Children's Voice Jan/Feb 2007

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Health Beat

Children's Dental Health: Something for Caregivers to Chew On

What is childhood without the ability to smile? Those of us in good oral health may take for granted the ability to eat comfortably, sleep through the night without pain, or simply smile for a picture. But many children across the country and around the globe are not so fortunate.

Dental caries, or tooth decay, is the most prevalent, chronic childhood disease in the United States, and is four times more common than asthma (42% versus 9.5% among children ages 5 to 17), according to the Centers for Disease Control and Prevention. Unfortunately, ignorance about the preventable disease is just as widespread.

Most people are unaware that dental caries is not just about cavities, says Burton L. Edelstein, professor of health policy and dentistry at Columbia University, and Founding Director of the Children's Dental Health Project. The disease starts early, causing victims to be at high risk for cavities and chronic tooth decay throughout their lives. Left untreated, dental caries can lead to severe pain, infection, tooth loss, and endentulism--total tooth loss.

"We have to train dentists to know about this," Edelstein says. "Your average dentist on the corner who was educated 10 years ago is probably unaware of a lot of this."

Dental caries is often established by age 2--as soon as a baby's first teeth appear, the child is at risk. Inherited traits, such as tooth enamel strength, or bad habits, such as a predisposition for sweet foods, may help establish the disease. Caries is also infectious, typically transmitted from mothers to their infants. Transmission may occur in a number of appropriate and natural ways, including a mother tasting baby food and then using the same utensil to feed the child, or a child sticking his fist into his mother's mouth and then into his own.

"We don't want most mothers to not do those normal things, but if a mother has had troubles with her teeth, and she has an older kid who has already had early tooth decay, we'd love to limit that transmission," Edelstein says.

Dental caries is most common among low-income and minority children, particularly Hispanic children.

"You tend to have higher concentrations of Latino kids in low-income populations," Edelstein hypothesizes, "and with income [comes] all kinds of social determinants of health and questions of competing needs and access to low-cost foodstuff that tends to be richer in sugars. It could be cultural; it could be related to feeding practices."

In Dominican populations, Edelstein points out, it's common to continue using the bottle for an extended period of time, and for putting lacerated food in the bottle, instead of more traditional liquids. In some countries, including Latin American countries, pacifiers containing reservoirs for honey, molasses, or other sugars are sold in stores.

Dental caries is preventable at a fairly low cost and yields exponential improvement in oral health if treated early. "The intensity of a person's disease tends to be fixed over life, and the disease itself is cumulative, so if you start with cavities early, you're prime to have more," Edelstein says.

Many prevention outlets are available, including keeping dentists current with information and lowering the standard checkup age--ages 3-5--to 1 or 2. But as Edelstein acutely observes, "The best source of all is in the population itself. Once enough dentists are providing infant oral health care, and enough pediatricians are talking about early childhood oral health care, then parent-to-parent networking is probably the most effective [form of prevention]."

February is National Children's Dental Health Month. Visit the American Dental Association's website,, to download free promotional materials. Also visit the Children's Dental Health Project,, for more health information.

--Ann Blake, Children's Voice Contributing Editor

Questions forPolicymakers in Your State

The Deficit Reduction Act of 2005 provides states with new opportunities to change the way they deliver dental care to low-income children covered by Medicaid. Child advocates should stay vocal about the need for dental coverage for these children.

Questions to ask policymakers to keep abreast of possible changes in your state include:
  • Are changes to Medicaid being discussed?

  • What changes are being considered?

  • Will comprehensive dental care for children be maintained?

  • Are cost estimates for these changes available?

  • Will proposals be available for public comment?

  • How will families or beneficiaries be informed of Medicaid program changes?

  • Can I provide any information or assistance?
Source: Children's Dental Health Project

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