A significant increase in the prevalence rates of dental caries in the primary teeth of children aged 2–5 years has experts urging primary care providers to reevaluate their role in preventing such outcomes.
In 1988–1994, 24% of children aged 2–5 years had dental caries in their primary teeth. By 1999–2004, that rate had edged up to 28%, according to a report from the Centers for Disease Control and Prevention.
The population sample from the CDC's National Center for Health Statistics involved more than 52,000 participants, aged 2–75 years and older. All of the participants had oral health exams, and they or their parents, in the case of children, underwent home interviews. About half of the group was assessed during 1988–1994; the other half was assessed during 1999–2004.
“It's not a surprise at all,” that the dental decay rates are going up among the youngest age set, said Dr. Alan B. Douglass, associate director of the family practice residency program at Middlesex Hospital, in Middletown, Conn. Eighty percent of dental disease clusters in the 20% of children who are at high risk for the disease because they are from low-income families. “It's the access to care issue that's the driver. We are seeing more dental decay because these high-risk kids are having trouble getting access to care.”
In many states, Medicaid reimburses dentists less than the cost of delivering care, which tends to involve high overhead because of the instruments required, Dr. Douglass explained.
Through hearings, such as those in Congress earlier this month, and with several legislative efforts at the state level, advocates hope to achieve parity for dental care under Medicaid.
But until better access is achieved, “It's incumbent upon family physicians to get involved,” Dr. Douglass urged. “They and other primary pediatric care providers are the only medical professionals who are seeing kids when the disease starts,” which in many cases is as soon as teeth start to erupt at 6 to 9 months of age.
Dental disease already has set in by the time a child is 2 years old, by which point “family physicians and other primary pediatric providers have seen these kids at least 7 or 8 times,” noted Dr. Russell Maier, program director of Central Washington Family Medicine Residency in Yakima.
Primary care providers can't treat dental disease once it's there, but they can do a lot to prevent it. At each wellness visit, they need to look at a child's teeth and decide if the individual is in the at-risk group. If the parents' teeth are missing or if they've had a lot of restorative work, that should raise a red flag, Dr. Douglass said.
Primary care providers are critical in raising parental awareness about the importance of oral hygiene, diet, and eating patterns, he added.
Moreover, primary care providers are well placed to address the need for flouride and to advocate on behalf of a high-risk patient to ensure that he or she sees a dentist at age 1 year.
Dr. Douglass admits that, in many cases, such advocacy would require “working the system” to overcome poor access to care—there are only about 5,000 pediatric dentists in the United States—and the difficulties in finding a dentist willing to accept Medicaid patients. (See column above.)
Dental disease is the most common unmet pediatric health care need in this country, and yet at the same time “we know what causes it. We know what we need to do to arrest and prevent its complications,” Dr. Maier said.