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Slowing the ‘silent epidemic’

June 1, 2010
Nearly 45% of children under age 6 experience tooth decay.1 According to a recent survey of dental health in California, 27% of preschool children and 55% of 6- to 8-year-olds have untreated decay.

Providing quality care to patients at a very young age

by Heidi Arndt, RDH, BSDH

Nearly 45% of children under age 6 experience tooth decay.1 According to a recent survey of dental health in California, 27% of preschool children and 55% of 6- to 8-year-olds have untreated decay. And tooth decay is four times more common than asthma among teens ages 14 to 17.2

These statistics might not surprise us as oral hygienists, but they do point to a larger issue that our industry — and society — needs to address quickly: the need to provide quality dental care to patients at a very young age.

How young? We’re talking six months here — not 3 years old.

In addition to the clinical risks, the costs of early childhood caries (ECC) — otherwise known as the “silent epidemic” — continue to skyrocket. Each year, millions of hours are lost at school and work as a result of ECC, and millions of dollars are spent on restorative treatment. Treatment sometimes requires hospitalization and even general anesthesia.3

The financial impact of ECC also places a substantial burden on third-party payers and public dental programs that largely cover the expenses for this treatment.

But that’s just the beginning.

A dangerous link

Oral health plays a critical role in the overall health of expectant mothers. However, even with all the existing oral health concerns, many mothers do not visit the dentist before, during, or after pregnancy.4 In fact, according to a Pregnancy Risk Assessment Monitoring Survey (PRAMS), only 23% to 43% of pregnant women receive dental care.

Oral health care before and during pregnancy is key to establishing and maintaining the health of the mother and the child.5 A mother’s oral health throughout pregnancy will help establish a solid foundation to promote good oral health for both child and mother after birth. Accordingly, mothers with poor oral health and high levels of bacteria before and during pregnancy are at greater risk for delivering preterm, low-birth-weight babies.6 What’s more, these children also have a greater risk for developing oral infections and dental caries.7

As you add up these risk factors, it becomes increasingly clear that pregnant women should make dental care a priority in the months leading up to birth. But to date, dental practices and patients haven’t embraced proper oral care. In fact, some dentists are reluctant to provide dental care to pregnant women because they perceive risks that simply don’t exist. According to the National Maternal and Oral Health Resource Center, oral health care is safe and effective for expecting mothers (visit for more information).

Establishing a dental home

With a better understanding of the risks and costs associated with this silent epidemic, what can we do about it? Establish a “dental home” for your very youngest pediatric patients.

What’s a dental home? The concept of a dental home is actually the result of the American Academy of Pediatrics’ (AAP) recommendation that every child have a “medical home.” The American Academy of Pediatric Dentistry (AAPD) took that model and created the “dental home.” This concept is based on a dental health specialist delivering or supervising primary dental care that is comprehensive, continuously accessible, family centered, coordinated, compassionate, and culturally competent. In essence, the dental home should mirror and complement the patient’s medical home.

Why is a dental home important? Research increasingly shows that children who visit the dentist early in life (before their first birthday) are more likely to return for regular cleanings and less likely to return for restorative procedures. In fact, here’s something to chew on: If the right preventive measures are taken early on, it’s possible for parents to raise a cavity-free child. Yes, dental disease is nearly 100% preventable. Think about that for a minute.

Starting them young

The question that hygienists and dentists hear most often from young parents is, When should I bring my child to the dentist for the first time?

The AAPD recommends children receive an oral health risk assessment from their pediatrician six months after the first tooth erupts, and no later than 12 months of age. From there, the AAPD suggests parents find a dental home for their child by his or her first birthday. This method will ensure preventive dental care is delivered to patients at a very young age, resulting in better long-term oral health.

It might seem premature to see infants before or near age 1, but getting younger patients in early is critical to identifying early signs of ECC, providing guidance and counsel on long-term treatment, and getting parents and children in the habit of visiting the dentist regularly.

The infant isn’t the only patient

Keep in mind, pregnant or new mothers are just as important as the infants in this equation. If you have a pregnant woman in your chair, take appropriate measures to care for her oral health and educate her about good oral health for the soon-to-arrive baby. Take a few moments to educate expectant mothers on how they can prevent their child from developing caries and when their baby should see the dentist for the first time (see recommendation above). Additionally, provide guidance to young mothers about when they should wean their baby off a bottle. These are important questions many parents are asking that very few dentists and hygienists address with new mothers today.

Don’t delay dental treatment or procedures for pregnant women either. A common misperception among dentists is that you can’t treat women while pregnant. Not true. While you are safe to treat pregnant women up until birth, the best window in which to treat is between 14 and 20 weeks, according to the New York Department of Health. As hygienists, we need to do a better job of changing this mindset among both pregnant women and the dentists with whom we work. We now know the dangers of poor oral health in pregnant women and ECC in infants, and we have the resources to do something about it. Let’s make it happen.

A personal story

Caries is more than just a professional diagnosis to me. It’s personal. When I was pregnant with my son almost two years ago, I had decay in my mouth prior to giving birth and chose to wait until after birth to treat it. Now, as a result, my son is at high risk for caries.

