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We can take care of children by taking care of their teeth

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This March, the New York City Board of Health put a proposal up for public review that would require preschool teachers and daycare staff to assist children with brushing their teeth with fluoride toothpaste. “Tooth decay is the most common disease in childhood,” Deputy Health Commissioner George Askew said. “And it is preventable.” He noted that 42 percent of NY City school kids suffer from tooth decay by the third grade.

It’s an unprecedented move for the city, but it’s necessary and N.Y. is not alone; other municipalities are doing this, and it’s time for a national program. We are in the midst of a tooth decay epidemic across the U.S. The implications of that epidemic to children’s health throughout their lives are bad enough that the federal government needs to get involved to secure the future health of America’s children.

{mosads}Tooth decay is the most common chronic condition our children face; five times more common than asthma, seven times more common than hay fever in five-to-17-year olds. Poor dental health disproportionately hits poor children, and leads to a lifetime of health problems that cost many billions to address.


Problems in adults who received inadequate care as children include more dental decay, teeth needing extraction, speech impediments and facial deformities; poor confidence; slowed educational development; obesity; poor nutrition; life-threatening infections in the ears, sinuses and brain; hospitalizations and even death.

To give you an idea of how widespread tooth decay is, consider that one out of five children aged five to 11 years have at least one untreated decayed tooth. The same is true of one in seven teens, aged 12 to 19. The frequency of children and adolescents aged 5 to 19 years with untreated tooth decay is twice as high in low-income households (25  percent) as in higher-income families (11 percent).

Dental pain alone, most commonly arising from tooth decay, accounted for more than one-million emergency room admissions in adults and children in 2017, costing more than $1 billion annually.  

A child with unhealthy teeth is at risk for health problems throughout life. For instance, if the tissue in the central portion of a child’s (baby) tooth is infected, the abscess can damage their permanent teeth. If a young child’s teeth are lost early or broken down due to decay, that child’s adult teeth are more likely to be improperly positioned or unable to grow in, leaving them vulnerable to caries and gum disease, and greatly increases the chance the child will require orthodontia.

The ability of tooth decay to impact overall health couldn’t be clearer. Children with caries are susceptible to chronic ear and sinus infections, and cuts and abrasions that won’t heal. Tooth decay can contribute to obesity, cardiovascular disease and diabetes. Even malnutrition because eating becomes so painful.

Several steps are within the scope of current public health programs to stem the tide of this epidemic, but they need championing in order to push them forward to help those children who most urgently need it.

The Pew Charitable Trusts report that at least 10 percent of residents in the states they surveyed do not have access to a dentist. We must foster a more balanced distribution of dentists — get them to the communities where they’re most needed —through a combination of providing incentives for new dentists and authorizing dental therapists to practice in these areas.

Named by the CDC one of the top-ten health achievements of the 20th Century, fluoridation of water is still not universal. Eleven states fail to fluoridate, and not every county in states that do can supply fluoridated water.

The CDC can help determine if your public water supply is fluoridated. Of a 2016 U.S. population of nearly 319 million people, approximately 108 million – nearly 34 percent, a proportion that has grown over the last decade, cannot access fluoridated water. According to the CDC, fluoridation reduces cavities by 25 percent. Since every dollar spent on fluoridation saves $38 in dental costs, expansion of federal programs is needed to help more than one-third of America’s children to avoid tooth decay.

Another program championed in low-income communities is sealants/varnishes. Fluoride varnish or gel can help protect both baby and permanent teeth from cavities, while sealants — a plastic, protective coating — are applied to the chewing surfaces of the back teeth to protect them from decay caused by the acid created by sugar-craving bacteria. Many children have sealants applied by their family dentist, but school sealant programs bring the procedure to underserved communities. Sealants work: the CDC reports schoolchildren receiving sealants have one-third the cavities than those who do not.

Lack of dental insurance hurts children’s teeth. While the Affordable Care Act expanded availability of children’s dental insurance, dental plans may be offered separately from medical coverage, significantly increasing costs for participating families, and benefits vary from state to state.

For patients covered by Medicaid, there are total benefit caps, low reimbursements for dental care, and very few dentists accept it. A report issued in September 2016 by the Center for Children and Families at Georgetown University’s Health Policy Institute identified changes needed to improve dental care under the law, and expand access to care for children covered by Medicaid and CHIP.  

Investing in children’s dental health is relatively inexpensive and pays dividends throughout the entire life cycle.

Jonathan Fielding, M.D., is a professor of public health and pediatrics at University of California, Los Angeles.

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