Dental caries (decay) remains the most common chronic disease in the U.S. and globally, despite decades of research and proven preventive strategies. In South Dakota, 60–65% of adults and over half of children have experienced tooth decay, with higher rates among low-income, rural and tribal populations. These disparities reflect longstanding challenges in accessing preventive care, especially in underserved areas.
Two of the most effective, evidence-based strategies to prevent dental caries are fluoride use and dental sealants. Community water fluoridation (CWF) and topical fluoride treatments help strengthen enamel and repair early damage, while sealants protect the deep grooves of molars, where 90% of cavities occur. Sealants can prevent up to 80% of decay within two years and remain partially effective for several more years. Yet only 49% of South Dakota third graders have sealants on at least one permanent molar, falling far short of the CDC’s Healthy People 2030 goal of 60%. Studies show that children from low-income or rural areas are at higher risk for decay – yet they are less likely to receive sealants.
Although South Dakota Medicaid covers sealants for eligible children, many dental practices do not accept Medicaid primarily due to low reimbursement rates, further limiting access. Meanwhile, over 94% of South Dakotans benefit from systemic fluoride through CWF, thanks to state regulations requiring optimal fluoride levels in public water systems. However, this cornerstone of public health is under threat.
In April 2025, the U.S. Secretary of Health and Human Services proposed ending CDC recommendations for CWF, citing alleged health risks. Despite continued support from the ADA, CDC and WHO, this shift has fueled a wave of anti-fluoride legislation across the country. Utah and Florida have already enacted statewide bans on water fluoridation, and several other states have introduced bills to restrict or eliminate it. In South Dakota, Senate Bill 133 sought to remove the mandate for maintaining optimal fluoride levels in public water systems. Although the bill was ultimately defeated, it reflects growing skepticism among some lawmakers and constituents. Similar legislation is likely to resurface in 2026, especially as national debates around fluoridation intensify.
The consequences of reduced access to fluoride and sealants are significant. Untreated caries can lead to emergency visits, costly restorative procedures and general anesthesia for children. Dental pain and infection also contribute to missed school and work, financial hardship and diminished quality of life – impacting nutrition, sleep, emotional well-being and social participation.
Sealants and fluoride are complementary, affordable and preventive, costing far less than treating decay. Their combined use is endorsed by the ADA and exemplifies the adage: An ounce of prevention is worth a pound of cure. Sustained protection depends on consistent access to both, especially for those most vulnerable.
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc®. For free and easy access to the entire Prairie Doc® ® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook. Carissa Regnerus, RDH, MA, FADHA, has been a licensed dental hygienist for over 25 years and a faculty member in the University of South Dakota’s Department of Dental Hygiene since 2001.
