It’s Not Just About Baby Teeth: Preventing Early Childhood Caries

  • Jennifer D. Zwicker University of Calgary
  • Carolyn Dudley University of Calgary
  • J.C. Herbert Emery University of Calgary

Abstract

Early Childhood Caries (ECC) is a serious disease that is about much more than cavities on baby teeth. In Canada, it is a growing public health problem with adverse long-term effects on children's physical, emotional and intellectual well-being. The failure to invest in preventive care has resulted in reactive, rather than proactive, measures against this disease. These measures are expensive and a needless drain on costs in the public health-care system. Children with severe ECC end up in hospital; in fact, in Canada, this disease is the most common reason children undergo day surgery. From 2010 to 2012, one in 100 children under age five required day surgery for ECC, with approximately 19,000 of these surgeries performed each year on children under age six. Canadian hospital costs for ECC day surgery in children aged one to five ranged from $1,271 to $1,963 per child, totalling $21.2 million between 2010 and 2012. Children from low-income families, along with aboriginal, immigrant and refugee children are disproportionately affected by dental disease, with between 50 per cent and 90 per cent of suffering from some form of ECC. This compares to an average of 57 per cent of children affected in the general population. A recent Alberta study indicates that when municipalities cease fluoridating their water supplies, children suffer increased levels of tooth decay. This has reignited the discussion around whether municipalities should add fluoride to the drinking water, or reinstate it in places where the water used to be fluoridated. While fluoridation can be an effective prevention strategy, this study also shows that fluoride alone is not enough. To reduce the costs and developmental consequences associated with severe ECC and improve well-being, oral health policies focused on disease prevention and health promotion are still necessary. This briefing paper provides background on the etiology, risk factors and prevalence of ECC in Canada to provide scope for the magnitude of this preventable disease in children. To address the avoidable socioeconomic costs, three areas require policy development. First is the need for increased public education and access to ECC prevention services for at-risk populations. Parents need to know they should reduce their children’s intake of sweet drinks, and avoid filling bottles with sugar water, juice or soft drinks, especially at night. They should also clean an infant’s gums with a soft toothbrush or cloth and water starting at birth. When the baby’s first tooth erupts, parents should commence daily brushing with toothpaste and book a first dental visit. Second is the need to empower health-care professionals to integrate ECC prevention in their early visits with parents of young children. Such visits are more common in family medicine, and these primary care providers can play a critical role in educating parents and promoting children’s oral health. Curriculum and continuing education for these health professions should be enhanced to emphasize ECC’s long-term health effects. Third, government should invest in preventive oral health services for children rather than relying on emergency dental care. Children should have access to early preventive dental services to instill in them habits for lifetime oral health. Provinces without universal public funding for children’s preventive dental health should remove the access barriers that children without dental insurance face.

References

Canadian Insitute for Health Information, 2013. “Treatment of Preventable Dental Cavities in Preschoolers: A Focus on Day Surgery under General Anesthesia,” Ottawa: Canadian Institute for Health Information.

U.S. Department of Health and Human Services, 2000. “Oral Health in America: A Report of the Surgeon General,” G , Editor. Rockville, MD: National Institutes of Health.

Edelstein, B. L., 2009. “Solving the Problem of Early Childhood Tooth Decay: A Challenge for us All,” Archives of Pediatrics & Adolescent Medicine, 163(7): 667-668.

American Dental Association, 2000. “Statement on Early Childhood Tooth Decay.”

Selwitz, R. H., A. I. Ismail, and N. B. Pitts, 2007. “Dental Tooth Decay,” Lancet, 369(9555): 51-59.

Featherstone, J. D., 2000. “The Science and Practice of Tooth Decay Prevention,” Journal of the American Dental Association, 131(7): 887-899.

Schwarz, E., E. C. Lo, and M. C. Wong, 1998. “Prevention of Early Childhood Tooth Decay -- Results of a Fluoride Toothpaste Demonstration Trial on Chinese Preschool Children After Three Years,” Journal of Public Health Dentistry, 58(1): 12-18.