Do I wish I had taken the proper preventive measures before birth? Absolutely. But all I can do now is brush my son’s teeth religiously and take him in for regular check-ups. Of course, I also take care of my teeth — regular brushing, fluoride varnishes, and mouth rinses are all part of my routine. I took my son to the dentist for his first assessment when he was just 6 months old. But I regret not taking the correct preventive measures prior to his birth when I had the chance.

As a dental hygienist, I thought I knew it all, when in fact there was a lot of existing information that I simply was not aware of. Education and prevention are the keys.

Steps, processes, and ideas to aid prevention of ECC

OK, so we know the risks. We’ve read the statistics. I’ve even shared my personal story. So what can we do, as hygienists, to stop the silent epidemic? There are a number of steps we can take and ideas we can implement:

  • Work arm-in-arm with obstetricians and pediatricians. Seek out and educate local obstetricians and pediatricians. Tell them about the dangers of poor oral health for expectant mothers and infants. Then make a plan. Consider working a dental education component into prenatal childbirth classes at local medical facilities. Ask obstetricians and pediatricians to refer patients to your clinic for visits before and after the birth. And encourage pregnant mothers to see a dentist and establish a dental home for their infants (just as they would a medical home) by age 1.
  • Educate your dental team about the “dental home” concept. Take time to meet with staff and dentists and discuss the dangers, challenges, and concerns about oral health risks for expectant mothers and infants. Then, do your part to make sure your team has all the facts. You can pull a lot of great numbers and resources from the American Academy of Pediatric Dentistry’s Web site at
  • Prepare your clinic to see younger patients. If you’re serious about preventing oral disease and caries in pregnant women and infants, then make sure you’re prepared to see, counsel, and treat those patients effectively. Make sure your team understands the assessment process forward and backward. Quiz hygienists regularly on the questions to ask expectant mothers. And make sure your team is up to speed with the latest techniques and treatment options for infant and toddler patients.
  • Focus squarely on prevention. There are a number of steps young mothers can take to aid in ECC prevention in infants and toddlers. Ensure that infants receive adequate fluoride exposure for their developing teeth. Limit the sugary foods their baby eats. Encourage breastfeeding vs. bottle-feeding. And suggest switching to a cup at six months.

It’s going to take a lot of hard work to stop the silent epidemic. Educate staff and patients. Work together with medical providers. And learn more about the risks and treatments yourself. It’s all worth it, isn’t it? After all, we’re talking about our children here. What’s more important than that?

Heidi Arndt, RDH, BSDH, is the national director, dental hygiene development for American Dental Partners, and the general manager for Focus Practice Consultants. Visit and You can reach Heidi at [email protected].

An appointment with a very young child

As dental professionals, how can we treat a 12-month-old at our clinics? Good question. There are several great resources available from the American Dental Association and CAMBRA that may help, but two areas I believe clinics should focus on include:

1) Conducting a basic risk assessment. Interview the parent(s). Clean the child’s teeth by laying him or her back in the lap of the parent. Conduct a visual oral assessment and look for visible decay. Provide a fluoride varnish treatment to protect the baby’s teeth. Finally, summarize the visit and provide final tips and advice to the parent on how to best care for the child’s teeth between visits.

2) Educating parents on oral health for the child. Talk about snacking and what’s appropriate as the child gets older. What about drinks? Talk about the dangers of sipping on fruit juice all day. Discuss cleaning the infant’s mouth with a soft cloth, brushing, and when the child should have his or her first toothbrush. Recommend how often the child should brush and how the parent should supervise or assist with brushing. Finally, talk about treatment options such as fluoride that can aid in early childhood caries prevention and ensure those baby teeth are strong and healthy.

  1. Dye BA, Tan S, Smith V, Lewis BG, et al. National Center for Health Statistics, “Trends in oral health status: United States, 1988-1994 and 1999-2004,” Vital Health Stat 2007; 11(248).
  2. CDC: Preventing dental caries with community programs, 2009.
  3. “Examining the Cost Effectiveness of Early Dental Visits” — White Paper.
  4. Gaffield ML, Gilbert BJ, Malvitz DM, Romaguera R. Oral health during pregnancy: An analysis of information collected by the pregnancy risk assessment monitoring system. Journal of the American Dental Association 2001; 132(7):1009-1016.
  5. Casamassimo P, Holt K, eds. Bright futures in practice: oral health-pocket guide. Washington, DC: National Maternal and Child Oral Health Resource Center. 2004.
  6. Boggess KA, Edelstein BL. Oral health in women during preconception and pregnancy: Implications for birth outcomes and infant oral health. Maternal and Child Health Journal, 2006; 10:S1,169-174.
  7. Ramos-Gomez FJ, Weintraub JA, Gansky SA, Hoover CO, Featherstone JD. Bacterial, behavioral, and environmental factors associated with early childhood caries. Journal of Clinical Pediatric Dentistry, 2002; 26(2):165-173.
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