Less than half of a group of four-year-olds the
researchers followed had ever visited a dentist, and caregivers who
neglected their own oral health tended to neglect that of their
"We know that both good oral health and dental problems tend to
cluster and co-occur in families," said Kimon Divaris, who led the
study at the UNC School of Dentistry at the University of North
Carolina at Chapel Hill.
According to the American Academy of Pediatric Dentistry, children
should visit a dentist for their first check-up when their first
tooth appears, or no later than their first birthday. The AAPD
recommends check-ups every six months after that to prevent cavities
and other problems.
Oral health is part of general health, and dental problems in young
children have been linked to other negative consequences including
discomfort and pain, reduced quality of life, failure to thrive,
time lost both from school and parents' work and financial
expenditures for families and the health system, Divaris told
Reuters Health in an email.
Although doctors and dentists have worked to make dental care more
accessible for all kids, parents and caregivers play an important
role in when and whether kids on Medicaid see a dentist, the authors
write in the journal Pediatrics.
"What we are still trying to figure out are the mechanisms that
underlie these associations: are they social, economic, cultural,
behavioral, genetic or a combination?" Divaris said.
The researchers accessed Medicaid data and caregiver interviews for
1,000 children with no previous dental visits in 2007 and used
records to follow the children for two years. On average, kids
entering the study were 16 months old.
Over the course of the study, 39 percent of the children saw a
dentist for the first time. For more than one in seven of these,
that first visit was for a dental emergency.
Kids who had oral health problems as 16-month-olds were more likely
to visit a dentist, and were more likely to require emergency care
during the study period.
But the analysis did not consider oral health screenings or
preventive services provided by pediatricians, which certainly would
qualify as improving oral health, said Justin Blackburn of the
Department of Health Care Organization and Policy at the University
of Alabama at Birmingham School of Public Health.
"We still need more research to understand the benefits of 'early
entry into the dental care system' as well as barriers to the
receipt of oral care," Blackburn told Reuters Health in an email.
The overwhelming majority of caregivers in this study were female,
single and low-income. Kids whose caregivers neglected their own
dental health were less likely to see a dentist, the authors wrote.
"Early, preventive visits are aligned with the establishment of a
'dental home'," said Divaris, where there's "an ongoing relationship
between the dentist and the patient, and comprehensive oral
healthcare is delivered in a continuously accessible, coordinated
and family-centered manner."
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Regular visits also help educate parents about oral hygiene,
diet, cavity risk and preventive measures like fluoride varnishes,
Because babies' teeth fall out, parents generally don't realize
they're important, according to Jane A. Weintraub, dean of the UNC
School of Dentistry.
Children develop tooth decay, toothache and infections, much of
which is preventable with good dental care, she told Reuters Health
in an email.
According to a 2010 U.S. study, 14 percent of
5-year-olds had untreated dental decay, including 25 percent of
kids living below the poverty level.
Although the new study, and others before it, have found that
individual characteristics of caregivers, like how much they care
for their own teeth, predict whether or not the child will visit a
dentist, there may be larger social forces at work, Divaris said.
There may not be enough dental providers in some communities, or
little community support, or there may be an attitude of "dental
fatalism," in which people assume getting cavities as a child is the
norm and is accepted, he said.
These barriers can't easily be addressed, he added, but there are
ways to reduce them.
Virtually all children will go to a pediatrician for checkups and
vaccinations, and pediatricians in that setting could perform oral
health screenings, educate parents and refer them to dentists, he
In some places, school-based programs deliver oral health services
without requiring parental involvement, he said.
"Actually, community water fluoridation is a great public health
success story along these lines, where a proven measure is delivered
in large population segments without relying on individuals'
actions," he said.
He urged parents and caregivers not to wait for a problem to develop
before taking their children to the dentist.
Pediatrics, online April 21, 2014.
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