Caries in children act like a different disease than we see in adults. Under a microscope, it is the same strep. mutans eating carbohydrates story, but when you step back and see a two-year-old with decay in every back tooth, you have to think, “Those teeth just erupted last month. How did this happen?” After restoring these young children, often with sedation or general anesthesia, studies reliably reproduce that these children will return with recurrent decay in these same “fixed” teeth (Almeida 2000, Tate 2002, Foster 2006). Parents are frustrated and blame soft teeth. Dentists are frustrated and blame restorative technique or materials. Kids are frustrated and lose motivation for their homecare when they continue to miss the “No Cavity Club” membership.
Traditional recommendations to brush, floss, and restore do not solve the early childhood caries disease. Nutrition is king, specifically frequency and duration of carbohydrate consumption (Gustafsen 1954, Warren 2009). I would suggest we all know this by now, but find it hard to change in our patients. If dieting were easy, I would make my ideal weight by New Years. But it is hard. Food is a basic need, modified by habits, emotions, and culture. The connection between nutrition and oral health is an equalizer from Center City Philadelphia to Johnstown. All children need their parents to offer nutritious food in a way that develops healthy habits.
Food insecurity, meaning the inability to always afford sufficient food, makes this harder. Statewide in Pennsylvania, one in seven children experience hunger. In some Philadelphia neighborhoods, one in three residents experience food insecurity. The COVID-19 pandemic has only exacerbated the problem. Serving as Clinic Director for the Department of Pediatric Dentistry and Community Oral Health Sciences at Temple University was in a way returning to my roots, practicing in the same building that I visited as an infant while my father finished his last clinical requirements in the 80s. The families in these clinics have come for generations and weathered so many challenges.
I listen to their stories and hear the underlying theme of food insecurity every day. One dad explains that repeat dental visits are hard because their child misses the free school breakfast and lunch, two healthy meals, each day they are absent or late. A mom and owner of a corner store is frustrated with her middle schooler who has rampant decay from the same foods she offers in her store. A mother of a young child at WIC asks, if juice is not healthy, why is it part of my benefits. My experiences in these busy clinics taught me to be curious about why a seemingly clear solution is not working.
When providers address nutrition for oral health, we are also reducing risk for diabetes, obesity, heart disease, sleep apnea, and more without treading on challenging topics like body image and weight (Wright 2019). As a pediatric dentist, one of the most rewarding roles is to introduce the whole family to wellness through the needs of the child. They are primed and ready to make changes for their children that they may not have prioritized for themselves. A general dentist has the other piece of the puzzle. The trust and long relationship built over decades of care means that expecting parents lean into your advice and you are there at the perfect time. Working together we can ensure a more aware family structure that starts before infancy and ends with the grandparents.
When I decided to open my own pediatric dental practice, no demographic report could lure me away from my beloved Philadelphia. Numbers cannot describe the diversity from block to block or the pulse of families that create each neighborhood. Being a provider in an urban community means opening your eyes and heart to an incredible variety of personalities and cultures. Those of us that do it with joy are building our cities into the communities of our dreams. Philadelphia Pediatric Dentistry opened in July 2021 with children’s nutrition at its foundation. For every new patient visit, Philadelphia Pediatric Dentistry will donate 10% to support the youth facing programs of The Food Trust. The Food Trust is tackling healthy food access at every angle—from teaching kindergarteners about where healthy snacks come from, to bringing fresh produce into neighborhoods designated as food deserts. Together, we are building a healthier Philadelphia.
References
- Almeida, A. G., Roseman, M., Sheff, M., Huntington, N., & Hughes, C. V. (2000). Future caries susceptibility in children with early childhood caries following treatment under general anesthesia. Pediatric dentistry, 22(4), 302–306.
- Bhoopathi V, Tripicchio G, Sarwer DB, Cordero-Ricardo M, Tellez M, Langenau E, Hill J. Nutrition Counseling and Obesity Prevention in Children: A Handbook for the Dental Community. Philadelphia, PA, Temple University Maurice H. Kornberg School of Dentistry, April 2019. Available at https://dentistry.temple.edu/NCOP_Handbook.
- Foster, T., Perinpanayagam, H., Pfaffenbach, A., & Certo, M. (2006). Recurrence of early childhood caries after comprehensive treatment with general anesthesia and follow-up. Journal of dentistry for children, 73(1), 25–30.
- GUSTAFSSON, B. E., QUENSEL, C. E., LANKE, L. S., LUNDQVIST, C., GRAHNEN, H., BONOW, B. E., & KRASSE, B. (1954). The Vipeholm dental caries study; the effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta odontologica Scandinavica, 11(3–4), 232–264.
- Hirsch, G. B., Edelstein, B. L., Frosh, M., & Anselmo, T. (2012). A simulation model for designing effective interventions in early childhood caries. Preventing Chronic Disease, 9.
- Tate, A. R., Ng, M. W., Needleman, H. L., & Acs, G. (2002). Failure rates of restorative procedures following dental rehabilitation under general anesthesia. Pediatric dentistry, 24(1), 69–69.
- Warren, J. J., Weber-Gasparoni, K., Marshall, T. A., Drake, D. R., Dehkordi-Vakil, F., Dawson, D. V., & Tharp, K. M. (2009). A longitudinal study of dental caries risk among very young low SES children. Community dentistry and oral epidemiology, 37(2), 116–122.
- Wright, R., & Casamassimo, P. S. (2017). Assessing attitudes and actions of pediatric dentists toward childhood obesity and sugarsweetened beverages. Journal of public health dentistry, 77, S79–S87.
