Oral Health in America - February 2022 Bulletin

Section 2A Summary

Oral Health Across the Lifespan: Children

Oral health in infancy and early childhood lays the foundation for good oral health in later stages of life. Section 2A of the NIH report Oral Health in America: Advances and Challenges delves into how the beliefs and behaviors of parents and caregivers, as well as societal, cultural, and commercial factors, influence children’s health outcomes. The section discusses the importance of risk assessment, early intervention, access to dental services, communication and education, and collaboration among health care providers to improve oral health for all children.

Current Knowledge, Practice, and Perspectives

Of all dental and craniofacial disorders that affect children, dental caries—the disease that causes tooth decay—remains the most prevalent. The prevalence of caries in permanent teeth has decreased from 25% to 18% in school-aged children. However, children from some minority racial groups and those affected by poverty have seen less improvement. In addition, nearly 1 in 5 children have special health care needs that can stem from physical disabilities, developmental disorders, or orofacial conditions, such as cleft lip and cleft palate. These conditions can make it hard for children to receive routine dental care, which can affect their oral health and quality of life.

Advances and Challenges

Over the past two decades, social determinants of health (SDoH) such as socioeconomic status and race have been recognized as significant contributors to oral diseases in children. About half of all American children do not receive regular dental care due to certain SDoH. Children from vulnerable populations have less access to oral health care and generally experience more dental caries. For children with special needs, the progress in access to dental care has lagged, in part due to the challenges faced by dental professionals without the in-depth training required to treat patients with complex conditions.

Promising New Directions

Expansion of dental insurance coverage has enabled early intervention for more children from low-income households; today, 9 in 10 children in the US have dental insurance. Integrating screening, preventive dental services, and referral into family and pediatric medical care has also improved oral health care access, allowing children to receive preventive dental services during regular medical care visits. Other opportunities for improving children’s oral health include emerging technologies for information-sharing to enhance caregivers’ oral health literacy, and scientific discoveries related to craniofacial conditions that could inform new approaches for prevention and treatment.

Additional Takeaways

A growing body of research shows that early childhood caries can have adverse effects, from pain and delayed development to poor self-image and socialization. Section 2A highlights the role of parents and caregivers in preventing and controlling dental caries through oral hygiene and dietary practices. Parental knowledge about oral health, which enables caregivers to obtain, process, and understand basic information and services, is closely tied to children’s oral health and vital for dental care decisions. Partnerships among dental practitioners, health care providers, and community professionals such as social workers and teachers can increase the likelihood that crucial oral health information reaches more families. Public health and patient-centered approaches are needed to reduce oral health inequities and support children’s transition to adolescence.

Call to Action

Policies and improved training are needed to reduce oral health inequities by encouraging health providers to focus more on individual and public health approaches to preventing the occurrence of new disease and managing disease earlier.

Read Section 2A of the Report

Q&A With Section Editor

A conversation with Paul S. Casamassimo, DDS, MS. He served as senior editor for report Section 2A: Oral Health Across the Lifespan: Children.

What are some important takeaways from this section?

Section 2A of the report highlights the continuing challenges presented by oral conditions that afflict children in the US. The section emphasizes the stubborn prevalence of dental caries throughout childhood, with an emphasis on its early occurrence and lingering effects throughout childhood. Readers should come away with a new respect for the pervasive impact these conditions can have on some children, from chronic pain and impaired growth and development to disfigurement and social isolation.

Another take-home message for the dental community is the impact of craniofacial disorders on quality of life. Challenges remain for craniofacial care; they include optimizing the craniofacial-specialized dental workforce, developing dedicated health care management systems, improving long-term management, and integrating scientific breakthroughs into medical advances.

Finally, we have lots to do to make oral health a constant across all socioeconomic and underrepresented groups of children despite some major gains in those areas for some. Dental caries remains far too prevalent among US children, impacting their success in many areas of life.

What was a surprising finding?

It was surprising to learn that progress in care of children with special needs really hasn’t improved much since the release of Oral Health in America: A Report of the Surgeon General, in 2000. Scientific advances in understanding the causes and medical management of these conditions haven’t permeated dental care or made oral health a given for children with special needs. Dental education remains well behind the curve in preparing general dentists to provide comprehensive care to this population. The care system, funding mechanisms, and awareness of practicing dentists need to be reoriented through education and systematic change toward a posture of health equity that includes people with special needs.

What should the American people know about this section of the report?

Those reading this section should know that the associate editors and writers contributing to this section are largely professionals who care for children and who blend science with hands-on care in their daily activities. The information in this section reflects their dedication, expertise, and day-to-day work with children and families. The messages in this section are those of people in the trenches, so to speak. Readers can feel good about the accuracy and insight of these editors and writers.

Section 2A of the report also reflects the realities and challenges of pediatric oral health in America. And while it acknowledges advances, it doesn’t downplay the work to be done to achieve a future child population for whom oral conditions are few and minor. The writers and editors of this section would want the American people to know that oral disease, as an obstacle to learning and optimal development for all children, can be conquered.

What is the main call to action?

Put simply, the message is that while we have a way to go to achieve oral health equity, if we harness advancing science, test it well, and then apply it to care of children, we can achieve a disease-free generation in our time. It will take engagement of communities and families by health professionals to refine our focus and accelerate the progress made since the 2000 Surgeon General’s report, to this end. The section calls for us to take an honest look at where we are, but also consider how far we’ve come, and use science and research to craft a new vision and map a plan to achieve that dream for all children.

Paul Casamassimo, DDS, MS, is a professor emeritus of pediatric dentistry at the Ohio State University. He received his dental degree from Georgetown University and master’s degree in pediatric dentistry from the University of Iowa. His research focuses on children with special oral health care needs and health policies.

Did You Know?

• About half of all American children do not receive regular dental care because of social, economic, and geographic obstacles. See context.
• About 1 in 3 preschoolers living in poverty have some form of early childhood caries. See context.
• Mexican American and non-Hispanic Black preschool children have a higher prevalence of caries than their non-Hispanic White peers. See context.
• Between 1998 and 2014, school-aged children from higher-income households saw a significant decrease in caries prevalence, from 23% to 13%, while those living in poverty saw a milder drop, from 28% to 24%. See context.
• The expansion of state-administered health insurance programs has increased access to dental care for an additional 4 million children from low-income households. See context.

Learn more about Oral Health in America: Advances and Challenges