You're never too young to see the dentist

Although there have been advances in health care access and public insurance, for some children, health care is still a privilege - and dental visits are more of a luxury.

A study released this month by the Agency for Healthcare Research and Quality said 31 percent of low income children have cavities that go untreated, compared to six percent of other children.

The Windy Citizen talked with leading dentist Indru Punwani, head of pediatrics at the University of Illinois at Chicago's Dental College, about the dangers and prevention of tooth decay in young children.
WC: At what age does a child need to begin seeing a dentist?

Indru Punwani: Well, I think our job is to educate the public that dental disease, or tooth decay, in the very young child is totally preventable. That's an educational thing that we haven't been able to adequately get to the public. Each child should see a pediatric dentist by the time the first tooth has erupted in the mouth or by the first birthday. If we could get a child at that stage, we can keep them disease free. We could be filing teeth our whole life, but it will never be sufficient.

WC: Why is dental treatment important for a child two or three years old, and what causes tooth decay that young?

IP: The Centers for Disease Control presented data that shows one child in every three has tooth decay by the time they start kindergarten, and in urban centers like Chicago, the prevalence is even higher. For example, here we start to see children around one year, but by 18 months we are seeing tooth decay - fairly aggressive tooth decay. The principle cause is [children sleeping with] a bottle and what you put in the bottle, usually juice. If we can educate the parents, that would be magnificent because you could prevent all these things from starting.

WC: Does tooth decay cause other health problems?

IP: People need to understand that tooth health is part of general heath. So, a year ago a child died from a tooth infection that went up to the brain. People need to understand that the bacteria can travel to other parts. Tooth decay and gum disease can have serious implications to the systemic health of the child, the general well being. It is the commonest chronic disease of the child, six times more chronic than asthma. This is the stage when a child is learning how to speak and you need teeth in the mouth to learn how to articulate sounds. Early loss of teeth can cause problems of the joints. Also, self-image; when a child is starting to socialize and you have no teeth in the front or they are black and rotted out, that's not going to contribute to the child's social well-being.

WC: But don't baby teeth just fall out?

IP: Parents don't understand that bacteria get lodged in the baby teeth and contaminates the teeth underneath. It gets into the gums underneath. It's a progressive disease that if you don't stop it - it goes from baby teeth, to permanent teeth, to tooth loss.

About 35 to 40 patients come in every morning with tooth emergencies, such as pain, infections, trauma, fevers, and that's become a serious challenge. When you begin your journey to oral health with a problem, it sets you back because of comfort levels and anxiety.

WC: Why are there disparities in treatment of cavities between children with low income and other children?

IP: If you look at the data, it's not just income; it's low education. Part of it is related to traditional barriers of access, transportation, being anxious about going because the parent may not have good experiences, babysitting. Then there are only 150 pediatric dentists in the state. There's just no way we can do justice to the large number of children. Part of it is educating the public to come and be seen. One hundred percent of the children that we see at UIC are on Medicaid, yet many of the parents are still reluctant to come. There is an access issue, and it partly comes from the fact that the reimbursement levels in Illinois are probably the lowest in the country. Children from underserved communities also have highest disease burden. It's been suggested that 75 percent of disease is in that 25 percent of the population. Early prevention is what we're trying to promote as much as we can.

UIC dentists serve the majority of low income children in Chicago, and are working to educate parents and communities about oral health. They began working with Head Start to reach children by age one, and train pediatricians to perform oral exams at a baby's one year check-up. Dental students spend about six months in urban or rural clinics to experience access issues and different cultures.

Dr. Punwani can be reached at ipunwani@uic.edu for further information.

How can parents prevent cavities in their children?

• Do not let your child fall asleep with a bottle or Sippy cup. It will cause bacteria to grow in the mouth.
• Bring your child to a dentist when they get their first tooth, or when they turn one year old
• Wipe your child’s teeth after you remove a bottle

As the child grows more teeth,

• Teach your child proper brushing and flossing
• Limit sugar intake
• Go over proper diet with a counselor
• Make sure your child gets fluoride – either through water, treatments or over-the-counter rinses
• Ask a dentist for sealants, which protect the biting surfaces on teeth

Most important, bring your child to the dentist regularly - do not wait until there’s a problem.