I will be on Fox News Tonight at 5 to discuss this issue. Here are the notes I’ve prepared for the broadcast:
Decay Story:
• Tooth decay in primary teeth of children aged 2 to 5 years increased from 24 to 28% – a 16% increase from the 88-94 period vs the 99-04 period
• Significant disparities along racial, ethnic and economic lines – Hispanics 6-11 showed 31% fill rate in permanent teeth vs 29 % non-Hispanic/white kids
• Three times as many children living below the poverty line ages 6-11 had unfilled cavities compared with those with incomes above the poverty line.
• Adults 20-64 showed a 4% decrease in dental visits at least once a year when comparing the same 88-94 vs 99-04 date parameters – tie into oral/systemic link
Causes of increased decay
• Access to care issues, and the fact that so few dentists participate in Medicaid system, which is frought with problems:
o Payment is very small
o Patients don’t keep appointments
o Limited numbers of procedures – eg Hg vs composite
Talk about California and Maine, and soon, other parts of the US
• Entitlement mentality
o If I don’t have dental insurance I don’t go to the dentist
o Boss is responsible for whether my family and I keep my teeth – this is a quality of life decision, not a quality of job decision
• The managed care system
o Babies don’t come with owner’s manuals – baby bottle syndrome used to be a precautionary lesson, I think today it’s glossed over
o Baby teeth are not expendable.
o Parental and grandparental coping mechanisms are not in place, priorities are misplaced, many mothers out in the workplace and therefore cannot control the diet children are getting during the day.
• A nation of over-indulged children and adults – check out love and logic.com
• Misplaced dollars – toys (child and adult), consumer debt, pampering (nails grow back, teeth don’t).
• Study faulted bottled water – this IMHO is not the case. Fluoridation has not been shown to be effective. In many areas water is not fluoridated. Osteosarcoma in adolescent males. Fluoride needs to be applied topically, not taken systemically.
• Baby teeth decay very rapidly
• Spaces between baby teeth are there so that there’s room for the larger permanent teeth. Sticky candies, like jelly beans get stuck between, and start the decay process. Also get stuck in grooves of teeth. This is something that is seldom taught to parents – How to brush your child’s teeth.
Effects of increased decay
• Invasive treatment on infants is scary both for the child and the dentist.
• Creates dental anxieties that can take decades, even a lifetime to overcome
• Budgetary changes which can lead to a lack of care, or undercare.
• Lack of access to care led to the death of a 12 year old in Maryland, so this simply isn’t only about teeth, it is a life and death issue.
• Many children’s decay is so severe that the children need to be treated under sedation or general anesthesia. This poses a substantially added risk to a situation that could have been avoided, had the proper nutritional and preventative information been given the parents.
What can parents do?
• The causes of decay in children must be understood. The cause of rampant decay like we see here in this child was baby bottle syndrome – there should be nothing but water in a bottle in the child’s mouth when it goes to sleep or for a nap. Sugar is present in juices, formula. It lays on the teeth and if not removed, starts the decay process. Once the decay starts, it gets deeper in the enamel and then it hits the underlying layer, the dentin which is 60 times softer than the enamel. From there it spreads like wildfire to the nerve of the tooth.
• Too many sweets that are sticky lock into the grooves in the top of teeth, and between spaces in the teeth, and again, spread like wildfire.
• Soda and fruit juices with sugar are major culprits – children should be encouraged to rinse and spit after ingesting these foods.
• Jellybeans and other sticky candies should never be used as rewards without an immediate toothbrushing by the parent.
• Children should not be entrusted to their own toothbrushing until around age 8 or 9.
• Parents should sit cross-legged on the floor so that they have visual access to all tooth surfaces and brush them. This position also trains the child for their first dental visit which will be in a dental chair, with them lying down.
• As soon as the teeth begin to erupt into the mouth, parents should start at least wiping the erupting teeth down with a gauze square.
• Children’s first dental visit should be around age 1 or 2.
• Dietary information and a whole lot of other information about this is available on our website at: http://www.cent4dent.com/html/treatment/kids_teeth.html
• If there is an older sibling who is a good dental patient, bring the younger sibling in, to observe the procedures and gain trust, take a ride in the dental chair.
• Sealants on permanent molars as soon as they erupt into the mouth.
When I first started practice, in 1976 I set up next door to a pediatrician so I saw a lot of child patients. The parents of these patients were well educated by the pediatrician, and it was backed up by the preventative procedures we used on them. I thought that we’d make life really easy for these kids, by providing them with regular, preventative services. Many of those children are now bringing their children into the practices, and understand what it takes to keep their teeth.
However, parents whose parents didn’t place these priorities on them while growing up are now facing large dental and financial problems because the knowledge was not passed forward. Hoping that the access to care for patients below the poverty line is going to get better is not going to eliminate this problem. Many dentists simply will choose, as we have, not to participate in a program where they are not being reimbursed and patients do not respect our time. Many of us get involved in various charity programs to assuage our guilt of not participating in government programs. In our office, we often will provide treatment for our patients of record who have fallen on hard times and cannot afford the treatment their children need. We do not do this for people outside the practice, because I get at least 3 emails a week from people searching for a dentist to treat them for free.