American Academy of Pediatric Dentistry, 2008. “Guideline on Infant Oral Health Care,” Pediatric Dentistry, 90-93. Chicago: American Academy of Pediatric Dentistry.

Leong, P. M., et al., 2013. “A Systematic Review of Risk Factors During First Year of Life for Early Childhood Tooth Decay,” International Journal of Paediatric Dentistry, 23(4): 235-250.

Smith, L., 2014. “Dispel the Myth, Save the Child,” Contemporary Pediatrics, Jan. 1.

Sheller, B., S. M. Lombardi, and B. J. Williams, 1997. “Diagnosis and Treatment of Dental Tooth Decay-Related Emergencies in a Children’s Hospital,” Pediatric Dentistry, 19(8): 470-475.

Drury, T. F., et al., 1999. “Diagnosing and Reporting Early Childhood Tooth Decay for Research Purposes, A Report of a Workshop Sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration,” Journal of Public Health Dentistry, 59(3):192-197.

Kagihara, L. E., V. P. Niederhauser, and M. Stark, 2009. “Assessment, Management, and Prevention of Early Childhood Tooth Decay, Journal of the American Academy of Nurse Practitioners, 21(1): 1-10.

Dye, B., S. Tan, and V. Smith, 2007. “Trends in Oral Health Status: United States, 19881994 and 1999-2004,” P P PPP, U.S. Department of Health and Human Services, Editor. Atlanta: Centers for Disease Control and Prevention: National Center for Health Statistics.

Federal, Provincial and Territorial Dental Working Group, 2009. “Summary Report on the Findings of the Oral Health Component of the Canadian Health Measures Survey 2007–2009.”

Schroth, R. J., D. J. Brothwell and P. Moore, 2005. “Prevalence of Early Childhood Tooth Decay in 4 Manitoba Communities,” Journal of the Canadian Dental Association, 71(8): 567.

Peressini, S., et al., 2004. “Prevalence of Early Childhood Tooth Decay Among First Nations Children, District of Manitoulin, Ontario,” International Journal of Paediatric Dentistry, 14(2): 101-110.

Leake, J., S. Jozzy, and G. Uswak, 2008. “Severe Dental Tooth Decay, Impacts and Determinants Among Children 2-6 Years of Age in Inuvik Region, Northwest Territories, Canada,” Journal of the Canadian Dental Association, 74(6): 519.

Irvine, J., et al., 2011. “Early Childhood Tooth Decay in Indigenous Communities: A Joint Statement with the American Academy of Pediatrics,” Paediatrics & Child Health, 16(6): 351-364.

Harrison, R., et al., 1997. “Feeding Practices and Dental Tooth Decay in an Urban Canadian Population of Vietnamese Preschool Children,” Journal of Dentistry for Children, American Society of Dentistry for Children, 64(2): 112-117.

Quinonez, R. B., et al., 2001. “Early Childhood Tooth Decay: Analysis of Psychosocial and Biological Factors in a High-Risk Population,” P , 35(5): 376-383.

Van den Branden, S., et al., 2013. “Oral Health and Oral Health-Related Behaviour in Preschool Children: Evidence for a Social Gradient,” European Journal of Pediatrics, 172(2): 231-237.

Schroth, R. J. and M. E. Moffatt, 2005. “Determinants of Early Childhood Tooth Decay (ECC) in a Rural Manitoba Community: A Pilot Study,” Pediatric Dentistry, 27(2): 114-120.

Schroth, R. J. and V. Cheba, 2007. “Determining the Prevalence and Risk Factors for Early Childhood Tooth Decay in a Community Dental Health Clinic,” Pediatric Dentistry, 29(5): 387-396.

Lawrence, H. P., et al., 2009. “Oral Health Inequalities Between Young Aboriginal and Non-Aboriginal Children Living in Ontario, Canada,” Community Dentistry and Oral Epidemiology, 37(6): 495-508.

