Jessica opened her mouth wide and howled.
At 16 months, the vivacious toddler played with rubber duckies while dental assistant Becka Benedict questioned her mother, Veronica Rivera Mateo, about the girl’s health history. A series of oral health questions established that Rivera Mateo had already started good oral habits: she cleaned Jessica’s teeth once a day before bed and gave 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.
Getting a good look
Dr. Joel Berg, an emeritus professor at the UW School of Dentistry, entered the exam room where Jessica and her mom sat waiting 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 the girl on her lap. Rivera Mateo leaned the little girl backward onto the dentist’s lap. The move resulted in a howl of protest, but it allowed Berg to look into Jessica’s mouth with a mirror, quickly brush her teeth, and coat them with a fluoride varnish.
“She has exactly the right number of teeth; they look clean,” Berg told Rivera Mateo.
The young mother 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 had a fairly rare genetic disorder that was causing her teeth to be discolored and translucent and susceptible to having the enamel chip off and break. Although it was a mild case, Jessica would need to be seen by a dentist every three months.
It’s unusual for children aged 3 and younger to need to see a dentist that often – every six months to a year is more common, Berg said.
But, Jessica’s case illustrates the importance of early preventative exams.
Why start so early?
Berg was 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 said.
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 the need for oral surgery. “If their mouth isn’t healthy; they’re not healthy,” Berg explained.
- Early loss of decayed baby teeth can cause permanent teeth to come in incorrectly, usually with more crowding and the 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 said. 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 the 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, a Seattle pediatrician affiliated with UW Medicine-University of Washington Medical Center and Seattle Children’s Hospital, said that parents need to establish a “dental home” for their children before they reach their first birthday. At the same time, Wright said 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.
Wright was 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.
As Dianne Riter, Senior Director, Strategy, Communications, and Evaluation at Arcora Foundation, pointed out: “Nearly four out of 10 kindergarteners in the state have some kind of tooth decay.” The foundation arm of Delta Dental of Washington, Arcora is working to advance oral health across Washington through prevention and getting dental care access to racial and ethnic communities where disparities in oral disease and access to care are significant.
According to the 2015-16 Smile Survey published by the Washington State Department of Health, oral health has been improving among kids in Washington State over the past decade and rates of untreated decay dropped significantly between 2005 and 2016.
More work to be done
According to the 2015-2016 Smile Survey:
- Too many children are adversely affected by dental caries, a preventable chronic condition.
- More than half of all third graders (53 percent) and almost four in 10 kindergarteners (38 percent) experienced tooth decay.
- Large gaps exist by income, race, ethnicity, and language spoken at home.10
- By the third grade, children from low-income households had at least 60 percent higher rates of decay experience in all categories11 and also needed treatment at a 60 percent higher rate than their more affluent peers.
- Children of color in second and third grades had significantly higher rates of decay experience and 40 to 180 percent higher rates of treatment needs than white children.
- Kindergarten and third-grade children whose primary language spoken in the home was not English had more than a 50 percent higher rate of treatment needs than English-only speakers.
“For a chronic and common disease that’s preventable, those rates are still too high,” Riter said.
What parents can do
- Wipe baby’s teeth with a wet washcloth (or brush them) once a day.
- Don’t put a 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 a 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.
American Academy of Pediatric Dentistry – Site offers information on finding a “dental home” by the child’s first birthday, FAQs on baby and child dental care, guidelines on preventing cavities, and information about dietary recommendations and fluoride. Got to aapd.org/dentalhome.