Through CDC Cooperative Agreement 3022, twelve states plus one U.S. territory have received five-year grant funding to build capacity for implementation of two evidence-based, population-level activities: community water fluoridation and school-based/school-linked dental sealant programs. As is often the case, grantee states have raised concerns about the sustainability of expanded oral health programs after their CDC capacity building grant periods end. According to the Association of State and Territorial Dental Directors (ASTDD) Best Practices for State Oral Health Programs, states with a legislative mandate for state oral health agencies are better able to maintain or increase services compared with those states without such a mandate. Thus, one potential approach to enhancing sustainability of gains made under the CDC program is to ensure that all grantee states have a legislative mandate in place. Furthermore, by pursuing the formal creation of an office or division of oral health, states may then use that stable infrastructure to facilitate the capacity building and future implementation of these two preventive measures for which the CDC grant calls. Accomplishing this requires that states understand the nature of these mandates and the typical process by which they are enacted. Grantees must also be fully apprised of both the educational opportunities and lobbying prohibitions that are involved in promoting this action. While some of the grantee states do possess this authority, there are several others that do not. This effort can be viewed as providing a foundation on which these population-based activities can be more successfully implemented. Likewise, efforts may also be made to support a legislative mandate for community water fluoridation in a state as a means of continuing programs that may be begun during the Capacity Building stage of this Cooperative Agreement.

Based on surveys conducted by ASTDD in 2003, 23 states were identified as having statutory authority for an office of oral health or equivalent division/program within their state health department. These states were: AZ, AR, CA, FL, HI, ID, IL, IN, KY, MD, MS, MO, NE, NV, NM, NY, NC, OK, OR, PA, RI TX, WY. Among these 23, Arkansas, Illinois, Nevada, New York, Oregon, Rhode Island, and Texas are grantee states possessing such mandates.

Statutory authority provides a mandate for an office of dental public health in the state's Department of Health. 23 states, including 7 grantee states enjoy such authority. States with this authority have higher levels of performance reported by ASTDD as 93% of mandated states "maintained or increased services" while 72% of non-mandated states experienced "decreased services." Click here (pdf) to view map.

Regarding community water fluoridation, 12 states were found to possess such a mandate: CA, CT, DE, GA, IL, KY, LA, MN, NE, NV, OH, SD. Of these 12, Illinois and Nevada are grantee states.

State statutes mandating community water fluoridation facilitate local implementation, promote accomplishment of the associated Healthy People 2010 Objectives, and build capacity by improving the policymaking environment. 12 states, including 2 grantee states, enjoy such authority. Of these 12 mandated states in 2004, the average percent of the populations served by public water systems that received fluoride was 78.3%, versus an average of 67.4% for the states lacking a mandate. Click here (pdf) to view map.

Though no legislative mandate is necessary for a statewide school-based dental sealant program, 25 states presently have such programs in place: AL, AZ, CO, GA, IL, IN, IA, KS, KY, ME, MA, MO, NE, NV, NH, NJ, NM, NY, OK, TX, UT, VT, VA, WA, WV, 5 of which - Colorado, Illinois, Nevada, New York, and Texas - are grantee states. The continuing success of these programs in reducing tooth decay will provide the evidence base to sustain the programs and perhaps encourage additional states to pursue such interventions.

Statewide school-based dental sealant programs are an evidence-based preventive initiative, which targets low-income children at risk. 25 states, including 5 grantee states, have such programs. Such programs have demonstrated a 60% reduction in posterior tooth decay and help to facilitate the attainment of the Healthy People 2010 Oral Health Objective for dental sealants. Click here (pdf) to view map.

Legislative Language Search Methodology

Using LexisNexis, each state's Code, Constitution, Rules & ALS were searched using variations of "oral health," "dental health," and "dental public health" to find the legislative language providing the mandate for such statutory authority. To supplement the search, some state legislature websites were also accessed for additional legislative language. Language explicitly mentioning some form of an office/division/bureau/program of oral health was found for 17 of the 23 states. Legislative language mandating community water fluoridation was found for all 12 states. From state to state, the language varies, as does the degree of detail for which the mandate is to be implemented. It is our hope to highlight important aspects of legislative language so that states currently not possessing a legislative mandate for either an oral health division within their health department or for community water fluoridation may use these resources as a guide for pursuing a mandate of their own. While a more detailed mandate may allow for specific activities and responsibilities to be conducted, even a broad mandate can have important benefits in terms of providing stability and flexibility to the oral health services in a given state.

Legislative language for an office of oral health

Legislative language for community water fluoridation

But, once you have drafted the language, what is the next step? This "Policy Tool" can help you plan a legislative strategy assessing the current political environment in order to create opportunities for oral health improvements in your state.