USA - Survey finds big holes in kids' dental care

Survey finds big holes in kids' dental care
Health and cultural habits at center of crisis
By Mary Ann Fergus Chicago Tribune
Tuesday, January 15, 2008
CHICAGO -- Katelyn Patthana confidently slid into a chair to have her molars sealed, no big deal for a 7-year-old who had lived through a dental horror story. The Gilberts, Ill., 2nd grader's tooth decay was so severe two years ago that dentists pulled six teeth, crowned two and filled five.
Katelyn is among a growing number of young children with cavities, creating concern among dentists and parents who hoped that brushing and avoiding candy was enough to silence the drills. But with continual snacking and the use of non-fluoridated bottled water on the rise, experts say parents have to be even more vigilant.
"There's plenty of new cavities coming through," says Dr. Nicola Hill-Cordell, a pediatric dentist in Hoffman Estates, Ill. "At least once a week, you get a new kid who is (younger) than 2 with a cavity."
Nationwide, nearly 28 percent of children ages 2 to 5 had at least one cavity, according to a federal survey covering 1999 to 2004. That represents a 4 percent climb from the previous survey, 1988 to 1994, and the first significant statistical increase in 40 years, said Bruce Dye, lead author of a National Center for Health Statistics report on oral health released this spring.
The federal government first assessed tooth decay in the 1960s. After massive efforts to put fluoride in tap water led to declining cavity rates in the 1970s, tooth decay among preschoolers leveled off in the 1980s -- until now.
Hectic family lives often leave little time for cooking and preparing fresh vegetables and fruit, Dye said. Trying to avoid sugary drinks, parents often turn to convenient bottled water, but it doesn't necessarily have the fluoride that dentists once fought for in tap water.
The American Dental Association has long recommended use of fluoridated water and hygiene products such as fluoridated toothpaste.
"Toothpaste is a significant way of delivering it but water is an additional way and it's cheaper," said Dr. Indru Punwani, executive director of the Illinois Society of Pediatric Dentists. "This is one way to ensure you are getting fluoride to the child -- to the poor, young and old. It's one more source."
Experts also partly attribute the surge in cavities to the fact that many immigrants have never been exposed to tooth-decay prevention measures.
"In many cultures, you do not go to a dentist until you get a toothache and they take it out and that's it," Punwani said. Born in Laos and raised in the United States, Seng Patthana said no one warned her against putting Katelyn to bed each night with a bottle of calcium-fortified orange juice. The working mother said she thought it was a healthy choice for a growing toddler who didn't like milk.
"It was shocking," Patthana said of the cavities. "I thought at least it had calcium. I wasn't thinking the sugar is sitting there overnight on her teeth."
The most recent National Center for Health Statistics report, released in April, did have some good news on the cavity front. It showed a decline in tooth decay overall among older children compared with the previous survey covering 1988 to 1994.
Decay in the permanent teeth of children 6 to 11 years old decreased from 25 percent to 21 percent; among adolescents 12 to 19, it dropped from 68 percent to 59 percent.
But the report also documents several disparities along ethnic, racial and economic lines.
Three times as many poor children had untreated dental disease compared with their more affluent counterparts, according to the report. Thirty-one percent of Mexican-American children ages 6 to 11 had cavities in their permanent teeth, compared with 19 percent of non-Hispanic white children.
About two-thirds of Medicaid children didn't receive dental care in 2005, according to Centers for Medicare and Medicaid Services data for that year.
The American Academy of Pediatric Dentistry recommends that children have their first dental visit by their first birthday or with the appearance of the first tooth.
An Illinois law passed two years ago requires kindergartners, 2nd and 6th graders to show proof of a dental exam in order to attend school, but experts say it's largely a symbolic gesture.
"I think it's the step in the right direction ... But given dental decay's progression, it's too late," Punwani said. "By the time the average child starts kindergarten, one out of three already have tooth decay."
With extensive cavities comes the need to find the right treatment and pain relief plan for children, some younger than 2. Punwani sees some of the most complicated cases as head of the University of Illinois at Chicago pediatric dental clinic, where as many as 30 children a day are treated on an emergency basis.
The death of 5-year-old Diamond Brownridge, who was over-sedated in a Chicago dentist's office last September, was "an aberration," Punwani said. Still, a state law recently passed as a result of her death promises to strengthen guidelines for dental equipment, monitoring and the training of dental assistants during sedation.
The pain-relief methods vary, depending on dentist and family preference. Some dentists use more natural methods, treating the child with a local anesthetic and plenty of positive reinforcement.
A more complicated case, such as Katelyn's, generally requires an out-patient hospital visit with general anesthesia.
Seng Patthana and her husband, Khamphone, say they've cut down on sweets and now serve milk or water with meals to their daughters Katelyn and Kaylee, 5, who also had several cavities two years ago.
"It was an ordeal," Seng Patthani said. "And it's expensive. It's better to prevent it."