Global Health Nexus, Millennium Issue
Ask Your Dentist
Linda R. Rosenberg, D.D.S.,
Associate Professor and Acting Chairman of Growth and Developmental Sciences (Pediatric Dentistry) and Acting Head of the Division of Growth and Developmental Sciences
Dental caries is a totally preventable disease and has declined significantly in the United States over the past two decades. Going into the new millennium, however, dental health care providers have not fully attained the Healthy People 2000 Oral Health Objective, which seeks to have 65 percent of 6- to 8-year-olds and 40 percent of 15-year-olds caries-free in the permanent dentition. Although we appear to be close to the goal for the 6- to 8-year old, we are far away from the adolescent objective.
Although progress has been made, the belief that caries is no longer a common health concern is unfounded. In fact, dental caries remains the most prevalent chronic disease in children. The number of missed school hours due to oral pain has been estimated at over 50 million. The prevalence of caries in the primary dentition actually is 42 percent for 5-year-olds and 56 percent for 9-year-olds. Accordingly, the number of caries-free children is not the complete story. The good news about the decline of caries in the permanent dentition is offset further by an increased proportion of early childhood caries (ECC), previously termed nursing bottle caries, with estimates of up to 10 percent of preschool children afflicted with ECC. Moreover, findings demonstrate that 80 percent of the caries is found in only 25 percent of the population, with risk factors including low socioeconomic status, inadequate level of parent education, and poor diet and oral hygiene practices.
Since dental caries is a preventable disease, the main objective of health care providers should be to educate parents and to provide age-appropriate preventive strategies for children. The American Academy of Pediatric Dentistry even suggests prenatal counseling and the first visit to a dentist by one year of age. This early visit allows the dentist to inform parents about tactics to decrease the transmission of mutans streptococci (MS), assure proper feeding patterns to avoid ECC, and determine the appropriate fluoride regimen for each child. Recent literature has demonstrated that if visible plaque is present, MS has already colonized and the child is at risk for developing ECC. Delaying MS colonization and providing parents with simple techniques to remove plaque can help to eliminate ECC. Primary incisor caries experience before four years of age is now seen as a predictor for additional caries in the primary and future permanent dentition.
The nutritional aspect of the caries process is now viewed primarily in terms of the frequency of eating and the oral clearance potential of the ingested foods. Although carbohydrates are viewed as critical in caries development, the retentiveness of food is of great importance. The most significant cause of the decline of caries is now attributed to the topical effect of the constant low-level doses of fluoride obtained through water fluoridation, fluoride supplementation, and twice-daily use of fluoride toothpaste. This maintains the oral fluoride reservoir necessary to support the process of remineralization of teeth. However, fluoride has little effect on pit and fissure caries, which now account for nearly 90 percent of caries in the permanent dentition. Accordingly, parents should be educated about the benefits of sealant usage in both the primary and permanent dentitions.
To encourage disease prevention and intervention, the Pediatric Dentistry Department at NYU has developed several partners-in-prevention programs, including the NYU Infant Oral Health Project, Playing It Safe (a mouth-guard program), and Oral Health Training for Non-Dental Healthcare Professionals. The premise of all of these programs is that we cannot prevent disease without partners who may be either parents, other health care providers, or the children themselves.
A newly created program is the Smile Team, which advances a concept originally proffered by Dr. Stephen J. Moss, professor emeritus of pediatric dentistry. The program promises that a child can remain free of dental decay until age 14 if a few simple rules are followed, and it compensates the dentist for preventing disease, rather than for treating it.
Here's how the Smile Team program works:
To enroll, a child must be between two years and 11 years of age or older and caries-free. If the child presents with caries, NYU Dentistry will restore the child's dentition at regular clinic rates, provide the preventive tools necessary for the child to remain caries-free, and enroll the child in the Smile Team program at a modest annual fee at her or his individualized recall visit if the child presents free of decay.
Preventive services include prophylaxis, fluoride therapy, sealants, oral hygiene counseling, custom-fitted athletic mouth guards, and assessment of the changing dentition for preventive and interceptive orthodontic needs. Any required restorative services will be provided free of charge.
Each parent-and-child team must agree to follow all recommendations, including:
- Brush at least twice a day with an ADA-approved fluoride toothpaste.
- Modify snacking behaviors as prescribed.
- Adhere to recommended recall appointment.
- Smile Team membership may be discontinued if faculty determine that compliance has not occurred.
- Care is individually tailored for each child.
- Preventive aspects of oral health are encouraged.
- Positive perception of going to the dentist is reinforced.
- Costs are kept low.
The dental profession has an obligation to help the population achieve optimal oral health. The Pediatric Dentistry Department at New York University invites all dentists to join in the "Ask Your Dentist" campaign to promote disease intervention, rather than surgical repair, by encouraging parents to "Ask Their Dentist" how to keep kids cavity-free forever. NYU Dentistry will launch this new "Ask Your Dentist" Campaign in Feburary, to mark Children's Dental Health Month. Look for the advertisement below in major New York City newspapers.