Mouradian, W. E., J. J. Crall, and E. Wehr, 2000. “Disparities in Children’s Oral Health and Access to Dental Care,” Journal of the American Medical Association, 284(20): 2,625-2,631.

Azevedo, M. S., et al., 2014. “Knowledge and Beliefs Concerning Early Childhood Tooth Decay From Mothers of Children Ages Zero to 12 Months,” Pediatric Dentistry, 36(3): 95-99.

Valencia-Rojas, N., D. Goodman and H. P. Lawrence, 2008. “Prevalence of Early Childhood Tooth Decay in a Population of Children with History of Maltreatment,” Journal of Public Health Dentistry, 68(2): 94-101.

Jessee, S.A., 1993. “The Neglect of Our Youth - a Dental Perspective,” Journal of Dentistry for Children, 60(6): 361-364.

Vadiakas, G., D. C. Dilley, and M.W. Roberts, 1991. “Child Abuse and Neglect: Ethical and Legal Issues for Dentistry,” Journal of the Massachusetts Dental Society, 40(1): 13-15.

Oliveira, L. B., M. Bonecker, and A. Sheiham, 2008. “Exploring the Association of Dental Tooth Decay with Social Factors and Nutritional Status in Brazilian Preschool Children,” European Journal of Oral Sciences, 116(1): 37-43.

Schroth, R. J., and W. F. Smith, 2007. “A Review of Repeat General Anesthesia for Pediatric Dental Surgery in Alberta, Canada,” Pediatric Dentistry, 29(6): 480-487.

Rowley, S. T., et al., 2006. “Utilization of a Hospital for Treatment of Pediatric Dental Emergencies,” Pediatric Dentistry, 10-17.

Graham, D. B., N. S. Seale, and M. D. Webb, 2000. “Pediatric Emergency Room Visits for Nontraumatic Dental Disease,” Pediatric Dentistry, 22(2):134-140.

Schroth, R. J., R. L. Harrison, and M. E. Moffatt, 2009. “Oral Health of Indigenous Children and the Influence of Early Childhood Tooth Decay on Childhood Health and Well-Being,” Pediatric Clinics of North America, 56(6): 1,481-1,499.

Schroth, R. J., et al., 2013. “Association Between Iron Status, Iron Deficiency Anaemia, and Severe Early Childhood Tooth Decay: A Case-Control Study,” BMC Pediatrics, 13: 22.

Colak, H., et al., 2013. “Early Childhood Tooth Decay Update: A Review of Causes, Diagnoses, and Treatments,” Journal of Natural Science, Biology and Medicine, 4(1): 29-38.

Clarke, M., et al., 2006. “Malnourishment in a Population of Young Children with Severe Early Childhood Tooth Decay,” Pediatric Dentistry, 28(3): 254-259.

Acs, G., et al., 1992. “Effect of Nursing Tooth Decay on Body Weight in a Pediatric Population,” Pediatric Dentistry, 14(5): 302-305.

Vania, A., et al., 2011. “Early Childhood Tooth Decay Underweight or Overweight, That is the Question,” European Journal of Paediatric Dentistry, 12(4): 231-235.

Joint Health Surveys Unit, 2003-2009. “Scottish Health Survey, 2003-2009 Colchester,” P I , Editor. Essex, UK: Data Archive.

Low, W., S. Schwartz and S. Tan, 1999. “The Effect of Severe tooth decayTooth decay on the Quality of Life in Young Children,” Pediatric Dentistry, 21(6): 325-326.

Versloot, J., J. Hoogstraten, and J. S. Veerkamp, 2009. “The Dental Discomfort Questionnaire: The Basis of a ‘Toothache Traffic Light’,” European Archives of Paediatric Dentistry, 10(2): p.67-70.

Thomas, C. W. and R. E. Primosch, 2002. “Changes in Incremental Weight and Well-Being of Children with Rampant Tooth Decay Following Complete Dental Rehabilitation,” Pediatric Dentistry, 24(2): 109-113.

