We see all kinds of symptoms. An 8-year-old boy with a badly swollen jaw due to an infection. A 2-year-old boy who weighs what a 1-year-old should because he can't eat solid foods. A 6-year-old girl who can't fall asleep at night or pay attention in school. A 4-year-old who gets teased at preschool because he "talks funny."
One look inside their mouths, and the telltale erosions and cavernous divots on their "baby teeth" bring to light the probable cause of all these problems that cause so much pain and disability, and yet are so preventable.
The common denominator for these children is the most common chronic medical condition and infection in children: early childhood cavities. The condition is five times more common then asthma and seven times more common then allergies.
A February 2012 report from U.S. Sen. Bernie Sanders titled "Dental Crisis in America" was a call to action for this mostly silent epidemic that affects 42 percent of all children age 2 to 11. It has been increasing most rapidly in the youngest children, mirroring the greatest risk factor for dental cavities: poverty. Almost half the children in America live in or near poverty. Half.
Other risk factors for early childhood cavities also mirror the poverty statistics that continue to exacerbate health disparities in America. One in four poor children in America has never been to a dentist by the first day of kindergarten. Uninsured children are 2.5 times less likely to receive dental care, and 16.5 million children go without basic dental care each year.
An oral health risk assessment tool has been developed to help primary-care providers identify children at highest risk. Besides poverty, these risks include
Having a mother with active cavities;
Frequent snacking or continual bottle/sippy cup use with anything other than water;
Not having a dentist;
Not drinking fluoridated water.
Most of these factors can be traced back to poor health-care access, food insecurity, and living in rural areas that lack fluoridation.
Early childhood cavities can cause pain, loss of teeth, infections in a child's head and neck, cavities later in life, impaired growth and weight gain, missed school days, speech problems, and a poorer quality of life. More than 51 million hours of school are missed each year because of childhood dental problems. The pain of having an untreated cavity makes it hard for a child to concentrate in school.
The American Dental Association and the American Academy of Pediatrics recommends an oral health risk assessment for all children by 6 months and a first dental visit by age 1. Fluoride varnish should be applied every three to six months to the teeth of children at high risk of cavities.
In care settings such as St. Christopher's Hospital for Children in North Philadelphia, an epicenter of childhood poverty, pediatricians are responding to this crisis in innovative ways.
Pediatricians are working with local advocacy organizations and insurers to make sure children who are covered by Medicaid can be seen by a pediatric dentist before complications set in. For example, Public Citizens for Children and Youth (pccy.org), which offers a helpline (215-563-5848) for families to find a dental home, and a "Give Kids a Smile Day" with free checkups.
St. Christopher's Foundation for Children (scfchildren.org) funds a community health initiative that brings dental care to the neediest children through the Ronald McDonald Care Mobile to local elementary schools, day-care centers, and homeless shelters.
Applying fluoride varnish has become a routine part of well-child visits at St. Christopher's, where we provide 400 treatments monthly along with toothbrushes, toothpaste and referrals to local dentists.
As child advocates, we must do more than observe this crisis among the young, the poor, and the marginalized. Pediatricians, nurse practitioners, and family medicine physicians are helping to tackle this epidemic, one child at a time.