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Do children have unique needs in the area of oral health? How is oral health relevant to overall health?

In 2000, the Surgeon General  defined oral health as, “health dealing with the mouth, which incorporates not only the teeth and the gums (gingiva) and their supporting tissues, but also the hard and soft palate, the mucosal lining of the mouth and throat, the tongue, the lips, the salivary glands, the chewing muscles, and the upper and lower jaws.”  Furthermore, the report outlines the burden of oral diseases and disorders including those affecting children in particular.  Common oral health problems affecting children and/or adolescents are dental caries (tooth decay); birth defects such as cleft lip and cleft palate; injuries to the mouth; tobacco use among teenagers; and symptoms such as pain, spread of infection, or lost time from school and work that arises from untreated dental disease. It is critical that providers and caregivers address these problems since most, if not all, oral diseases are preventable or amenable to early intervention.

Despite this well recognized need for quality oral health care for children, there continue to be barriers to access to care.  A number of factors contribute to lower rates of access to dental coverage and oral health outcomes for children, including: lack of dental insurance and a limited number of dental providers who participate in Medicaid, parental expectations and lack of oral health knowledge, lack of training of dentists in pediatric dentistry, and an absence of providers in some geographic areas, among many others. Disparities in access to quality dental care between privately and publicly insured children are long standing. A 2008 GAO report cited that 33% of children enrolled in Medicaid had untreated tooth decay, almost double the rate for privately insured children at 17% and comparable to the rate for uninsured children at 35%. Further, a 2010 GAO report discussed children’s access to dental care through Medicaid and CHIP, highlighting both recent improvements and ongoing challenges.

Children face numerous unique oral health needs across their growth and development.  Oral health care is crucial for the pediatric population, beginning with the first tooth through adolescence.  According to the American Academy of Pediatrics , groups at particular risk for caries during infancy and early childhood include:  

• Children with special health care needs
• Children of mothers with a high rate of tooth decay
• Children with demonstrable tooth decay, plaque, demineralization, and/or staining
• Children who sleep with a bottle or breastfeed throughout the night
• Children from families of low socioeconomic status

Infants at risk for dental caries without sufficient oral health intervention are more likely to become children and adolescents at risk for dental caries – particularly those with special health care needs, tooth decay, or low socioeconomic status.  Among children, dental caries is the most common chronic childhood disease.  In the year 2000, dental caries were five times more common than asthma and seven times more prevalent than hay fever, according to the Surgeon General.  In the roughly 10 years since the Surgeon General’s report, a 2009 article in Academic Pediatrics reports that the prevalence of early childhood caries has increased and the disease remains mainly untreated among children of preschool age.  The American Academy of Pediatrics notes that without prevention or treatment, advanced tooth decay can occur in children before age 3.

Establishment of a dental home for the child better enables providers to deliver preventive care, thus reducing a child’s risk for preventable oral disease.  The American Academy of Pediatric Dentistry notes that like the medical home, the dental home seeks to provide care that is accessible, continuous, comprehensive, family-centered, coordinated, and culturally sensitive.  Coordinated care, particularly between medical and dental providers, is essential to child and adolescent health and well-being.

For children and adults alike, oral health is an integral part of overall health. Risk factors to general health arising from a lack of recognition of and treatment for oral infections include systemic infection, gum disease, and an increased risk for heart disease and stroke – according to the Surgeon General. Also, health problems of the mouth often present warning signs for other conditions that may be present but undiagnosed. Therefore, it is important that primary care providers also pay attention to a child’s oral health and encourage proper hygiene and the establishment of a dental home for the child.

Related Resources

• Children's Oral Health: Overview – Centers for Disease Control and Prevention (CDC) (2009).
• National Maternal and Child Oral Health Resource Center – Georgetown University.
• Bright Futures in Practice: Oral Health – Pocket Guide. Casamassimo P & Holt K, eds. (2004).
• Family Voices Oral Health Publications – Provides information on dental health issues for children and youth with special needs along with oral health resources, activities, and materials.