Health & Development
Check the Gum by Age One
Jessica Rivera Mateo opened her mouth wide and howled.
The 16-month-old girl with a bright pink vest and matching boots smiled and played with rubber duckies while dental assistant Becka Benedict questioned her mother, Veronica Rivera Mateo, about her health history. A series of oral health questions established that Rivera Mateo had begun good habits: she cleans Jessica’s teeth once a day before bed and gives her mostly milk and water to drink. Benedict asked about fluoride toothpaste and talked about the importance of not letting sugary liquids or snacks sit on the teeth for a long time. If the mother had not been doing such a good job, Benedict would have demonstrated simple toothbrushing.
Dr. Joel Berg, director of the Center for Pediatric Dentistry in Seattle, entered the exam room wearing “funny glasses” with magnifying lenses. Jessica smiled tentatively at him. Gently explaining the procedure, Berg sat knee-to-knee with Jessica’s mother, who had Jessica on her lap. Rivera Mateo leaned the little girl backwards onto the dentist’s lap. This brought a howl of protest, allowing Berg to look into Jessica’s mouth with a mirror, to quickly brush her teeth and to coat them with a fluoride varnish.
“She has exactly the right number of teeth; they look clean,” Berg tells Rivera Mateo. She had brought Jessica to the dentist because she was worried that her daughter’s teeth are “small and not white; sort of see-through looking.” Berg told her that Jessica has a fairly rare genetic disorder that causes the teeth to be discolored and translucent and susceptible to having the enamel chip off and break. Although it’s a mild case, Jessica should be seen by a dentist every three months.
It’s unusual for children 3 and younger to need to see a dentist that often – every six months to a year is more common, Berg says. But Jessica’s case illustrates the importance of early preventative exams.
Why Start So Early?
As chair of the Department of Pediatric Dentistry at the UW School of Dentistry, Berg is passionate about early oral screening. “Almost all tooth decay is preventable in children, and there is nothing more important in dentistry than the first visit by the first birthday,” he says.
Here’s why preventing decay in baby teeth is important:
- Cavities can result in infected teeth and gums, causing pain that interferes with learning and play and, in extreme cases, leading to swelling in the face, abscesses and need for oral surgery. “If their mouth isn’t healthy; they’re not healthy,” Berg explains.
- Early loss of decayed baby teeth can cause the permanent teeth to come in incorrectly, usually with more crowding and need for later correction.
- Loss of some baby teeth, especially incisors, can delay proper speech development.
- Dark or decayed teeth can affect children’s self-esteem.
Another vital part of a baby’s exam is educating the parent and demonstrating how to brush teeth, Berg says. This is especially needed if the child is high risk: siblings or the mother have dental decay, or nutrition habits are poor.
Students going through dental school now receive training to screen children after the first few teeth have come in (6 months to no later than first birthday.) Programs such as ABDC (Access to Baby and Child Dentistry) train dentists throughout the state to see young children.
The Physician Alternative
Dr. Jeff Wright, medical director of the UW Medicine Pediatric Care Center in Seattle, would like to see all parents establish a “dental home” for their children before they reach their first birthday. At the same time, he realizes that many parents won’t know about that recommendation. He believes that pediatricians and family practitioners – who see babies five times during their first year – are uniquely placed to provide those first oral screenings, where the emphasis is on risk assessment and prevention.
As an Associate Professor of Pediatrics and an Adjunct Associate Professor of Dentistry, Wright is instrumental in training UW medical residents to include early childhood oral health in their studies. Medicaid now reimburses physicians for oral risk screening and parent counseling, as do some private insurance companies.
The Washington Dental Service Foundation is another resource that provides in-office oral health training to private primary care medical providers around the state.
Dianne Riter, program manager, estimates that WDSF has trained about a third of Washington pediatricians and family practitioners, and wants to see the numbers grow. “Nearly four out of 10 kindergarteners in the state have some kind of tooth decay,” she says, citing the 2010 Smile Survey published by the Washington State Department of Health. The good news is that rates of untreated decay dropped significantly over the preceding five years, especially for low-income children.
“For a chronic and common disease that’s preventable, those rates are still too high,” Riter says.
More About This Story...
What Parents Can Do
- Wipe baby's teeth with a wet washcloth (or brush them) once a day.
- Don’t put baby to bed with a bottle, except for water.
- Ask for oral screenings during well-child visits. The first dentist visit should be between the age of 6 months and his first birthday.
If there is no fluoride in the drinking water, consider having a fluoride varnish put on teeth periodically. Note: the American Dental Association does not recommend using fluoride toothpaste for babies or young children until they can rinse and spit it out.
ABCD (Access to Baby and Child Dentistry) – Preventive and restorative dental care for Medicaid-eligible children from birth to age 6. Call for eligibility: 800-756-5437, King County; 253-798-4720, Pierce County; 425-339-5219, Snohomish County; www.abcd-dental.org.
Washington Dental Service Foundation – Easy-to-understand information on oral health from pregnancy through preschool. 206-528-2337; www.kidsoralhealth.org. (For information about curriculum and training, visit www.cavityfreekids.org.)
American Academy of Pediatric Dentistry – Finding a “dental home” by the child’s first birthday, FAQs on “Dental Care for Your Baby,” guidelines on preventing cavities, dietary recommendations and fluoride. 312-337-2169; www.aapd.org/dentalhome.