Dental repairs performed under general anesthesia have always been an option for children that are unable to cooperate with dental procedures for physical or mental health reasons. But a recent New York Times article pointed out that these costly procedures are becoming more common, as the number of fillings, root canals, crowns and extractions that children undergo increases.

Studies show that 41% of children aged 2 to 11 years have cavities in their primary teeth, and 42% of those aged 6 to 19 years have cavities in their permanent teeth.  Although children of lower socioeconomic status are affected more, this is a problem for all children. It is now becoming unreasonable to expect children to cooperate with the amount of dental work they require, and also very expensive, with costs ranging anywhere from $2,000 to $5,000.

So why are so many more children suffering from rampant dental decay when most homes have water supplies treated with fluoride? There are two main reasons.

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Infants and children now have many more snack options available than before, and most of these are composed of carbohydrates — the substrate or fuel, if you will, for Streptococcus mutans, the bacteria that cause tooth decay. 

Many are familiar with the classic baby bottle tooth decay, which occurs when a infant’s teeth are constantly bathed in carbohydrate-containing liquids, like formula, at naptime and bedtime. Breastfeeding infants are also at risk once teeth have erupted if they nurse in frequent small bursts throughout the night. 

As children grow, the risk continues to increase. Picture the toddler in the office eating cheerios from a Tupperware container and carrying a bottle with juice (this may also be cola or sweet tea, depending on where you live). Even sugar-free sodas are high in acids that cause the pH in the mouth to drop, stimulating bacterial growth.

The other main cause of dental decay in children, is that most younger than the age of 7 or 8 years have a difficult time effectively brushing their teeth. The younger the child, the more help he or she needs with this endeavor.

This is where primary care providers come in. We are the first health-care providers to look into an infant’s mouth, and are perfectly situated to provide information on cavity prevention.

Primary care health-care providers can make a difference by encouraging parents not only to clean their children’s teeth as soon as they erupt, but also by focusing on how important it is for them to continue to assist and supervise this important twice-daily habit as appropriate.

While the American Dental Association recommends that children visit a dentist starting on their first birthday, lack of dental insurance and the subsequent cost of preventive dental visits are prohibitive for many families. 

For children who are at high risk for poor oral hygiene or dietary habits, fluoride varnish is a great way to help prevent caries.  It is easy to teach patients how to apply fluoride varnish, and can be done in primary care settings. In most states, Medicaid reimburses this service. For permanent teeth, dental sealants do a great job of protecting the pits and crevices in molars from tooth decay, but this must be applied in a dental office setting.

Dental caries are the number one infectious disease in U.S. children.  This is one disease primary health-care providers can positively impact without even prescribing antibiotics.

Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.

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  1. Saint Louis, C. “Preschoolers in surgery for a mouthful of cavities.” New York Times. March 6, 2012.
  2. CDC. “Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis — United States, 1988-1994 and 1999-2002.”  MMWR. 2005; 54(03):1-44.