CHILDHOOD DENTALCARIESAlex FullerMPH O655Des Moines University

• Define childhood caries• Describe the importance of childhood dental

caries • Explore prevalence and distribution• Understanding the risk factors & protective

factors– Model of causal relationship

• Review current studies and recommendations for future research

• Describe methods of prevention

OBJECTIVES

• A multi-factorial chronic disease • Primary factors for caries formation– Susceptible tooth– Plaque– Individual's diet

• Children significantly affected

OVERVIEW

• Barriers to dental care– Access to care– Affordability of services– Workforce Shortages– Geographic location

• Policies that address these barriers

HEALTH POLICY

• Economic burden of dental caries– fourth most expensive disease in

the United States • Current methods of treatment

economically unsustainable – ER visits for treatment

• Indirect effects of childhood caries & their economic burden– Nutrition deficiency, negative health

outcomes, missed school• Methods for sustainability

ECONOMICS

• Children represent a vulnerable population

• They are limited in their:– Education– Resources– Strength and ability to provide self

care• Strong dependence on others poses

problems– Can childhood caries be considered

neglect or abuse?• Dentists’ role in ethics

ETHICAL CONSIDERATIONS

• United States– Most common chronic childhood

disease – Occurs more frequently than asthma,

early childhood obesity, and diabetes• In 2012

– 60% of children ages 5 to 17 had caries• Effects are seen by the time children start

school– >40% have caries by kindergarten– >50% have cares by 2nd grade

DISEASE INCIDENCE

• Person– Children – Ages 2 to 19– Male vs. Female– Race is a significant factor

DISTRIBUTION

AGE & RACE DISTRIBUTION

• Place – Counties with low levels of

fluoridated water– Low-income communities– Rural locations

DISTRIBUTION CONT.

• Time– Secular time trend

DISTRIBUTION CONT.

Percentage of Children Aged 2--4 Years Who Ever Had Caries in Primary Teeth,* by Race/Ethnicity† and Sex --- National Health and Nutrition Examination Survey, United States, 1988--1994 and 1999--2004

• Community– Policy– Healthcare availability

• Family– SES– Educational attainment

• Individual – Biological– Lifestyle /Behaviors

RISK FACTORS

• Policy– Fluoridated water

• Healthcare– Access to dentists and other healthcare

professionals• Age– Permanent teeth vs. deciduous teeth

• Genetics– Child dental disease prevalence similar

to parents

PROTECTIVE FACTORS

• Web of Causation– Risk factors– Protective factors

MODEL OF CAUSAL RELATIONSHIP

• Cross-sectional studies– Risk factors – Health needs of minority populations

• Randomized controlled trials– Effectiveness of clinical interventions

• Prospective cohort studies– Documentation of factors that

contribute to dental caries

PUBLISHED RESEARCH

• Strengths– Growing amount of literature on

childhood caries– A wide variation of studies– Large sample size

• Limitations– Limited research on behavioral

characteristics– Caries remain a significant problem– Not recognized widely as a public health

crisis

RESEARCH STRENGTHS AND LIMITATIONS

• Improve understanding of race and SES in risk of caries formation

• More studies on oral health care from health care providers that are not dentists

• Intervention effectiveness

RECOMMENDATIONS FOR FUTURE RESEARCH

• Primary– Fluoride exposure– Dental sealants– Education about proper oral health– Behavior modification– Oral health risk assessments

• Secondary– Clinical exams for early diagnosis followed by

prompt treatment• Tertiary

– Fillings – Dental sealant restoration– Removal of teeth

• Replace with bridges, implants, dentures

PREVENTION METHODS

• Multi-factorial disease• Current barriers to care • Caretakers responsible for presence of

caries• Significant health crisis • Importance of research and policy• Our role in reducing disease incidence

DISCUSSION & CONCLUSION