Neglect Blamed for Rising Tooth Decay Among State’s Children

Children in California are suffering rampant tooth decay in a “neglected epidemic” of dental disease fueled by paltry prevention measures and poor access to treatment, according to the state’s first comprehensive survey of youngsters’ oral health.

Almost a third of preschoolers and more than two-thirds of elementary and high school students were found to have some form of tooth decay, with a fifth of high school sophomores in “urgent need of dental care” for decay, pain or infection, according to the study by the nonprofit Dental Health Foundation.

The study, to be released today in Sacramento, was based largely on dental examinations of 6,643 preschoolers, kindergartners through third-graders, and 10th-graders in the 1993-94 school year.

But the report came under immediate attack from the very entity that provided most of the funding. In response to a federal requirement, the state Department of Health Services provided $500,000 for the study, yet a department representative said Wednesday that the findings were a rehash of “some old data.”

“Access [to dental health care] is good and continues to improve every year,” said Stan Rosenstein, a Medi-Cal deputy at the state health department. “[The report] needs to be updated.”

Rosenstein said the picture will improve after implementation of recent legislation to expand health insurance, including a dental package, to nearly 600,000 children of the working poor. He rejected the report’s call for appointment of a state dental officer, calling it unnecessary, as the department already employs three dentists.

Dr. Jared Fine, chairman of the Dental Health Foundation, said the delay in publication is typical for any good study that is based on thorough analysis and scientific review. He acknowledged, however, that the report’s release was partly timed to coincide with the announcement of a $2.1-million follow-up project, funded by the California Endowment, including development of pilot, school-based intervention programs in 10 communities.

In general, the report’s authors lamented that, until now, no one has made a public health priority of teeth--which they stressed are “live organs” with blood vessels, nerves and obvious utility.

But the long-term risks of ignoring the problem are real, Fine said. They include tooth loss and loss of ability to chew, disfigurement and loss of self-esteem, gum and orthodontic problems, he said.

“We are creating dental cripples.”

The study compares California unfavorably to the rest of the nation in many ways, even though the latest available national statistics are 10 years old. For example, 55% of children aged 6 to 8 were found to have untreated tooth decay in the state, compared to 27% nationwide in 1986-87.

A children’s advocate said Wednesday that they and health professionals have been neglecting the issue to children’s detriment.

“This is only really the kick-start,” said Alan Watahara, president of the California Childrens Lobby. “It’s really going to be up to [us], as well as dental health community and lawmakers, to move this issue forward.”

The authors blamed spotty fluoridation for California’s problems, noting that only 16% of residents have access to adequately fluoridated water--”the most cost-effective means to prevent tooth decay”--compared to 62% nationally.

“It is one of the lowest rates in the nation,” said Donald Lyman, chief of chronic disease and injury control for the state health department.

Lyman said a 1995 law that mandates fluoridation in communities with more than 10,000 hookups will help. However, the law came with no funding attached. He and the dental report’s authors say they hope philanthropic foundations, in particular, will contribute.

In Los Angeles County, only two cities, Long Beach and Beverly Hills, add protective levels of fluoride to their water, said Dr. Timothy Collins, the county’s dental health officer and leader of a state fluoridation task force. He said the city of Los Angeles is preparing its facilities for a two-phase fluoridation project, but it has not yet begun adding the fluoride.

There is a widespread misconception that most of the water in the state is already fluoridated, Collins said.

He and others said that a small-scale, but vocal, opposition to fluoridation has hampered the state’s efforts at expanding fluoridation. But they said there now is strong scientific consensus that fluoride in drinking water is both safe and effective.

Another significant problem noted in the report is the relatively few children who benefit from another protective measure: dental sealant. Although fluoride works to protect the smooth surfaces of the teeth, sealants--which are transparent plastic-like coatings applied by a dentist--protect the pits and grooves, where most decay occurs.

Yet only 10% of 8-year-olds and 13% of 15-year-olds in California have received sealants, according to the report (although this is roughly comparable to national rates). In fact, 30% of California kindergartners have never had a dental visit, according to the report.

The problem is largely one of access. More than 40% of high-schoolers, for example, were found to lack dental insurance at the time of the survey. (These findings, in particular, were considered out of date by Rosenstein.)

Among the report’s recommendations:

* Seeking financial and community-based support for fluoridation.

* Expanding parent education and school- and community-based prevention programs. Parents in particular need instruction about how to prevent so-called baby-bottle tooth decay, caused by frequent or prolonged feeding with sugar-filled liquids.

* Requiring that every child have a certificate of completed dental care to enter elementary school.

* Increasing payments to dentists to at least cover costs and expanding the scope of services in dental plans for children.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Decaying Dental Health

The percentage of California children with untreated tooth decay far exceeds the national average. Those whose parents have less than a high school educatiochoolduation fare even worsein dental health. Figures given are for the most recent years available.

Children Ages 6-8 With Untreated Cavities

California, 1993-94

All: 55%

With parents lacking high school education: 69%

*

United States, 1986-87

All: 28%

With parents lacking high school education: 43%

*

Children Age 15 With Untreated Cavities

California, 1993-94

All: 45%

With parents lacking high school education: 67%

*

United States, 1986-87

All: 23%

With parents lacking high school education: 41%

Sources: The Dental Health Foundation; Selected Findings and Recommendations from the California Oral Needs Assessment of Children, 1993-94