implants & eventually denture implants.
Another thing, Coca Cola & Pepsi. That crap would need to be outlawed, as would all that crappy sugar candy. When I look at an older toilet, scrubbing that is a good indication of wearing out ceramic porcelain. Toothpaste can’t even be good for scrubbing crowns. I had an orthodontist growing up with those metal band braces. I just recall going to that quack and he would use this small thumb hammer device like a jack hammer to install those bands. It’s amazing I have any healthy natural teeth left in my head. I wonder how many dentists spot a cavity and let nature take it’s course to ring up future fillings, root canals, crowns, implants ? Let’s face it, there hasn’t been a roofing contractor that inspected a roof and opted for a roof repair vs a complete roof replacement. Would that guy tell you that a roof was fixable, knowing that the bigger payday of a roof replacement was going to result from not fixing it ? Same thing with a dentist. They have their insured list of billable procedures. They kick that can down the road for the bigger payday for billable procedure of a root canal & the out of pocket that insurance doesn’t cover for crowns & implants ?