In a perfect world, everyone would have access to consistent and comprehensive dental care from the eruption of their first tooth. Sadly, this is not true for many Americans. In fact, only 63% of adults saw a dentist in 2020.1 Too many children and adults go without basic preventive services and education, let alone restorative treatments, due to financial constraints or lack of accessible dental professionals.2 Dental hygienists are prevention specialists and an integral part of the health-care delivery system. So, what can we do to improve oral health disparities?
As RDHs, we’re in a unique position to change the oral and overall health of our country’s most vulnerable populations. We’re able to provide much-needed care to children, especially in rural areas. This includes taking actions to prevent dental anxiety and fear by using painless and noninvasive procedures. Innovation in dental materials allows us to apply traditional resin, as well as glass ionomer sealants and silver diamine fluoride (SDF). Now we can play major roles in both preventing and arresting caries.
Many children ages 2 to 11 have untreated caries, and economically disadvantaged and minority groups account for a disproportionate share of that number. While 27.9% of all children ages 2 to 5, and 51.17% of children ages 6 to 11, have caries, those in underserved populations are 1 1/2 to 2 times more likely to have caries. More than half (54.40%) of all children whose families fall below the poverty line will have one or more carious lesions and 32.52% of those will be untreated.3
The Centers for Disease Control and Prevention (CDC) reports, “For children aged 2 to 5 years, 17% of children from low-income households have untreated cavities in their primary teeth, three times the percentage of children from higher-income households. By ages 12 to 19, 23% of children from low-income families have untreated cavities in their permanent teeth, twice that of children from higher-income households.”2
Tools for dental hygienists
Oral health disparities are not a new problem, but the fact that dental hygienists working independently can do something about it is a new solution. Mobile and portable clinics are rapidly changing who has access to services. Dental hygienists are using mobile clinics to bring equitable services to schools, community centers, nursing facilities, WIC, and more. Where once a public health clinician working in a remote environment may have felt powerless against the insurmountable amount of caries they were seeing, the addition of SDF and glass ionomer has enabled us to do something about it! These innovative products are not just for public health.
At what age do you, or the office you work in, recommend that children be seen? The American Dental Association (ADA) and American Association of Pediatric Dentistry (AAPD) recommend that a child’s first dental visit take place after the first tooth appears and no later than their first birthday.4
SDF and glass ionomer sealants are saving children from what could be traumatic dental visits, especially if the visit involves local anesthesia, general anesthesia, or extraction of teeth. Have you ever had a 2-year-old patient with deep grooves in their molars and brown stains suggesting early caries? You may have thought, ”I wish I could do something to stop this without the child having to go through a difficult procedure.” Did you worry what these areas would look like 6 and 12 months down the road when the child was old enough to withstand treatment? First visits are far more important than we give them credit for. We’re trying to build rapport with a child, help prevent caries, and create good oral hygiene habits.
What if you could do more? RDHs are experts on placing resin sealants, but do we feel the same about placing glass ionomer sealants? Do you place glass ionomer sealants in your office? If not, why not?
How to approach treatment
Risk assessments and the social determinates of health such as access to nutritious foods, transportation, and household income can play a crucial role in treatment planning. It is critical that we do everything we can for our patients when we have them in our chair. There are so many barriers to access and it’s often not clear when we’ll see a patient again or if they’ll be able to return for restorative treatment.
The ADA states, “Pit and fissure sealants are one of the most effective, yet underutilized, interventions for preventing caries, especially among children.” Unfortunately, sealants are not an option for many children. “Children ages 6 to 19 years from low-income households are about 15% less likely to get sealants and twice as likely to have untreated cavities compared with children from higher-income households.”5 Studies have concluded that sealants are effective in preventing and arresting pit and fissure occlusal carious lesions of permanent and primary molars in children. Some have also concluded that sealants could minimize the progression of initial lesions.
What if you applied SDF when you saw early caries and then placed glass ionomer sealants over the area? Innovative products—such as the amorphous calcium phosphate (ACP) found in the glass ionomer material used in SDI Riva Protect glass ionomer fissure and tooth protector—enhance the remineralization of glass ionomer to help re-form the natural tooth structure. It is a relief to be able to use these preventive measures to change the oral health outcomes of vulnerable populations. The ease of application with glass ionomer means that unlike resin sealants, moisture control is not a concern.
Working with young patients
Placing sealants on newly erupted primary teeth is not without its challenges. Young patients will most likely not care for the taste of the material or to have your fingers in their mouth. They may become upset and even scream, but rest assured, the benefits of placement outweigh the discomfort of the situation. In my experience, parents are so grateful, and they understand that their child is not in pain. Even though children may become upset during placement, this is short-lived and often forgotten before they leave the office.
There will always be those times when you can’t do as much as you’d like to. Placing fluoride varnish may be the only thing you’re able to do for a child who bites or refuses to open. This is where oral health education is so critical. Even with the minimum, you have the opportunity to improve oral and overall health by recommending the right toothbrush and toothpaste. My patients like the new strawberry enamel and cavity protection toothpaste by Crest Kids.
The role that RDHs play keeps expanding, in part because a large portion of the population doesn’t have the luxury of consistent access to oral health providers. We should bring oral health education and care to those most in need. Now, starting with the youngest patients, we have options to use breakthrough treatments such as SDF and glass ionomer to retard and prevent painful caries.
For further discussion about oral health disparities, visit ruralhealthinfo.org/topics/oral-health.
Editor's note: This article appeared in the April 2022 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
- Oral and dental health. CDC. https://www.cdc.gov/nchs/fastats/dental.htm
- Disparities in oral health. CDC. https://www.cdc.gov/oralhealth/oral_health_disparities/index.htm
- Dental caries in (tooth decay) in children age 2 to 11. National Institute of Dental and Cranial Research. https://www.nidcr.nih.gov/research/data-statistics/dental-caries/children
- Your baby’s first dental visit. Mouth Healthy. https://www.mouthhealthy.org/en/babies-and-kids/first-dental-visit
- Beauchamp J, Caufield PW, Crall JJ, et al. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants. 139;8(3);257-268. J Am Dent Assoc. doi.org/10.14219/jada.archive.2008.0155
