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March 01, 2012

By Graydon Gordian

The Importance of Dental Hygiene in Children

Dr. James Crall is a pediatric dentist and a professor of pediatric dentistry and public health & community dentistry at UCLA. He has served as a member or consultant on numerous national panels concerning oral health and advised Sesame Workshop on the development of our new oral health outreach initiative. We spoke with Dr. Crall in order to learn more about the general state of children’s oral health in this country and ways parents can help encourage an emphasis on oral health.

Sesame Workshop: First and foremost, tell me about the general state of oral health among young children in this country?

Dr. James Crall:  Looking at the big picture over time there have been significant improvements in children’s oral health in this country. However, the first ever U.S. Surgeon General’s report on oral health in 2000 noted that there remains a “silent epidemic of dental problems.” Nationally things have improved since then, but despite those improvements there is still disparity in children’s oral health and millions of children still face significant problems accessing dental care, especially young children.

SW: Tell me more about that disparity. What groups is it between?

JC:  Some work analyzing national data has demonstrated that low-income children, in particular low income children from certain ethnic and racial minority groups, have rates of tooth decay 3 to 5 times higher than their more affluent white counterparts. There also has been an increase in kids developing cavities in their pre-school years, what we refer to as Early Childhood Caries or ECC. Many times the decay is severe enough that by age one or two these children have to be taken to the hospital for treatment under general anesthesia or they end up in emergency rooms, despite all the improvements we’ve made overall. A lot of this is avoidable if we can help families understand the importance of good oral health habits early in life.

SW: What’s causing these health issues? Are there gaps in knowledge or incorrect assumptions on the part of parents that are fueling the problems you’ve seen?

JC: There’s an attitude that we know still persists. People say a children’s first set of teeth – which many refer to as baby teeth, but which I prefer to call primary teeth – well, those are going to fall out anyway so we don’t need to pay attention to them. That attitude even persists with many parents who are well educated.

Overall about ¾ of the kids in the country today have pretty limited experience with dental disease. Those kids generally are doing the things we recommend and their parents are vigilant about their oral health – so the problems with those kids are minimal. Those kids have limited experience with cavities during their pre-school years. Maybe they get an occasional cavity as they get older. The other 25 percent still have some very significant problems. Those kids sometimes have large numbers of decayed teeth by age two, which can lead to infections that spread to other parts of their body and cause pain and other consequences that often go unnoticed or neglected.

I don’t want to create the notion that it’s only about low-income kids. Although they tend to get decay earlier and have more decay, it also happens in more affluent and more educated families as well. Overall, we still need to do a much better job of educating the public. We also have work to do on the professional side to make sure that all dentists understand the importance of early dental visits, ideally beginning by age 1.

SW: What should parents do to ensure these early oral health issues don’t affect their children?

JC:  Children should have a dental visit by their first birthday. Kids’ first teeth usually start to come when they’re about six-months-old. Parents often don’t realize that they need to begin taking care of their kids’ teeth at that early age and often don’t start until it’s too late, that is until the youngsters already have cavities and dental disease. A big part of why there is an increase in tooth decay in young children in this country after years and years of decline is the persistence of some basic gaps in the public’s general knowledge about how to best care for children’s teeth.

SW: What are some other day-to-day things parents can be doing to encourage healthy oral habits?

JC:  Parents do have to work with their kids on a daily basis, especially preschool children who generally lack the motor skills to brush their teeth properly. They have to be taught to brush all the surfaces of all their teeth. They have to be taught to use an appropriate amount of fluoride toothpaste and to avoid swallowing the toothpaste. Parents also have to minimize kids’ exposure to refined sugars, whether  in drinks or foods, and avoid putting a child to bed with a bottle that contains liquids other than water. They should minimize sticky, sugary foods and offer healthy alternatives: vegetables, fruits, and more natural foods that, as the Muppets say go “crunch” when they’re eaten. And again, it’s important for your children to start visiting the dentist early, ideally by age 1.

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