Children Who Have Dental Decay or Cavities

Percentage of children, 1-20 years of age at the start of the measurement period, who have had dental decay or cavities during the measurement period as determined by a dentist

This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSP23320095627WC; HHSP23337008T) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.

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Dental caries is the most chronic disease among youth aged 6-19 years. Data from the National Health and Nutrition Examination Survey from 2015-2016 showed that approximately 45.8 percent of children and youth aged 2-19 years had total caries (untreated and treated). Prevalence of total dental caries (untreated and treated) in primary or permanent teeth increases with age, going from 21.4 percent, 50.5 percent, and 53.8 percent among ages 2-5, 6-11, and 12-19, respectively. Total dental caries was highest in Hispanic youths aged 2-19 at 57.1 percent compared to 48.1 percent for non-Hispanic black, 44.6 percent for non-Asian, and 40.4 percent for non-Hispanic white youth. Monitoring prevalence of untreated and total caries is vital to preventing and controlling oral disease (Fleming & Afful, 2018). 

Children who have dental decay or cavities are less likely to be in very good or excellent overall health than children without decay or cavities (Edelstein & Chinn, 2009). Children with decay are also more likely to have other oral health problems such as toothaches, broken teeth, and bleeding gums (Data Resource Center for Child and Adolescent Health, 2007).

The American Academy of Pediatric Dentistry (AAPD) provides clinical recommendations for pediatric oral health assessments and preventative services (AAPD, 2023). The recommendation states that the first clinical oral examination should occur around 12 months of age. The clinical oral exam should be repeated every 6 months or as indicated by the child’s risk status or susceptibility to disease. Further, caries risk assessment must be repeated regularly and frequently to maximize effectiveness.

A lower score indicates better quality

Reference Type: CITATION

Reference Text: 'American Academy of Pediatric Dentistry. (2022). Periodicity of examination, preventive dental services, anticipatory guidance/ counseling, and oral treatment for infants, children, and adolescents. The Reference Manual of Pediatric Dentistry, 2023:288-300.'

Reference Type: CITATION

Reference Text: 'Data Resource Center for Child and Adolescent Health, Child and Adolescent Health Measurement Initiative. (2007). 2007 National Survey of Children’s Health. Baltimore, MD: Author.'

Reference Type: CITATION

Reference Text: 'Edelstein, B. L., & Chinn, C. H. (2009). Update on Disparities in Oral Health and Access to Dental Care for America’s Children. Academic Pediatrics, 9(6), 415-419.'

Reference Type: CITATION

Reference Text: 'Fleming, E., & Afful, J. (2018). Prevalence of Total and Untreated Dental Carries Among Youth: United States, 2015-2016. NCHS Data Brief No. 307. Hyattsville, MD: National Center for Health Statistics.'

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This eCQM is a patient-based measure.

Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth.

This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Children, 1-20 years of age at the start of the measurement period, with a clinical oral evaluation by a dentist during the measurement period

Equals Initial Population

Exclude patients who are in hospice care for any part of the measurement period

Children who had a diagnosis of cavities or decayed teeth in any part of the measurement period

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Not applicable