Preschoolers’ poor oral health leads to severe tooth decay

By the time children in California reach kindergarten half of them already have cavities. More than a quarter of them have untreated tooth decay. Photo: emrank/Flickr

Tooth decay, the most prevalent chronic disease of childhood in the United States, is also preventable.

Every week, children come into the Asian Health Services dental clinic in Oakland’s Chinatown with severe tooth decay. “It’s not uncommon that these children- especially immigrant children- have anywhere from 6-20 cavities in their mouth,” says Dental Director Huong Le.

In order to treat such extreme tooth decay they have to put the children under oral conscious sedation – a costly procedure. Half of their pediatric patients – about two thousand children – fit into this category.

The Centers for Disease Control and Prevention CDC that found in 2007 that as every other aspect of oral health improved, the rate of cavities in preschoolers aged 2-5 had increased since the previous study a decade before.

Experts attribute the increase to lack of knowledge among parents and lack of access to pediatric dentists.

California has the third worst children’s dental health, ranked just above Arizona and Texas in the National Survey of Children’s health conducted in 2007 – the last year most of these studies were done.

By the time children in California reach kindergarten, half of them already have cavities. More than a quarter of them have untreated tooth decay. Among poor children and children of color the numbers are even worse. Seventy-two percent of children on free and reduced lunch have cavities and a third have untreated tooth decay.

Children with serious untreated tooth decay often have nutritional problems because of difficulty chewing. They also have challenges speaking and miss school days.

Asian Health Service has two pediatric dentists on staff, but their services are in such demand that patients usually have to wait nine months before they can get an appointment for the procedure. Most of the clinic’s pediatric patients are covered by Medi-Cal, which pays for the treatment, but it doesn’t cover the oral conscious sedation medication.

In the worst cases, when the patient cannot wait nine months, AHS refers them to an outside specialist who is willing to work for the Medi-Cal reimbursement rate but charges the patient for the medication. Three years ago, Le got a grant from the Alameda County Dental Society Foundation to cover the cost of the medication.

“So that has helped out tremendously with our backlog,” Le said.

Dental departments in community clinics are usually a small part of their overall operation. The dental clinic at AHS only has the capacity to treat 8,000 of their 22,000 patients. Le recommends all pediatric patients be referred to dental by the time they are one year old.

Since they don’t have the capacity to see all those patients, they’ve trained staff in the pediatric medical clinic to apply fluoride and varnish so they don’t have to be referred to dental.

Arlene Glube, director of Southern California Operations at The Center for Oral Health, points out that extreme tooth decay is preventable. Two years ago, she started working with women in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) to educate them on how to prevent tooth decay in their kids.

“Parents think first teeth are going to fall out – so why spend the money on the first set of teeth?” Glube said.

But Glube says mothers need to start thinking about oral health from the moment they know they are pregnant. She tells the parents she works with that by the time their child is one they should go to the dentist.

“Make an appointment for yourself, have your baby sit on your lap and say ‘have a look at my baby.’ It opens the conversation,” Glube said.

Part of the problem is that some doctors and dentists don’t realize that children need to begin seeing a dentist by the age of one. Glube says there are pediatric dentists who will only see patients once they’ve turned five.

“That, to us, is malpractice,” Glube said. “We work very closely with our dentists so that they never turn a mom away with a young child.”

Both Glube and Le recommend that when a child gets their first tooth, his or her parents should start brushing with a small soft toothbrush and fluoride toothpaste after breakfast and before bed. And Glube says they should continue to help until their child is eight years old.

Glube also recommends healthy snacking and weaning from a bottle by the age of one. “And no bottles in bed,” Glube said. “Certainly no bottles in bed with anything exciting like juice or kool-aid.”

She also points out that it is better for kids to drink fluoridated water from the public water supply than bottled water.

So far the WIC program has been successful, Glube said. Most mothers are glad to learn how to take care of their children’s teeth.

“The most exciting thing is going to the WIC site and mom comes back with her next children,” she said.

There are other barriers to Californian children’s oral health. While it is much easier for children than adults to get affordable dental coverage, about a quarter don’t have any.

Parents of children in California’s thirteen rural counties may have difficulty finding a pediatric dentist willing to take new clients. They may especially have difficulty finding a dentist willing to work for the low Medi-Cal reimbursement rates.

Glube has been working in the field for more than 30 years. “I just can’t bear to retire. I love what I do and I love the people,” Glube said. “I can’t imagine waking up in the morning and not worrying about them.”

But over those 30 years, she’s seen oral health programs come and go. At one point she coordinated an eleven-person staff. “We had almost four hundred thousand children getting preventive services at school,” Glube said. “But Governor Schwarzenegger cut that program out.”

She said when that happened, it felt like she had climbed a mountain and slid all the way back down.

The Center for Oral Health got a Health Resources and Services Administration grant in 2011 to integrate dental services into the school-based health centers at Murchison Elementary, and Plasencia Elementary in the Los Angeles Unified School District.

School-based health centers provide an ideal setting for dental screening and preventative services. Dentists have easy access to their clients, and if a child misses an appointment, they can simply call the next child on the list.

“We’re just starting all over again, climbing that mountain,” Glube said.

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