"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.

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.

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.

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.

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.