As reported by the National Institute of Dental & Craniofacial Research, 42% of children between the ages of 2 and 11 have had dental caries in their primary teeth, with that percentage increasing for multicultural children and those from low income families.1 Many circumstances beyond the child’s control predispose him or her to dental caries. In order to take preventive measures with your adolescent patients, it is important to know what you can do as a practitioner to identify at-risk patients. Just as important, understanding the etiology of dental cases should also be on the mind of every dentist.
With diagnostic technology advancing and preventive measures, such as fluoride, readily available, why do dental caries continue to be prevalent among children? Courtesy of educator and pediatric dentist Dr. Greg Psaltis, here are some reasons why dental caries continue to affect pediatric patients.
The Vulnerable Population
To start, it’s important to focus on how the vulnerable population (e.g., patients of low socioeconomic status) is different from the rest of the population. Children who are at a higher risk for dental caries often have oral health needs that are unmet and untreated.2 Those from minority groups3 or are of special needs4 have an even tougher time obtaining adequate treatment. Without consistent treatment, vulnerable communities have a lack of self-care instructions, have no “dental home,” and no overall oral health education.
With limited access to care, caries in pediatric patients don’t get properly diagnosed, which continues this trend of neglected treatment. As treatment for dental caries is delayed, the child's condition worsens and becomes more difficult, the cost of treatment increases, and the number of clinicians who can perform the more complicated procedures diminishes.5
There’s a major disparity between the geographic distribution of dentists and where dental care is most needed. While many dental students show interest in practicing in urban and rural areas,6 there is still a lack of dentists presently in these areas. In rural Southern and Midwestern states, for example, patients have to travel far to see a dentist, particularly one that takes Medicaid insurance. The ADA’s Health Policy Institute recently introduced a detailed, interactive map that lays out the geographic access to dental care within each state in the U.S.
To counteract this unfortunate reality, many dental schools, educational grants, and organizations such as dental support organizations look to turn dental students towards the advantages of practicing in these areas, often through loan repayment programs. For many, the idea of being financially supported to work in an underserved community, while also possibly having more production than a more competitive state (e.g. California) is a compelling offer. With more dental schools opening to address these geographical shortages in dentists, students now are more aware of these disparities than ever before.
Federal Insurance Programs
While the number of children under Medicaid and similar insurance coverages has increased over the years, with more children insured now than ever before, it’s not always easy to find providers. Because of the low reimbursements options that are offered to dentists through these coverages, some dentists refuse to see patients that have this insurance. With dental caries rampant amongst pediatric patients and families that are of a low socioeconomic status,2,3 Medicaid is often the only affordable and appropriate coverage for these patients. This stalemate between low-income families and available Medicaid dentists continues to thwart the improvement of children in vulnerable communities.
Dental caries affects millions of pediatric patients. The question lies in how this disease can best be managed in young populations, with a heavier lens on those that have direct barriers to access. Without the combined efforts of both the knowledgeable dentist and the continued improvement to healthcare systems, children in these vulnerable communities and areas will continue to be at a high risk. When these parties come together to overcome these barriers to care, children will be better cared for and better educated on the importance of sustaining their oral health.
1. Dental Caries (Tooth Decay) in Children (Age 2 to 11). National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/DentalCariesChildren2to11.htm. Published May 28, 2014. Accessed June 12, 2017.
2. Grant J, Peters A. Children's Dental Health Disparities. The Pew Charitable Trusts. http://www.pewtrusts.org/en/research-and-analysis/analysis/2016/02/16/childrens-dental-health-disparities. Published February 16, 2016. Accessed June 12, 2017.
3. Swann BJ. Impact of Racial Disparities. Perspectives on the Midlevel Practitioner. http://www.dimensionsofdentalhygiene.com/ddhnoright.aspx?id=23960 Published October 2016. Accessed June 12, 2017.
4. Mitchell JM, Gaskin DJ. Dental Care Use and Access for Special Needs Children. Maternal and Child Health Research Program. https://mchb.hrsa.gov/research/documents/finalreports/mitchellR40mc04296FinalReport.pdf. Published March 2007. Accessed June 12, 2017.
5. Çolak H, Dülgergil ÇT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. Journal of Natural Science, Biology, and Medicine. 2013;4(1):29-38. doi:10.4103/0976-9668.107257.
6. Sweeney SE, Groves RM. 2016. The changing dental career landscape: The impact of dental school graduates’ pathway into the profession. Mahwah, NJ: Next Media Group. Accessed November 23, 2016. Available at http://thenextmediagroup.com/shop/researches/