Baby Teeth| A.J. is awaking calmly in the recovery area after an in-office intravenous sedation and full-mouth dental rehabilitation. She is four years old and just had 12 of her 20 baby teeth treated. The cost is $500 for anesthesia and $3,150 for dental restorations, extractions, and a space maintainer. Today, there are three other patients scheduled for sedation because of the amount of work needing to be completed, their age, and their inability to cooperate or hold still to receive quality dental work. Unfortunately, this happens weekly in our Colorado Springs pediatric dentistry and orthodontics practice.
For the first time in 40 years, dental caries in children is on the rise, nationally. It occurs in every racial and socioeconomic group. Research by the Center of Disease Control and Prevention found that dental caries is the most prevalent disease in children. It is five times more prevalent than asthma and seven times more prevalent than hay fever. Almost half of all children in the U.S. exhibit symptoms of the disease by the time they reach kindergarten. In the state of Colorado, 16percent of two -four year olds have untreated decay and the statistics only get worse as the population increases with age.
Dental caries is a disease where there is loss of calcium and phosphate from the enamel and dentin of teeth. Dental decay or a cavity is the primary symptom of the disease, but there is an increasing spectrum varying from a white spot lesion to actual loss of tooth structure, necrosis of the nerve tissue, and infection of the alveolar bone surrounding teeth. The health and preservation of cavity-free, primary teeth is important for chewing food, proper development of the facial structures and jaw relationships, eruption sequence and position of permanent teeth, and an increase in self-esteem. Unfortunately, once teeth decay they become a source of significant infection and pain.
The disease of dental caries characteristically starts due to the presence of cariogenic bacterial organisms that, when combined with simple sugars in the diet, form acid. These organisms only colonize on teeth and are not present at birth. Infants get the bacteria transferred from their care takers via an orally cleansed spoon or pacifier. Individual prevention as well as providing prenatal, oral-health guidance to pregnant mothers can minimize the mother’s bacterial count and delay the transmission and colonization of the bacteria in the infant.
Ironically, this disease is almost completely preventable. The most successful strategies have not changed for many years. These include, establishing and maintaining good oral hygiene, optimizing fluoride exposure, and the elimination of simple sugars in the diet. Advances in prevention include dental sealants and most recently, the support of the American Dental Association (ADA) and the American Academy of Pediatric Dentistry (AAPD) for the establishment of a dental home by the child’s first birthday. This idea follows the ‘medical home’ model. A dental home is a place where children can receive comprehensive care, dental anticipatory- guidance, and establish a dentist-patient relationship allowing the patients to have confidence in dental professionals for continuing and emergency care.
In America, there are approximately 30 times more general dentists than pediatric dentists, and thus the majority of children will be treated by the former. Unfortunately, most dentists do not want to see children until age three, about two and a half years after the child has teeth. That is too late. In our practice, we follow the recommendations of the AAPD and want to see children by their first birthday to establish a dental home. Most children only have four to six teeth at this age but a focus on anticipatory guidance, an oral screening, placement of fluoride varnish, and most importantly parental education is critical.
Parent’s own dental health, attitudes regarding dentistry and oral hygiene, and their anxiety significantly affect the child’s dental health. Often parents were traumatized by a dentist in their childhood because of outdated, behavior-modification techniques or the need to restore numerous decayed teeth. By starting at a young age, trust is garnered and anticipatory guidance-practices prevent decay and difficult restorative procedures, resulting in children who love to see the dentist and have good oral health. If children are cavity free by the age of three, the likelihood of that child experiencing dental decay in the future decreases significantly.
All health care providers can be advocates for the dental health of children. Family physicians and pediatricians most often see children during the age of the initial eruption of the primary teeth and traditionally see them seven to eight times before the first dental visit. Direct dental anticipatory-guidance from medical providers is very beneficial. There are great resources found on the websites of the American Academy of Pediatrics (AAP), ADA, and the AAPD on how to perform an oral screening, provide fluoride, and evaluate risk. Establishing a dental home by age one with a pediatric dentist will also be vital and should be recommended at the early well-baby visits. The age-one dental visit is so important in our practice - if the child is not covered by insurance - exams and preventive procedures are complimentary until the age of two.
A.J.’s parents certainly experienced a more difficult and expensive path for restoration of good oral health and will now be more proactive in the prevention of oral disease with their younger son in the future. Early and frequent evaluation of dental health will lead prevention of dental caries and improve overall health. Children can and should grow up with a positive image of dentistry. Pediatric dentists are best equipped to handle this burden but based on the sheer number of children in America, they need help from their general dental and medical colleagues.
Joshua B. Erickson DDS MSD is a unique dual specialist having been residency trained in both orthodontics and pediatric dentistry.
University of the Pacific Arthur A. Dugoni School of Dentistry—Dental School
University of Washington—Orthodontics
University of Tennessee—Pediatric Dentistry
Kirk A. Skidmore DDS spent a year in advanced general and hospital dentistry after dental school and then two years in pediatric dentistry.
University of Washington—Dental School
University Hospital at the University of Utah—General Practice Residency
Lutheran Medical Center, Hawaii—Pediatric Dentistry
Erickson Pediatric Dentistry & Orthodontics
8580 Scarborough Drive, #220
Colorado Springs, CO 80920
16055 Old Forest Point, #202
Monument, CO 80132