Adolescents' independent behavior, competing priorities, and sense of invulnerability make oral health behavior modification a challenging task. But there are ways to get the message across.
Adolescent health promotion covers a broad array of topics including eating disorders, depression risk, and substance abuse. One topic repeatedly overlooked has been adolescent oral health. Incredibly, between 50% to 68% of all US teenagers have untreated caries.1 These margins are even greater among minorities and those living in poverty. Only 43% of adolescents visit the dentist regularly.2 For black and Hispanic teens, the rates are closer to 25%, and worse in all categories for teens who are poor.3
Other factors, beyond socioeconomic status, influence the oral health of adolescents. Participation in extracurricular activities (ie, organized sports) and social trends place teens at risk for dental problems. Case in point: approximately one third of all adolescent dental injuries occur as a result of a sports-related trauma.4 Oral piercing, a popular choice among this population, has also been shown to cause trauma to the mouth, as well as oral infections. Finally, while there has been a decrease in substance abuse among teens, there is still a significant rate of alcohol (43%), tobacco (23% smoking and 8% smokeless), and drug use (20% marijuana, 3% cocaine, and 6% methamphetamines) that can lead to oral cancer and other dental pathology.5,6
Despite this body of evidence, adolescent oral health remains neglected in primary care. While 90% of primary care physicians believe oral health is important, only 50% reported that they had any training in the subject. Only 9% could answer four simple oral health questions.7,8
Good oral hygiene is fundamental for oral disease prevention, and should be fostered from infancy. Brushing with fluoridated toothpaste is the most effective strategy to remove plaque, thereby decreasing the risks of tooth decay and gum disease.9-11 Dental flossing is equally important to remove plaque between the teeth and under the gums. Factors affecting tooth brushing among adolescents include their busy school, extracurricular, and work schedules. Rebellion against what parents ask them to do may be yet another factor in a teen's reluctance to maintain good oral hygiene.
Teens often respond to how others view them more than direct health effects.12 Therefore, framing regular brushing and flossing as important for preventing bad breath and maintaining a better-looking smile may be more relevant to an adolescent than the threat of future complications. Suggesting to teens to brush to music for the duration of one song may increase brushing times.13 For those who wear braces, recommend using a fluoride rinse after brushing to prevent dental decay in areas covered by these orthodontic appliances. Advice for parents should focus on modeling healthy oral health behaviors. Making oral health care resources readily available in family bathrooms, and giving choices regarding the type of brush, floss, and toothpaste, may encourage their regular use.