February 2008
Health & Safety: Start Oral Health Screening Early
When that soft pink gum inside your baby’s mouth starts to get tender and a tiny white sharp tooth begins to erupt, you know what happens next: tears and lots of drool. Parents can do little but soothe and rock and walk the floor while feeling bad for their babies.
But having a plan for early oral health care might mean less pain and more sleep for everyone as your child gets older.
The American Academy of Pediatric Dentistry, the American Academy of Pediatrics and the American Dental Association recommend that children have their first dental check-up by the time their first birthday candle is lit – instead of waiting until ages 3 to 5 as parents have been previously told.
“First of all, the damage happens way before age 3,”
says Dr. Joel Berg, chair of the University of Washington pediatric dentistry
department and a board member of the American Academy of Pediatric Dentistry.
“The purpose of one-year visits is to prevent it from happening.”
Tooth decay is the most common chronic childhood disease in the United
States.
Less than a year ago, the Centers for Disease Control and Prevention released
findings that show that although Americans in general have seen improvements
in their oral health, tooth decay in baby teeth increased in children
ages 2 to 5. Throughout 1988 to 1994, and 1999 to 2004, the study concluded
that tooth decay for these children increased from 24 to 28 percent.
By the age of 2, children can have 10 teeth with cavities, Berg says.
As children get older, it’s not uncommon for them
to develop acute facial infections as a result of early oral neglect;
many are seen in emergency rooms. The cost can be high in hospital bills
if abscesses have to be drained, not to mention in pain and suffering
for the child. “They might spend days in hospital,” Berg says.
The news isn’t all bad: tooth decay in children ages 6 to 11 dropped
from 25 to 21 percent and decay in kids ages 12 to 19 from 68 to 59 percent.
Starting Early
Seattle’s Odessa Brown Children’s Clinic, part of Children’s Hospital and Regional Medical Center, provides dental exams and treatment by a team of pediatric and general dentists for children ages 18 months to 21 years. Examinations for Head Start are also available. Odessa Brown has special clinics on occasional Saturdays where parents with low incomes, whose children are often more affected by tooth decay, can take their children for early screening.
Dr. Chris Delecki, dental director at Odessa Brown, also travels to parent education nights for Head Start and the Early Childhood Education and Assistance Program and talks about infant and toddler oral health care. These programs are working. The number of infants and toddlers seen has risen significantly.
“We started four years ago,” Delecki says. “Every year we almost double (the number of children we see).”
In an effort to have family care providers screen infants and toddlers for oral health issues, the state Department of Social and Health Services provides a financial incentive to those doctors who will take part. Washington’s Access to Baby and Child Dentistry, or ABCD, program matches kids under 6 years old who qualify for Medicaid with dentists.
Changes are also being made in schooling for dentists in our own backyard. The students who graduated from the dental program at the University of Washington in 2007 are the first to have gone through intensive training programs on early oral health care for infants and toddlers. Subsequent graduates will receive the same training.
Dentists working with infants and toddlers often use the lap-to-lap examination, in which children share their mother’s or father’s lap and that of the dentist. Kids wrap their legs around the parent, and then lean their head back into the dentist’s lap. The quick examination can mean long-term prevention in early oral health care.
Delecki stresses that it is very important for infants and toddlers to have a dental home early, so that they don’t fear going to a dentist.
Keeping Decay at Bay
During the first visit, parents and dentists can go over what care needs to be taken to ensure healthy teeth and gums. Three categories to talk about are: diet, hygiene and fluoride, Berg says.
A diet with minimal sugar and more fruits and vegetables can help to prevent cavities. Allowing children to go to bed with bottles, consume sugar-loaded drinks throughout the day and eat frequent snacks can create dangerous problems when teeth and gums are not taken care of.
Delecki says that as sugar consumption per capita continues to rise, infants and toddlers are more exposed to these tooth-decaying foods and drink. “I’m really amazed at the number of parents that feel comfortable with juice,” Delecki says.
A five-ounce carton of pure apple juice has the same amount of sugar as five apples. Delecki worries that these drinks are not a once-a-day treat. Some kids have them at all three meals.
Children with special needs, who take medications with sugar or those born prematurely, are much more likely to have dental problems. Some medications have the side effect of dry mouth. “Saliva is one of the great protectors against cavities,” Berg says.
In the area of hygiene, it takes discipline and commitment to clean your child’s teeth every day. But the reality is that this step in early oral health care can prevent cavities and lots of pain for your child.
During a visit to Odessa Brown, parents with babies and
toddlers are given instructions on how to brush and floss their child’s
teeth, when and what amount of fluoride to use, and how to lift the child’s
lip each day to check teeth and gums.
Under the age of 15 months, a child’s diet is typically very soft
and gums are easy to clean. When children’s teeth begin to erupt,
at 6 months and older, parents can brush and clean gum lines.
And if you tell a dentist that your child won’t let you brush their teeth, then remember that dentists have heard all that before. Parents would be wise to help their children brush their teeth until they are 8 or 9 years old.
One of the biggest risk factors in early childhood oral health is a mother’s ability to pass bacteria from her mouth to her child’s new teeth. Kids should have their own utensils.
“The evidence shows that bacteria in the mom are transmitted
by close contact,” Berg says. Bacteria breed well between teeth,
especially those close together.
Making sure that children have proper exposure to fluoride, in the water
supply or from drops or in pill form, helps teeth to develop. Berg recommends
a tiny amount daily.
“You don’t want to give too much,” Berg says. “A lentil size.”
Early dental visits are a good time for parents to bring up other questions on subjects such as pacifiers, sippy cups and breastfeeding.
Pacifiers are generally not a problem in early oral health
care. Thumb and digit sucking only has a significant effect on permanent
teeth at ages 4 or 5. “At 6 it can be a problem in terms of bite,”
Berg says.
But if you talk to Berg about sippy cups, most parents’ non-drip
friend, you’ll find out that when it comes to your child’s
oral health, they are bottles disguised as cups. They allow bacteria to
pool in the child’s mouth.
If children are breastfed frequently, then parents need to take special
care in oral health.
“We support and encourage breastfeeding,” Berg said. “But make sure teeth are clean.”
In addition, Berg says that it’s never too early for dentists to talk to parents about injury prevention, such as coffee table bangs and bumps on the teeth and mouth.
Parents can prevent many problems by having their pediatricians do an initial oral screening during well-baby check-ups and by finding an early dental home for their children.
Christina Harper is a Snohomish County writer and mother of two.
Resources
Access to Baby and Child Dentistry (ABCD) focuses on preventive and restorative dental care for Medicaid-eligible children from birth to age 6, with emphasis on enrollment by age 1. The Web site for Washington provides contact information and lists of participating dentists in each county, as well as information on what to expect at your first oral health exam. Log on to www.abcd-dental.org. Some programs, including King County’s, help coordinate transportation and language services. For information on ABCD in King County, call 206-296-4600 or log on to www.metrokc.gov/health/kgc/abcd; in Snohomish County call 425- 339-8639; in Pierce County, call 253-798-4720.
The American Academy of Pediatric Dentistry (AAPD) has a comprehensive list of agencies that are involved in children’s oral health care. As well as many other resources, the AAPD has information on how to find a pediatric dentist in your area. It offers parent information brochures and tips for busy parents on brushing, sealants and diet. Visit www.aapd.org.
The American Dental Association (ADA) provides information on how to find dentists in your area and early child oral health and tips for choosing a dentist. Those whose primary language is Spanish can also get information on children and oral health care. Located in Chicago, Ill., the ADA can be reached at 312-440-2500, or log on to www.ada.org.
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