Acs, G., et al., 2001. “Perceived Outcomes and Parental Satisfaction Following Dental Rehabilitation Under General Anesthesia,” Pediatric Dentistry, 23(5): 419-423.

Blumenshine, S. L., et al., 2008. “Children’s School Performance: Impact of General and Oral Health,” Journal of Public Health Dentistry, 68(2): 82-87.

Versloot, J., J. Hoogstraten, and J. S. Veerkamp, 2006. “Dental Discomfort Questionnaire: Assessment of Dental Discomfort and/or Pain in very Young Children,” Community Dentistry and Oral Epidemiology, 34(1): 47-52.

Petersen, P. E., S. Estupinan-Day, and C. Ndiaye, 2005. “WHO’s Action for Continuous Improvement in Oral Health,” Bulletin of the World Health Organization, 83(9): 642.

Kramer, P. F., et al., 2013. “Exploring the Impact of Oral Diseases and Disorders on Quality of Life of Preschool Children,” Community Dentistry and Oral Epidemiology, 41(4): 327-335.

Jackson, S. L., et al., 2011. “Impact of Poor Oral Health on Children’s School Attendance and Performance,” American Journal of Public Health, 101(10): 1,900-1,906.

Williamson, R., et al., 2008. “Association Between Early Childhood Tooth Decay and Behavior as Measured by the Child Behavior Checklist,” Pediatric Dentistry, 30(6): 505-509.

Health Canada, 2007-2009. “Report on the Finding of the Oral Health Component of the Canadian Health Measures Survey.”

Ramraj, C., et al., 2014. “A Macroeconomic Review of Dentistry in Canada in the 2000s,” Journal of the Canadian Dental Association, 80: e55.

U.S. Department of Health and Human Services, 2000. “Oral Health in America: A Report of the Surgeon General,” Department of Health and Human Services, National PPP GP Rockville, MD: National Institutes of Health.

Romanow, R. J., 2002. “Building on Values: The Future of Health Care in Canada, Commission on the Future of Health Care in Canada.

Calonge, N. and U.S.P.S.T. Force, 2004. “Prevention of Dental Tooth Decay in Preschool Children: Recommendations and Rationale,” American Journal of Preventive Medicine, 26(4): 326-329.

Iheozor-Ejiofor, Z., et al., 2015. “Water Fluoridation for the Prevention of Dental Tooth Decay,” GP PP R, 6: CD010856.

McLaren, L., et al., 2016. “Measuring the Short-Term Impact of Fluoridation Cessation on Dental Tooth Decay in Grade 2 Children Using Tooth Surface Indices,” Community Dentistry and Oral Epidemiology: n/a-n/a.

Health Canada, 2010. “Report on the Findings of the Oral Health Component of the Canadian Health Measures Survey 2007-2009.”

Allin, S., 2008. “Does Equity in Healthcare Use Vary across Canadian Provinces?” Healthcare Policy, 3(4): 83-99.

Canadian Dental Association, 2010. “A Position Paper on Access to Oral Health Care for Canadians,” Ottawa: Canadian Dental Association.

Duncan, L. and A. Bonner, 2014. “Effects of Income and Dental Insurance Coverage on Need for Dental Care in Canada,” Journal of the Canadian Dental Association, 80: e6.

Arrow, P., M. Miller, and J. Raheb, 2013. “Brief Oral Health Promotion Intervention Among Parents of Young Children to Reduce Early Childhood Dental Decay,” BMC Public Health, 13: 245.

Gao, X., et al., 2013. “Innovative Interventions to Promote Positive Dental Health Behaviors and Prevent Dental Tooth Decay in Preschool Children: Study Protocol for a Randomized Controlled Trial,” Trials, 14: 118.

Barnes-Boyd, C., K. W. Nacion, and K. Fordham Norr, 2001. “Promoting Infant Health Through Home Visiting By a Nurse-Managed Community Worker Team,” Public Health Nursing, 18(4): 225-235.

