I often meet families in our clinic at Hennepin County Medical Center in Minneapolis when their child is seen for a pre-operative exam prior to dental care under anesthesia. In fact, in my practice this is the most common reason a pre-operative exam is performed. While sedated, these children undergo dental examination, x-rays, dental cleaning, restorations of decayed teeth with fillings and capping, and, very often, extraction of baby teeth.  It typically requires over an hour of anesthesia and costs an average of $2,000-$5,000. And each time I see these children, I think about how we’ve seriously failed in our efforts to keep kids healthy.

Over half of US children under age 5 years have or have had caries, commonly known as cavities. The greatest burden is carried by low-income children, whose prevalence of caries is increasing and disproportionate, starting earlier in life, with more affected teeth, more severe complications, and more teeth lost. The impact of dental disease on children may go far beyond the simple structures of their teeth and gums. It can be found in their experience of chronic pain, or self-consciousness about their appearance, in their general health and difficulty eating, and in increased Emergency Department visits, child absences from pre-school and school, and parental absences from work. Some researchers hypothesize that chronic inflammation from dental disease can cause a generalized inflammatory response in the body linked to premature deliveries in pregnant women and cardiac disease in adults.  Those who’ve said “don’t worry, they’re just baby teeth” need to re-think their belief that the health of little mouths doesn’t matter.

Recently, Children’s HealthWatch analyzed data on the associations between oral health status and health outcomes among children ages 1-4 years old. Of these young children, only 35% had ever seen a dental health provider, despite the fact that the American Academy of Pediatric Dentistry and the American Academy of Pediatrics recommend that children have their first visit to a dental health provider by the age of one. 8% of the children’s caregivers reported that their child’s oral health status was either in fair or poor condition. We found that children with fair or poor oral health were at increased risk of being underweight and having developmental delays, setting children up to struggle with their health and education over both the short and long term.

Many of my patients have parents who are immigrants or are immigrants themselves. It’s been shown that children of foreign-born mothers are at greater risk of dental disease than children of mothers born in the U.S.  Our research bears this out – we found that young children of foreign-born mothers were 73% more likely than children of U.S.-born mothers to be in fair or poor oral health.  However, our analyses showed that foreign-born mothers and U.S.-born mothers were themselves equally likely to have fair or poor oral health.  In other words, children with poor oral health did not necessarily have mothers with poor oral health.  Something is happening that specifically endangers children’s oral health, and since the mouth is part of the body, endangers their overall health.

We believe that one of the contributing factors is the higher rates of food insecurity among children of foreign-born mothers. Young children living in families struggling to provide enough healthy food were 58% more likely to have fair or poor oral health compared to similar children in families who had enough to eat.

Oral health disparities and the medical complications to which they contribute can be avoided. Historically, low-income children have faced barriers to accessing dental care because many dental health providers do not accept Medicaid. Under the Affordable Care Act, all children’s insurance is supposed to include dental care as an ‘essential benefit’. However, the implementation of that benefit has varied state to state based on the state’s model for selling insurance on their health exchange.  Efforts are underway to fix the issue, so that a painful, infected mouth does not have to be the reality for any child.

At my clinic in Minneapolis, we apply dental varnish, which contains a high concentration of fluoride used to help prevent tooth decay, at check-up visits for young children beginning in infancy. A recently published review article supports this as a best practice in clinics serving low-income communities.  Other dental health-promoting practices include programs to teach oral hygiene habits to caregivers of young children, encouraging the regular consumption of adequately fluoridated water and use of fluoride toothpaste, addressing diet and feeding habits, and referring children to dental providers in order to establish on-going, formal dental care. Consciously addressing oral health disparities nationally and ensuring that dental coverage qualifies for subsidies in all state health exchanges as an essential benefit just like medical coverage, will improve the oral health of children across this nation. Additionally, by locally implementing inclusive community education and preventative clinical practices in partnership with the dental community, and proactively helping families to secure enough healthy food resources, I believe we can greatly improve the general health and well-being of young children, now and in the future.  As much as I enjoy meeting families and their children, I would be very happy to meet far fewer for the purpose of the dental pre-operative exam.

 

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