Education Is the Key

February is National Children’s Dental Health Month—a time when the dental profession focuses on bringing awareness to the importance of children’s oral health and its relationship to overall health. Unfortunately, achieving optimal dental health in American children remains a work in progress. Few population groups are more vulnerable to oral disease than young children, and early childhood caries (ECC) remains far too common. Children of low socioeconomic status and those belonging to racial/ethnic minority groups continue to be affected disproportionally, and data show that poor diet, lack of parental education, and poverty make these children 32 times more likely to develop ECC.^1,2

Dental caries is the most prevalent chronic disease of childhood, with an incidence five times that of asthma.³ Millions of school hours and work hours are lost annually due to dental caries in children.^4,5 One in four children younger than 5 already has caries, and nearly three in 10 third-graders have untreated decay.^6,7 Given these grim statistics, dental professionals have much work to do to achieve the goal of optimal oral health in this vulnerable patient population.

STRATEGIES FOR SUCCESS

To improve children’s oral health in the United States, intervention efforts must begin early, and several critical components are necessary. The first strategy is ensuring that all children experience their first dental visit by age 1 or the eruption of the first tooth. Too many pediatric dental professionals are seeing children for their first dental visit at age 3 or older, at which time significant tooth decay may be present. Many of these children require extensive and expensive treatment that must be provided while the child is sedated or under general anesthesia.

Parents need to understand that early dental care is critical to maintaining and/or improving the oral health of children. This message needs to come not only from dental professionals, but also from the greater health care community. Our medical colleagues have done an excellent job in educating the public that all newborns should receive periodic health care from their pediatricians during the first year of life, and these “well-baby visits” are now considered routine and necessary. Unfortunately, dentistry has not been nearly as successful in ensuring the age 1 dental visit becomes similarly accepted. Dental hygienists are integral to educating expectant and new parents about the importance of their infants seeing a dentist as soon as teeth begin to erupt.

The second strategy for improving children’s oral health is to ensure that every child has a dental home. A dental home is defined as the ongoing relationship between a dental professional and patient, in which all aspects of oral health care are delivered in a comprehensive, accessible, coordinated, and family-centered manner. This concept has been slow to catch on, in part because it requires a paradigm shift from the way parents traditionally have thought about dental care for young children and the importance of primary teeth. While the dental home has been endorsed as the standard of care by the American Dental Association, American Academy of Pediatric Dentistry, and American Academy of Pediatrics for the past 10 years, a recent survey found that fewer than one in 10 parents had even heard of the concept.⁸ Just as with the age 1 dental visit, oral health professionals need to educate parents about the importance of prevention in achieving optimal dental health. The best way to implement preventive care is through the dental home.

Finally, dental professionals need to do a better job of reaching parents. Dental caries is a disease that is largely preventable. Just because parents experienced tooth decay in their youth does not mean their children need to follow the same path. The crux of the solution is to ensure that parents take charge of their children’s oral health—from serving healthy meals to making sure their children brush twice daily with the appropriate amount of fluoride toothpaste (a smear or grain of rice-sized portion for children younger than 3 and a pea-sized portion for preschool-aged children and older). Parents must also provide assistance with toothbrushing until children are able to properly brush on their own—usually second grade or third grade.

Oral health clinicians also need to educate other professionals who work with children—including physicians, nurses, pharmacists, and teachers—that it is no longer recommended for children to wait to visit the dentist until age 2 or 3. The first dental visit should occur by age 1 and a dental home should be established.

In short, pediatric dentists believe that early involvement and intervention are absolutely critical, and we recognize the role that dental hygienists play in achieving the goal of improving the oral health of children. Recent data from the US Centers for Disease Control and Prevention indicate that the rate of dental caries among preschool-age children has slightly decreased.⁹ The specific reason for this dip is unclear. What is clear is that early dental visits for children and increased parental education and involvement will only help reach the goal of optimal oral health for all Americans.

REFERENCES

1. Drury TF, Horowitz AM, Ismail AA, et al. Diagnosing and reporting early childhood caries for research purposes. J Public Health Dent. 1999;59:192–197.
2. Mobley C, Marshall TA, Milgrom P, Coldwell SE. The contribution of dietary factors to dental caries and disparities in caries. Acad Pediatr. 2009;9:410–414.
3. Vargas CM, Crall JJ, Schneider DA. Sociodemographic distribution of pediatric dental caries: NHANES III, 1988–1994. J Am Dent Assoc. 1998;129:1229–1238.
4. Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits. Am J Public Health.1992;82:1663–1668.
5. Pourat N, Nicholson G. Unaffordable Dental Care Is Linked to Frequent School Absences. Available at: healthpolicy.ucla.edu/publications/Documents/PDF/Unaffordable%20Dental%20Care%20Is%20Linked% 20to%20Frequent%20School%20Absences.pdf. Accessed January 7, 2015.
6. Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 1988–1994 and 1999–2004.Vital Health Stat. 2007;11:1–92.
7. Dental Health Foundation. Mommy, It Hurts to Chew—The California Smile Survey: An Oral Health Assessment of California’s Kindergarten and 3rd Grade Children. Available at: centerfororalhealth.org/images/lib_PDF/dhf_2006_report.pdf. Accessed January 7, 2015.
8. American Academy of Pediatric Dentistry. The State of Little Teeth. Available at: aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf. Accessed January 7, 2015.
9. ADA News. CDC Data Show Early Childhood Caries Trending Down. Available at: ada.org/en/ publications/ada-news/2014-archive/october/cdc-data-shows-early-childhood-caries-trending-down. Accessed January 7, 2015.

From Dimensions of Dental Hygiene. February 2015;13(2):18–19.