Olds, D. L., 2002. “Prenatal and Infancy Home Visiting by Nurses: From Randomized Trials to Community Replication,” Prevention Science, 3(3): 153-172.

Pugh, L. C., et al., 2002. “Breastfeeding Duration, Costs, and Benefits of a Support Program for Low-Income Breastfeeding Women,” Birth, 29(2): 95-100.

Hannula, L., M. Kaunonen, and M. T. Tarkka, 2008. “A Systematic Review of Professional Support Interventions for Breastfeeding,” Journal of Clinical Nursing, 17(9): 1,132-1,143.

Naylor, N., et al., 2015. “Unleashing Innovation: Excellent Healthcare for Canada,” Health Canada.

B.C. Ministry of Health, 2013. “Pediatric Summary of Totals: Dental Surgery.”

Innovation, APoH, 2015. “Unleashing Healthcare Innovation: Excellent Healthcare for Canada,” Health Canada.

Lawrence, H. P., 2010. “Oral Health Interventions Among Indigenous Populations in Canada,” International Dental Journal, 60(3 Suppl 2): 229-234.

Rowan-Legg, A., 2013. “Oral Health Care for Children – A Call for Action,” Paediatrics and Child Health, 18(1): 37-43.

Kay, E. J. and D. Locker, 1996. “Is Dental Health Education Effective? A Systematic Review of Current Evidence,” Community Dentistry and Oral Epidemiology, 24(4): p. 231-235.

American Academy of Pediatrics, 2013. “More State Medicaid Programs Pay for Children’s Oral Health Prevention Services in Doctors’ Offices,” Elk Grove Village, IL: American Academy of Pediatrics.

Rozier, R. G., et al., 2003. “Prevention of Early Childhood Tooth Decay in North Carolina Medical Practices: Implications for Research and Practice,” Journal of Dental Education, 67(8): 876-885.

Casamassimo, P. S., et al., 2009. “Beyond the DMFT: The Human and Economic Cost of Early Childhood Tooth Decay,” Journal of the American Dental Association, 140(6): 650-657.

Edelstein, B. L., 2002. “Disparities in Oral Health and Access to Care: Findings of National Surveys,” Ambulatory Pediatrics, 2(2 Suppl): 141-147.

Alberta Health Services, 2015. P P . Available from: http://humanservices.alberta.ca/financial-support/2076.html.

Amin, M. S., 2011. “Utilization of Dental Services by Children in Low-Income Families in Alberta,” Journal of the Canadian Dental Association, 77: b57.

Amin, M. S., P. Nyachhyon, and A. Perez, 2014. “Barriers to Utilization of Dental Services for Children Among Low-Income Families in Alberta,” Journal of the Canadian Dental Association, 80: e51.

Crowley, S. J., A. C. Campain, and M. V. Morgan, 2000. “An Economic Evaluation of a Publicly Funded Dental Prevention Programme in Regional and Rural Victoria: An Extrapolated Analysis,” Community Dental Health, 17(3): 145-151.

Marino, R., J. Fajardo, and M. Morgan, 2012. “Cost-Effectiveness Models for Dental Tooth Decay Prevention Programmes Among Chilean Schoolchildren,” Community Dental Health, 29(4): 302-308.

Gold, M. R., L. B. Russell, J. E. Siegel, and M. C. Weinstein, 1996. Cost-Effectiveness in Health and Medicine, New York: Oxford University Press.

Stearns, S. C., et al., 2012. “Cost-Effectiveness of Preventive Oral Health Care in Medical Offices for Young Medicaid Enrollees,” Archives of Pediatric and Adolescent Medicine, 166(10): 945-951.

Samnaliev, M., et al., 2014. “Cost-Effectiveness of a Disease Management Program for Early Childhood Tooth Decay,” Journal of Public Health Dentistry.

Published
2016-04-08
Section
Briefing Papers