Oral health:
An overlooked epidemic
Kenyaree Jones wasn’t happy about her first dental appointment. At 10 years old, she had already heard the horror stories.
“They could pull your teeth out,” she recalled. “Or they could put braces on you.”
Or, as Kenyaree later discovered, they can find cavities. She had four of them, each requiring a filling. And by getting the fillings she prevented more serious problems, such as infection or extraction.
It wasn’t fun, but it was a way of teaching valuable lessons. “The [dentist] taught me how to brush my teeth,” she said. “I brush every night, but sometimes I forget.”
That sort of forgetfulness has generated a veritable growth industry. Increasing each year by nearly 6 percent, dental services in 2005 alone accounted for almost $87 billion dollars, according to one recent report analyzing the use and costs of health care services in the United States.
In human terms, the numbers are staggering.
Affecting one in four elementary school children nationwide, tooth decay is the most common chronic disease of childhood — and it gets worse with age. Two-thirds of adolescents have tooth decay, as do an astounding 90 percent of adults.
It’s surprising, then, that oral hygiene was seldom included in national health care discussions. That changed nearly a decade ago when U.S. Surgeon General Dr. David Satcher presented the first-ever report on the oral health of the nation in 2000.
Satcher identified a “silent epidemic” of dental and oral diseases that disproportionately burdened the poor and the elderly. To combat the problem, Satcher called for a change in public perception of oral disease and implored government health officials to create an effective public policy to improve America’s oral health.
Unfortunately, Satcher’s report was unable to reverse what appears to be a never-ending problem.
In Massachusetts, according to a recent report by the Catalyst Institute, more than one-fourth of kindergarten children had evidence of tooth decay in 2007. More than 40 percent of third-graders had a problem, the report said, as did one-third of sixth-grade adolescents.
And the numbers for blacks, Hispanics and lower-income families were not good. The incidence in these groups was almost twice that of white and higher-income students from kindergarten to sixth grade.
Tooth decay is caused by bacteria that thrive on sugars and starches. Left unchecked, the bacteria produce an acid that eventually dissolves the enamel of the tooth.
Or worse.
The seriousness of oral health problems was underscored last year when 12-year-old Deamonte Driver of Baltimore died from complications caused by tooth decay. The bacteria had spread to his brain and by the time his mother found a dentist — a difficult process without adequate dental insurance — it was too late. Despite two operations and more than six weeks of hospitalization, Deamonte died.
The tragedy not only revealed the seriousness of oral disease, it also raised a slew of questions about the accessibility and affordability of dental services.
For starters, dental insurance is not as common as medical insurance and applies stringent limitations in coverage. Even those with Medicaid cannot always get the care they need because of the paucity of dentists who accept the state-administered insurance.
Dr. Stephen Colchamiro has seen a lot of cavities during his almost 40 years as the dental director at Brookside Community Health Center in Jamaica Plain. Cavities are “the most common disease, not only of children, but of everyone,” he said.
And that’s part of the problem. People don’t see cavities as a disease.
According to Colchamiro, the most significant factor leading to tooth decay is diet — and sugar is the biggest culprit.
In one extreme case, he said, a mother brought in a 3-year-old baby. Right before the check-up, Colchamiro noticed that the baby’s bottle contained soda instead of milk. Quite naturally, the toddler had four cavities.
A more common enemy is sugared cereal. “It’s the worst,” he said. “It has more sugar than M&M’s. So every time a child eats sugared cereal for breakfast, it’s like giving them candy for breakfast. And kids don’t have it just for breakfast — they eat cereal for lunch, snacks and supper.”
Colchamiro stresses that although sugar in itself is harmful, the amount of time it remains in contact with the teeth is the key. Chewing gum and hard candies are some of the worst transgressors — they stay in the mouth too long, constantly coating the teeth.
The lack of oral hygiene can also spread into the classroom. According to Colchamiro, pain from tooth decay limits one’s ability to learn. Children can lose school days because of dental pain. It can also impact their nutrition and self-esteem.
The news is not all bad, however. The introduction of fluoride to drinking water since World War II has been called by the Centers for Disease Control and Prevention “one of the 10 great public health achievements of the 20th century.” For every dollar spent on water fluoridation, as much as $38 is saved in tooth decay treatments.
Another major achievement is the introduction of dental sealant, a plastic material used to line the pits and fissures of the molars of children where decay is most likely to form. Sealants form a barrier between the surface of the tooth and bacteria, thereby preventing the onset of cavities. Sealants are 100 percent effective, especially when reapplied periodically.
Massachusetts is doing its part. Almost 60 percent of the state’s population receives fluoridated water, and in 2007, 46 percent of third-graders and 52 percent of sixth-graders had at least one dental sealant.
Additional good news is that dental decay is largely preventable through a regimen of good hygiene and lifestyle changes. Brushing the teeth with fluoride toothpaste at least twice a day — in the morning and before bed — and flossing daily can significantly reduce or prevent cavities. Flossing dislodges food between the teeth that a toothbrush cannot reach.
Healthy eating, not smoking and regular exams and deep cleaning by the dentist are also important.
Good oral hygiene should start early. Parents should wipe the gums of their infants with a Q-tip or damp gauze pad, and start brushing their children’s teeth as soon as they erupt. Generally, visits to the dentist should begin at age 3, but pediatric dentists hope to first see children around the age of 1.
After 40 years, Colchamiro still remains positive. “Tooth problems can be prevented,” he said.
And that is exactly what Kenya Testamark said she hopes for her daughter, Kanyaree Jones, a fourth-grader at Orchard Gardens K-8 School.
When her daughter brought home papers from the school requesting parental consent, Testamark said she jumped at the chance to provide her daughter with dental care.
Orchard Gardens participates in Smart Smiles, a preventive dental program offered in the Boston public schools. Services are provided by dental health professionals from Boston University Goldman School of Dental Medicine.
“When the school made the offer, I jumped on it,” Testamark said. “I welcome any opportunity that improves the health of my child. You benefit in the long run. They [Smart Smiles] do a good job. You can’t ask for more.”
Testamark is 35 years old and knows about the importance of oral hygiene.
She has had teeth removed and now wears removable partial dentures. She brushes after every meal to prevent decay from forming around the clasps.
That’s a few minutes every day she says she does not mind taking. But she readily admits that she has to remind her daughter to brush at times.
Colchamiro points out that many parents are strict with their children in terms of daily brushing, especially if they themselves had teeth removed at a young age. They don’t want their children to suffer the same consequences.
“She remembers it in the morning, but at night she sometimes forgets,” Testamark said. “You have to be on it.” |
| (Top) Kenyaree Jones (left), a 10-year-old fourth-grader at Orchard Gardens K-8 School, receives dental hygiene supplies from Kathy Lituri of Boston University through Smart Smiles in Boston Public Schools.
(Bottom) Stephen Alan Colchamiro, D.M.D.
Dental Director
Brookside Community Health Center
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David Satcher, M.D., Ph.D.
Surgeon General of the United States
February 1998 through January 2001
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