Viewpoint: Caries in primary teeth

September 1, 2008

Commentary about the evidence that children, especially pre-school children, children with special health care needs, and children who are poor, have been overlooked with regard to their dental health.

Most of the articles published in Contemporary Pediatrics fall into one of three categories. Some are review articles meant to remind and update readers about areas of pediatric health care most of us learned about at some point. Some describe a new discovery, such as a genetic disorder or infectious disease. And some provide advice and suggestions about delivery of health care.

"The ECC Epidemic" an article by Drs. Wagner and Oskouian in this month's issue, is a different sort of article. It is a call to action. The authors admonish all pediatric health care providers to wake up to a largely unrecognized epidemic that has been, literally, right under our noses. How many times have we peered into the mouths of young children searching for erythema, exudate, ulcerations, and malformations, without noticing signs of what Wagner and Oskouian appropriately describe as the most common chronic disease in childhood?

There is plenty of evidence that children, especially pre-school children, children with special health care needs, and children who are poor, have been overlooked with regard to their dental health. The Agency for Health Care Research and Quality of the Department of Health and Human Services has called dental care "the most prevalent unmet healthcare need for children" ( http://www.ahrq.gov/chiri/chirident.htm/. A report from the Surgeon General released in May 2000 states that, despite improvements in nutrition and access to fluoridated water and dentifrice, caries in the primary teeth of children have not decreased in the past 10 years.1

The teeth have always been there. They frame the tongue we ask children to stick out, and bite the tongue depressor we insert so that we can see more clearly. Some of us have mistakenly thought that primary teeth didn't matter much, and that the time for dental care came only once permanent teeth had erupted. Wagner and Oskouian provide a convincing argument that identification of early childhood caries is an important responsibility of all child health providers, and that we have a considerable public relations task ahead of us in helping parents to understand that primary teeth are important-even before they are relinquished to the Tooth Fairy.

References

1. United States Public Health Service's Office of the Surgeon General's National Institute of Dental and Craniofacial Research: Oral health in America: A report of the surgeon general. NIH publication 00-4713 2000;1