Dental caries, better known as tooth decay or cavities, is the most common disease in the world. It affects 92% of the world’s population and it is almost totally preventable. The caries disease process has 6 stages, as defined by the International Caries Detection and Assessment System.
Stages of Dental Caries
Stages 1, 2 and 3 are the reversible stages of the disease, which we can alter with simple behavioral changes. Stage 4 requires only minimal intervention, a small filling, stage 5 requires a very large filling or a crown and Stage 6 requires a root canal treatment, a post and a crown and possibly a course of antibiotics and / or an extraction. Stage 6 can also lead to hospital admission and even death.
The USA is on track to spend $123.6 Billion on dental services in 2016, for only a fraction of its population. 1 in 5 of all children’s healthcare dollars is spent on dental care. For every individual without HEALTH insurance, there are 5 without DENTAL insurance. This resonates painfully here in Utah because we have more uninsured per capita than in other states.
I volunteer every week at the People’s Health Clinic in Park City. 65.6% of expectant mothers and 78.8% of children I see are either at HIGH RISK FOR CARIES or already have signs of the disease. I know this because for almost 3 years I’ve been tracking them. Children like Lucia. When I first saw her, she already had several small cavities. Stage 4. She definitely needed fillings but her mother, Elsa, had no insurance and no money. Lucia was in no pain and showed no signs of infection, so she didn’t fit the profile for referral to the Assistance League. After a few visits I could tell that Elsa was now vigilant with home care. Lucia’s teeth were shiny and I could no longer find plaque at the gumline or food debris between her teeth. But like me, Elsa was frustrated to see Lucia’s condition deteriorate. When tooth enamel is already broken down and the underlying dentin is exposed, the opportunity for effective and relatively inexpensive prevention has been lost. The disease progresses and the sooner we drill and fill, the better.
In the end, Lucia’s disease progressed to the point that she had to get 12 crowns under general anesthesia, in a hospital OR, at an estimated cost of $10,000.00 to $12,000.00. The rate of relapse such a treatment is 52% to 79%, so despite the HUGE expense, children like Lucia continue to suffer from the disease into adulthood. Lucia is just ONE case, and with dimes a day, we could have prevented this.
High Cost of Curative Care
Curative care is labor intensive, time consuming and very expensive. Millions of people like Lucia and her mom can’t afford it. And certainly, we can’t afford to continue on this track. Despite the $Billions we sink into curative care in USA, 27% of people still walk around with untreated disease. In certain populations that % is much higher: for Hispanics, like Lucia and her family, it’s 36%. And for African Americans, 43%. Judging by the number of children in the 2 Park City Title 1 schools who walk around with a mouthful of stainless steel crowns, I suggest that in this community alone we have recently spent more than $1Million to care for children with severe dental caries, Stages 5 and 6, most of whom will relapse well before they graduate from elementary school.
The Need For Preventive Care
We need PREVENTATIVE CARE! If we are going to break the cycle of dental diseases, we need:
- To start with making oral health visible.
- More inclusive basic prevention upstream into the school system and into the community.
- To expand the importance of oral hygiene beyond dental offices and home bathrooms.
ORAL HYGIENE BELONGS IN THE COMMUNITY JUST LIKE HAND HYGIENE
I propose a program of daily oral health practices in schools. Very simple practices of 5 minutes each day under the supervision of elementary and pre-school classroom teachers.
We have successfully tested such programs in 4 Kindergarten classrooms in 2015 and 2016 at MPES and at St Mary’s church with pre-schoolers n the spring of 2016.
93% of the teachers said they will support this movement and the parents need it. The numbers speak for themselves: 73% of parentshave a hard time getting their children to brush their teeth at bedtime, before school or both. Half of the parents say they’re willing to pay to support such a program and 91%, almost all of them, said they would participate if the program included a home portion. We know from the National Supervised Tooth Brushing Program in Scotland that programs like this make a BIG difference. In Scotland, over decades and with close to 100,000 children, they have consistently and significantly reduced the incidence of dental caries in every school, every community and across the whole country simply by introducing a supervised tooth brushing programs in schools.
Let’s launch a similar programs right here in USA.
Think about this. The average cost of a single filling is $200.00 initially and upwards of $6,000.00 in a lifetime. That’s because the life expectancy of a 2+ surface filling is only 5 to 11 years according to Dr Gordon Christensen, an expert on dental materials. With a solid preventative program we could use the $12,000.00 spent on 1 child like Lucia, to provide more than 100 children with the benefits of supervised flossing and brushing, leading to savings of more than twice the initial investment in prevention, short term, and up to 30 folds that amount long term. Amazing what the proverbial ounce of prevention can do.
It Takes A Village to Raise A Child. I say It takes a healthy village to raise a healthy child. We have the opportunity to make a very big difference for everyone if we are willing to re-think WHERE, HOW and by WHOM effective prevention is offered.