The importance of dental care for children
Children's Dental Health Project chairman Burton Edelstein, DDS, MPH, told the Alliance for Health Reform/Kaiser Family Foundation briefing on dental health issues that it is important to focus on children's oral health because "everything that goes wrong in people's oral health throughout a lifetime is initiated during the pediatric years. Tooth decay is the single most prevalent chronic disease of childhood, five times more prevalent than asthma. Pediatric dental caries, early childhood caries, is established as a disease process before age 2. So anything that we do after age 2 is no longer primary prevention."
Likewise, Dr. Edelstein said, gum disease, which is the single greatest cause of tooth loss in the United States, is established as a disease process during late childhood and early adolescence. And oral cancer, the third major disease of the oral cavity, has all of its determinant and risk exposures established by young adulthood.
"If we are going to be serious about lifelong improvements in oral health," he declared, "the only time to nip it in the bud is early on. And the trajectory, once established, can be quite negative and impactful and consequential in children's lives as they become adults."
In terms of health policy, Dr. Edelstein said, dental is the best example of the worst case in too many instances. "Whether we are talking about access or Medicaid performance, or work force adequacy, or consequences of a preventable disease, or failure to prevent a preventable disease or disparities or safety net adequacy, or almost any such issue, dental is one of the most outstanding problems," he asserted.
Some 25% of all preschoolers already have visible cavities, and that increases to 50% by the time they enter first grade. And while 80% of Medicaid children get a medical visit in a year, only 30% get a dental visit. "If it can be done on the medical side, it can be done on the dental side," Dr. Edelstein insisted.
Preventable and manageable
Despite the policy issues, he said, the really good news is that dental disease is virtually 100% preventable, and if not prevented in the first place, it is almost 100% controllable or manageable. He said that while tooth decay is diet-dependent and fluoride-protected, what is known about the science of the disease and the science of behavioral interventions has not been well employed to reduce the disease and its consequences.
"We need to redefine early childhood tooth decay prevention and control," according to Dr. Edelstein. "Needed is public policy support to make that happen so that dental and dental hygiene professionals, pediatricians, Head Start, and child workers, all of the people who come in contact with children, can promote oral health.
"Consider the mouth and its orphan status. Think about the functions of the mouth. Respiration, we breathe through it," he added. "Digestion, we eat through it. Sensation, we taste through it. Communication, we speak through it. Protection and immunity, our body is protected from exposure from the outside world through it. These are essential medical components of our health and our well-being, and the distinction between policy on oral health and policy on general health is just not tenable.
"Too many children suffer too much, too often, from a completely preventable set of diseases. Policy action is now needed to improve the financing; to ensure a competent, adequate, and available work force; to bolster the safety net; and most of all to empower federal programs on prevention and control of childhood caries. The No. 1 thing we can do now to get the most bang for the buck is to stem the tide of ongoing disease and turn off the tap instead of chasing after the repair or existing disease," Dr. Edelstein concluded.
Children's Dental Health Project chairman Burton Edelstein, DDS, MPH, told the Alliance for Health Reform/Kaiser Family Foundation briefing on dental health issues that it is important to focus on children's oral health because "everything that goes wrong in people's oral health throughout a lifetime is initiated during the pediatric years.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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