Minnesota Title V MCH Needs Assessment Fact Sheets

Children and Adolescents

Dental Health for Children and Adolescents

August 2004

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Size of the Problem

Minnesota 2000 census data report for children ages 0 to 17 years: 1,286,894 total; 121,691 below poverty level; and 231,289 minority (population minus white alone non-Hispanic) [1].

Seriousness

  • Tooth decay is the most common childhood disease in the U.S. – occurring five times more often than asthma and seven times more often than hay fever [2].
  • More than 51 million school hours are lost each year to dental related illness [3].
  • Approximately 25 percent of children living in poverty enter kindergarten without ever having seen a dentist.
  • Some 23 million children in the U.S. have no dental coverage – making them three times less likely than children who have coverage to receive dental care.
  • 25 percent of children and adolescents experience 80 percent of all dental decay occurring in permanent teeth [4].
  • In MN 2003, more than 391,000 children under age 21 were enrolled in Medicaid and only about 126,000 received any dental visits [5]. Also of these children, only about 20 percent received protective sealants on any permanent molar tooth [6].
  • In 2004, there are about 3000 active practicing dentists in MN and only about 30 are in the specialty practice of pediatric dentistry.
  • Behaviors begun in adolescence can have both immediate and long-term oral health consequences. Tobacco use, excessive alcohol consumption, and poor dietary practices contribute to the development of oral lesions, cancers, and gum diseases [7]. In addition, adolescents are prone to head, mouth, and neck injuries resulting from sports and automobile accidents [6].

Vulnerable populations of children at risk for tooth decay

  • Child primary incisor decay before age 4 [8].
  • Families: homeless/low incomes/cultural minority/without dental insurance.
  • Children with special health care needs [9].
  • Mothers with high caries rates pass cariogenic organisms to infants [2].

Disparities
Low-income and minority children have a higher prevalence of dental caries and have a higher percentage of untreated lesions than have their peers, and are less likely to have had a dental visit in the last year [10].

Approximately 5 percent of children under 18 have untreated dental problems, but that percentage rises to 39 percent for African American children and 60 percent for Mexican American children.

Interventions

Oral health strategies that work:

  • Community water fluoridation
  • Dental sealants
  • Daily oral hygiene –brushing with a fluoride-containing toothpaste and flossing; periodic professional dental care; oral health education programs in schools and communities; eliminating use of tobacco products and limiting alcohol consumption; healthy eating habits; using protective gear to prevent oral-facial sports injuries; keeping baby bottles except those with water away from infants at bedtime and weaning infants from baby bottles by 12 months of age [7].

Dental caries is a “biosocial” infectious disease that needs to be addressed through a multi-factorial approach that addresses family and community determinants of oral health. Universal access and use of dental services may reduce inequities in access to dental care but not necessarily inequalities in oral health status. There must be a balance between professional dental care and other health promotion programs [11].

Considerations for Treating Adolescent patients:

  • Obesity – can be influenced by excess caloric intake (e.g., snacking on high-starch foods, high soft drink consumption) and decreased physical activity (e.g., sitting in front of a computer or television) [12].
  • Obesity and Type II diabetes have been linked to soft drink consumption and diabetes has clear oral health consequences [11].
  • Caffeine, sugar and erosion – Most soft drinks contain phosphoric, citric, tartaric and/or carbonic acid. The combination of these acids with those produced by the oral flora from the sugar in soft drink potentiates the erosive capability of the beverage. Soft drinks available throughout the day through school vending machines influences choices in terms of drink preferences. Sugar-free carbonated drinks still may contain high concentrations of natural fruit sugars and have low acidic properties [11].
  • Eating disorders – such as anorexia nervosa and bulimia nervosa erode the lingual surfaces of the teeth from the chronic exposure to the acid in the vomitus. Gingival recession may also be apparent [11].
  • Orthodontics – The importance of excellent oral hygiene and limitation of dietary sources of acid and sugar must be stressed throughout orthodontic treatment to avoid early demineralization and severe decalcification [13].

Status

Minnesota Resources
The Minnesota Department of Health, the Minnesota Board of Dentistry, and the Minnesota Department of Human Services have implemented programs and strategies that increase access to dental services for children and adolescents.

  • Critical access dental provider designations.
  • Expanded authorization for dental hygienists and expanded duties for dental auxiliary.
  • Licensure of foreign-trained dentists and a retired dentist program.
  • Removal of authorization restrictions for a number of children’s dental services.
  • Increased dental provider reimbursement rates for diagnostic examinations, dental radiographs, fluorides and sealants for children [10].

References

1. United States Census 2000. Database query. Accessed 8/18/2004. www.lmic.state.mn.us/datanetweb/ [Attn: Non-MDH Link]
2. American Academy of Pediatrics. (2003). Policy statement: Oral health risk assessment timing and establishment of the dental home. Pediatrics, 111(5): 1113-1116.
3. U.S. Department of Health and Human Services. (2001). Oral health and learning.
4. Kaste, LM, Selwitz, RH, Oldakwoski, RJ, Burnelle, JA, Winn, DM, Brown, LJ. (1996). Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. Journal of Dental Research, 75(Special Issues): 631-641.
5. American Dental Association. (2003). State innovations to improve access to oral health care for low-income children: A compendium.
6. Cell, P. Minnesota Department of Human Services. Personal communication to M. Roesch. July 29, 2004.
7. Partnership in Prevention. (2001). Oral health: Common and preventable ailments. Priorities in Prevention.
8. Al-Shalan, T., Erickson, P., Hardie, N. (1997). Primary incisor decay before age 4 as a risk factor for future dental caries. Pediatric Dentistry, 19:1: 37-41.
9. U.S. Department of Health and Human Services. (2003). A health professional’s guide to pediatric oral health management. Online module 1: An introduction to infants’ and young children’s oral health. Online resource: www.mchoralhealth.org/pediatric/OH [Attn: Non-MDH Link]
10. U.S. General Accounting Office. (2000). Oral health: Dental disease is a chronic problem among low-income and vulnerable populations. Washington, DC: U.S. General Accounting Office.
11. Ismail, A., Woosung, S. (2001) The impact of universal access to dental care on disparities in caries experience in children. Journal of the American Dental Association, 132: 295-303.
12. Soxman, J. (2003). Considerations for treating adolescent patients. General Dentistry, Jan-Feb: 24-26.