I often ask medical students who come to our clinic for ambulatory training to name the No. 1 chronic infectious disease in children under five years of age. The majority fail to get the correct answer.
In addition when we see patients with asthma, I ask them what infectious disease is five times more common than asthma — a common condition where most students and residents do not lack in knowledge of its diagnosis and treatment. Again, the majority of trainees fail to get the correct answer.
Finally, when trainees are asked to name the most common reason for day surgery in Canada, they strike out.
One can excuse students in training for not knowing that the correct answer to the above questions is early childhood caries (ECC).
What is inexcusable is an experienced dentist who tells families that the first dental checkup can be done at age three.
The Canadian Dental association is very clear in its recommendations regarding the timing of the first dental visit: it should take place soon after the eruption of the first tooth or no later than 12 months (for more detail on the official position statement see cda-adc.ca).
Because pediatricians and family doctors often see children under age one before a dentist has input, we recommend a first dental visit as per the CDA’s position statement. And yet over the past decade the trend continues where some general dentists misinform families when they suggest that the young patient come in for a first check up at a much later age.
Families should be told to find a dentist who is comfortable to see younger children.
Parents whose children needed dental restorations under general anesthesia are increasingly advocating that all dentists should adhere to the official position of the CDA. Yet, too many general dentists opt to see children when they are quite older than one year.
ECC is a condition where tooth decay takes place at a very early age. This is secondary to poor nutrition, extended exposure of the teeth to sugars, juices, and formulas. ECC can even occur in breast-fed babies where the human milk exposes the teeth for prolonged periods, usually when the baby falls asleep.
According to the Canadian Institute for Health Information, close to 19,000 day surgery operations for children younger than six years take place each year. Roughly one in 100 children under age five need this surgery where dentists have to tackle the tooth decay under a general anesthetic. The cost of this situation runs over $21 million annually.
Not only does lack of appropriate dental care at an early age cost society millions of dollars, it also affects the quality of life in these young patients.
Children with ECC sleep poorly feed poorly, experience pain, and lab investigations reveal iron deficiencies, anemia, protein deficiencies in the worst cases, slower growth and unexpected visits to the ER.
There really is no excuse for a general dentist to explain to folks that a child is too young to be seen at the age of one year. ECC is a serious public health issue and it is preventable as long as children receive timely care.
In Calgary, the decision was made to remove fluoride from the public water supply. This decision was made in a manner that stoked controversy and the side that led that decision maintains it was wise. Time has already shown that it was not wise (the number of ECC cases has steadily climbed in Calgary in contrast to earlier numbers when there was fluoride in the water). From personal communication with pediatric dentists, there is an anecdotal trend toward more ECC. However officials figures are not yet available since fluoride was removed from Calgary’s water supply.
In Ottawa, the public water supply is fluorinated. In Gatineau, a city on the other side of the river, it is not. In both cities, children use the same type of toothpaste and yet the incidence of ECC varies greatly between those two cities with a much lower incidence in Ottawa. The argument that all one needs is fluorinated toothpaste is rather weak.
Because of no fluoride in the water supply of some cities, it is even more important to get the first dental visit done at the age of one year.
In the Universal Journal of Public Health Vol. 2, No. 4 (April 2014), Dr. Leonard Smith et all wrote, It’s About More Than Just Baby Teeth: An Examination of Early Oral Care in Canada. The authors make the point that there are long-term effects to late diagnosis and treatment of ECC. They lament the fact that nearly 20 per cent of children between the ages of two and five years old who present with dental caries did not receive prior or appropriate treatment.
The CDA’s website is a useful resource for other dental topics, such as dental injuries, tooth bleaching, oral jewelry, snoring and sleep apnea, frequency of dental care and junk food.
Dr. Peter Nieman has worked as a community pediatrician in Calgary since 1987. He is a bi-weekly medical contributor on CTV Morning Live, the president of the Alberta Chapter of the American Academy of Pediatrics and the host of www.drnieman.com