“It’s just a baby tooth. It will fall out, and a new one will grow in.” This common sentiment, heard from parents, caregivers, and even teachers, may seem harmless. However, it overlooks a crucial truth: good oral health, like overall health, begins well before birth and continues throughout life. It is a lifelong journey, starting in early childhood, through adolescence, and into adulthood and senior years (1). Teeth are unique in that they cannot repair or regrow once damaged. The development of teeth begins in the fetus around 6 weeks of gestation, and any disturbance to the mother’s health can affect tooth formation. How a child is cared for and fed in the early years also has a direct relationship to their dental health. For example, transferring cavity-causing bacteria, like Streptococcus mutans, from a parent’s mouth to the child through activities like kissing, sharing utensils, or food can increase the child’s risk of cavities. Feeding infants foods and drinks containing sugar during the first 18 months of life has been shown to be linked to the presence of Streptococcus mutans in a child’s mouth (2). Tooth decay is the most common disease in the mouth. In a review article authored by Pitts N.B. etall, dental caries (Tooth decay) has been described as “a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues. Caries can occur throughout life, both in primary and permanent dentitions, and can damage the tooth crown and, in later life, exposed root surfaces. The balance between pathological and protective factors influences the initiation and progression of caries” (3). This interaction of factors helps classify people into different caries risk groups, making it easier to provide personalized care.
The mouth is often called the “gateway to the body,” and for good reason. The 2000 Surgeon General’s Oral Health Report identified two key findings that are still relevant today: tooth decay is a silent epidemic, and there is a strong link between oral health and general health (4). Tooth decay is one of the most common childhood diseases and can have significant physical, emotional, and social consequences. If left untreated, tooth decay can cause pain, infection, and difficulties with essential functions like eating and speaking. In rare, severe cases, infections can spread to other parts of the body, potentially causing brain abscesses, disability, or even death (5). Toothache is not merely an episodic inconvenience, but rather a persistent and chronic condition affecting millions of individuals, impacting their quality of life.
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Beyond physical health, poor oral health can negatively affect a child’s self-esteem, especially when unhealthy or missing teeth are visible. This can lead to psychological and social challenges, which may carry over into adulthood. Research has shown that poor oral health can also correlate with poorer academic performance (6) and difficulties securing employment later in life.
The statistics are eye-opening. According to the Centers for Disease Control and Prevention (CDC),(7):
- By age 9, 50% of children will have had cavities in their primary or permanent teeth.
- Each year, an average of 34 million school hours are lost due to emergency dental care, costing over $45 billion annually in the U.S.
- About 10% of adolescents aged 12 to 19 have at least one untreated cavity.
Oral Health Disparities in Children
A concerning issue in children’s dental health is the stark disparity in oral health outcomes, often driven by socioeconomic factors. Data reveals clear differences in tooth decay prevalence across various demographic groups (8):
- Untreated cavities are nearly three times more common in children aged 2 to 5 from low-income households (18%) compared to those from higher-income households (7%).
- 70% of Mexican American children aged 6 to 9 have had cavities in their primary or permanent teeth, compared to 43% of non-Hispanic White children.
- 60% of children aged 6 to 9 from lower-income households have had cavities, compared to 40% of those from higher-income households.
- Among adolescents aged 12 to 19, untreated cavities are more prevalent in low-income households (14%) than in higher-income households (8%).
These disparities are preventable but require a multi-faceted approach. Addressing these inequities involves improving public health services, infrastructure, and policies. Key factors such as low health literacy, food insecurity, systemic racism, education, unemployment, geographic isolation, transportation, and lack of access to care must be tackled. Research and a focus on the social determinants of health (SDOH)—the conditions in which people live, learn, work, play, and age—are crucial for improving both oral and overall health outcomes.
The Role of Public Health Programs in Improving Oral Health
Public health programs, such as the Healthy People initiative, play a key role in improving the oral health of all Americans, including children. Healthy People 2030 (7) aim to reduce the proportion of children and adolescents who experience tooth decay in their primary or permanent teeth. Preventive measures, including the use of dental sealants, fluoride toothpaste, and topical fluoride treatments and Silver Diamine Fluoride (SDF), have proven effective in preventing cavities. Furthermore, promoting good oral health practices during pregnancy and the early years of life can significantly reduce the risk of tooth decay in children.
Conclusion: A Lifelong Approach to Oral Health
In conclusion, oral health is intimately connected to overall health, and the consequences of tooth decay extend far beyond physical symptoms—it impacts emotional, social, and academic aspects of a child’s life. Oral health disparities in children are prevalent, but they are preventable through individual actions and systemic change. Healthy People 2030 strive to reduce these disparities by promoting preventive measures and improving access to care for all children. Maintaining good oral health is not just about caring for teeth; it’s about laying the foundation for lifelong health and well-being.
Earn an Online Postgraduate Degree in Community Oral Health
Do you like learning about a variety of issues while focused on the unique needs of community health dental programs? Consider enrolling in the Herman Ostrow School of Dentistry of USC’s online, competency-based certificate or master’s program in Community Oral Health.
References:
- Oral Health in America: Advances and Challenges [Internet]. Bethesda (MD): National Institute of Dental and Craniofacial Research(US); 2021 Dec. Section 3A, Oral Health Across the Lifespan: Working-Age Adults. Available from: https://www.ncbi.nlm.nih.gov/books/NBK578294/
- Habibian M, Beighton D, Stevenson R, Lawson M, Roberts G. Relationships between dietary behaviors, oral hygiene and mutans streptococci in dental plaque of a group of infants in southern England. Arch Oral Biol. 2002 Jun;47(6):491-8. doi: 10.1016/s0003-9969(02)00017-1. PMID: 12102766
- Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, Tagami J, Twetman S, Tsakos G, Ismail A. Dental caries. Nat Rev Dis Primers. 2017 May 25;3:17030. doi: 10.1038/nrdp.2017.30. PMID: 28540937.
- U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.
- Moazzam AA, Rajagopal SM, Sedghizadeh PP, Zada G, Habibian M. Intracranial bacterial infections of oral origin. J Clin Neurosci. 2015 May;22(5):800-6. doi: 10.1016/j.jocn.2014.11.015. Epub 2015 Mar 21. PMID: 25800939.
- Seirawan H, Faust S, Mulligan R. The impact of oral health on the academic performance of disadvantaged children. Am J Public Health. 2012 Sep;102(9):1729-34. doi: 10.2105/AJPH.2011.300478. Epub 2012 Jul 19. PMID: 22813093; PMCID: PMC3482021.
- Oral Health Facts. [CDC]. https://www.cdc.gov/oral-health/data-research/facts-stats/index.html
- Health Disparities in Oral Health. [CDC]. https://www.cdc.gov/oral-health/health-equity/index.html
- Healthy People 2030. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions
