Executive Summary

The Colorado Department of Public Health and Environment (CDPHE) conducted the Basic Screening Survey (BSS), an intraoral screening of kindergarten and third-grade students, during the 2022-23 school year. The BSS is a surveillance tool used to assess the burden of childhood oral disease at two critical oral developmental stages. This surveillance was conducted by applying methods recommended by the Centers for Disease Control and Prevention (CDC), the Behavioral Risk Factor Surveillance System (BRFSS), and the Association of State and Territorial Dental Directors.

Previous BSS results indicated a general improvement in children’s oral health in the 15 years between the first and third survey data collection. However, the most recent data collection does not suggest this positive trend has continued. Though direct statistical comparisons between the previous and current BSS surveys are not possible due to changes in sampling methodology, the findings of the current BSS indicate clear evidence of the significant magnitude of oral disease among children and the disparities among different demographic groups.

Methodology and Study Participation

A total of 2,773 students from 42 elementary schools participated in the screening. School selection was completed by a random, stratified process to ensure representative sampling across four key variables: Free and Reduced-price Lunch program participation (as a proxy for household income), race and ethnicity, rurality, and Colorado Department of Education state regions (Colorado Department of Education, 2022b). Additionally, screening data samples were weighted according to Colorado-wide proportions of these variables in the child population to further enhance the representativeness and generalizability of the findings of the screening.

Key Findings

Observed dental caries (tooth decay) experience is higher in third-grade (60.6%) when compared to kindergarten (46.2%). However, untreated decay and urgent need for treatment is similar in the two grade groups. As discussed in the report, this is an indication of the importance of early intervention to stem the progression of caries in young children. Caries experience was observed to be higher in children from schools with greater proportions of students receiving Free and Reduced-price Lunch benefits. This suggests that household income and/or related socio-demographic factors are important risk factors for oral disease, though the measure is an indirect indicator of household income.

The survey findings highlight racial disparities in oral disease burden among Colorado’s children. Black and Hispanic kindergarten students experience caries at a rate (59.0% and 60.9%, respectively) nearly twice that of their white peers (34.0%). Racial disparities were smaller among third-grade students and remain statistically significant. Approximately one-quarter of students screened needed urgent or immediate dental care. Racial disparities persisted in these data where Black and Hispanic children more frequently required urgent follow-up than white children. Black children receive dental sealants about half as frequently as white children.

When comparing urban and rural populations, the findings indicate that urban third-graders had a 26.4% prevalence of untreated decay, compared to 17.0% of rural third-graders. This is similar to findings regarding dental sealant placement where 54.6% of urban students had sealants placed compared to 74.6% of rural students. All participating rural schools in this BSS were partnered with oral disease prevention initiatives, including school-based oral health programs and CDPHE-funded Regional Oral Health Specialists. The caries and sealant findings support a positive link between these prevention programs and oral health outcomes.