Improving Oral Health: April is Oral Health Month

California is still struggling to address the dental needs of its residents. In 2003, a California report stated that 4 percent of the children in classrooms are unable to concentrate because they are actually in pain or suffering from a dental abscess. The report went on to call dental disease a hidden epidemic of California’s school children.

The surgeon general’s report in 2000 stated that dental caries is the single most common chronic disease of children — five times more common than asthma and seven times more common than hay fever. Following up on the report in 2003, the surgeon general’s office issued a “National Call to Action to Promote Oral Health.” This public-private partnership was a wake-up call against the silent epidemic of oral disease. The five strategies outlined called for a change in perception about oral disease, removal of barriers, building of a diverse and flexible work force, building a science base, and increases in collaboration. While this destructive infectious epidemic has received attention, the battle is far from being won.

The oral health of California children is substantially worse than other states. Of 25 states recently surveyed by the National Oral Health Surveillance System, only Arkansas ranked below California in kids’ dental health. In 2004–05, a survey of 200 randomly selected California schools showed that 70 percent of the kindergarten and third-grade students had experienced dental decay; at any given moment, more than a quarter had untreated tooth decay; and, finally, poor children and children of color are much more likely to have tooth decay and suffer the consequences.

As the science base addressing oral disease has expanded, it has shown that tooth decay is infectious and is often passed to babies from their caregiver through saliva transfer occurring in various ways, including cleaning pacifiers and sharing of food and utensils. In addition, studies show that during the early stages of decalcification, the decay can be reversed by use of fluoride products and other identified mechanisms. However, restoring decayed teeth does not stop the disease from re-occurring. Up until recently, dental health professionals have faced this dilemma alone, but recent science shows that dental health may impact more than just the oral cavity, and now other health professionals must get involved.

Untreated decay is progressive, cumulative, and becomes more complex overtime. As the disease spreads, the decayed teeth serve as a reservoir of pathogens that circulate throughout the body, leaving the individual prone to other potential health complications related to heart disease, diabetes, pre-term, low birth weight babies, pneumonia, sinus infections, and medical complications. Media has told the story more then once that these dental related complex outcomes can ultimately lead to death.

In response to the dental epidemic, in 2007, the California Legislature passed AB1433, which requires an oral health evaluation by a dental professional for children entering public school for the first time. This legislation is designed to identify children who need further examination and dental treatment and to help them establish a dental home. Results of the first year of implementation show that in San Diego, 40 percent of kindergarteners completed the oral health assessment with nearly 10 percent having visible caries or fillings. Despite the visibility of the caries, 22.5 percent were left untreated. Worrisome is that 60 percent of the parents opted out of this evaluation for their child, often reporting a lack of resources or inability to find a dental professional, but more often they saw no need for the evaluation.

As a medical professional you can help improve the oral health of San Diego residents. Medical and dental professionals working together can reduce and help to eradicate the dental disease epidemic. The following lists provides “10 Actions to Eradicate Dental Disease” that you can take to help address this issue:

1. Refer children by age one for their first dental exam as recommended by both the American Academy of Pediatrics and the American Academy of Pediatric Dentistry.
2. Look at the teeth and refer all children to a dental home during all periodic medical exams.
3. Check the teeth when a parent complains about a child crying or not eating.
4. Explain to parents the outcome of ignored dental disease — “They’re just baby teeth … why bother?” — can lead to hospitalization and death.
5. Apply fluoride varnish at the medical office to reduce dental decay.
6. Get to know dentists in your area, and establish a referral list to assist patients in finding a dental home. Call the San Diego County Dental Society at (619) 275-0244 for a list of dentists in your area.
7. Remind parents that children entering kindergarten need an oral evaluation.
8. Suggest a mouth guard during a sports physical.
9. Refer families to San Diego Kids Health Assurance Network for assistance with dental insurance at 1 (800) 692-8428.
10. Remember a healthy mouth is part of a healthy body, and be sure you and your staff have good oral health.

Committing to just one of these actions will help improve the health of today’s children. San Diego’s goal is that 100 percent of the children entering school have a dental home and have an opportunity to learn pain free.

For more information on oral health, contact “Share the Care” at (619) 692-8858 or visit www.sharethecaredental.org.

San Diego County Healthcare Statistics:

• In San Diego County, 78 percent of children ages 2–17 have dental insurance, according to the California Health Interview Survey 2005 (1).
• There were 3,500 dental-related emergency department discharges — a rate of 114 per 100,000 population — in San Diego County for fiscal year 2005–06 (2).

To request additional health statistics describing health behaviors, diseases and injuries for specific populations, health trends and comparisons to national targets, please call the County’s Community Health Statistics Unit at (619) 285-6479. To access the latest data and data links, including the Regional Community Profiles document, visit www.sdhealthstatistics.com.

References:

1. 2005 California Health Interview Survey, ask CHIS accessed 7-7-08 hhtp://www.chis.ucla.edu/main/default.asp.
2. HASDIC, CHIP, County of San Diego, Health and Human Services Agency, Emergency Medical Services, Emergency Department Database; SANDAG, Current Population Estimates, 9/27/2006.