New York Times reporter Catherine Saint Louis looks at why preschoolers are getting more cavities in yesterday's article, "Preschoolers in Surgery for a Mouthful of Cavities."
From the article:
The Centers for Disease Control and Prevention noted an increase, the first in 40 years, in the number of preschoolers with cavities in a study five years ago. But dentists nationwide say they are seeing more preschoolers at all income levels with 6 to 10 cavities or more….
There is no central clearinghouse for data on the number of young children undergoing general anesthesia to treat multiple cavities, but interviews with 20 dentists and others in the field of dental surgery suggest that the problem is widespread.
We asked CDS member, pediatric dentist and mom Dr. Cissy Furusho for her thoughts about the article.
“I had a lot on my mind, and brushing his teeth was an extra thing I didn’t think about at night,” said Melody Koester, quoted in the article.
“I’ve heard that from many of my patients,” Dr. Furusho said. “And I get it. When you’re trying to get out of the house in the morning—maybe you’ve got three kids who all still need some help getting ready—it’s hard to make the time to make sure everyone brushes their teeth.”
Her advice? “In an ideal world, you’d make sure everyone brushes their teeth after breakfast,” she said. If that doesn’t work, she offers these tips:
If possible, brush after lunch instead. “Families need to make sure their kids brush their teeth at least twice a day. Once just won’t cut it.”
Let them try to brush their teeth themselves. “Afterwards, you’ll still want to get in there to make sure the teeth are brushed well, but hand them the toothbrush with a bit of toothpaste and see what they can do.”
Have everyone brush their teeth together. This works well if you have more than one kid. “You can make sure that everyone brushed their teeth that day,” Dr. Furusho said.
“I tell parents at my practice, ‘Any toothbrushing is better than none,’” Dr. Furusho said. “If your morning efforts aren’t thorough, you especially need to do a good job brushing their teeth in the evening.”
"It’s not just about kids in poverty, though kids of lower socioeconomic status tend to get more cavities,” said Dr. Rochelle Lindemeyer, director of the pediatric dentistry residency program at Children’s Hospital of Philadelphia and the University of Pennsylvania dental school. Affluent families may have nannies who “pacify kids by giving them a sippy cup all day,” Dr. Lindemeyer said.
“I encourage parents to make sure their caregivers are educated about oral health for children, especially infants and toddlers,” Dr. Furusho said. “Sometimes parents will bring their nannies or even grandparents with them on dental visits so that I can talk with them and teach them how to take care of children’s teeth. Parents need to make sure that whoever is caring for their kids know the basics about good oral health.”
Brushing teeth twice a day used to be nonnegotiable, [Dr. Lindemeyer] said, but not anymore. “Some parents say: ‘He doesn’t want his teeth brushed. We’ll wait until he’s more emotionally mature.’ It’s baffling,” she added.
“If you can’t brush your child’s teeth well because they fight you, you need to increase the number of times you brush their teeth in a day,” Dr. Furusho said. “I tell patients, “If you brush 3-4 times a day, even if it’s a struggle, odds are that you’ll hit each tooth at least once.”
“I know kids can really resist getting their teeth brushed. But I look at this way. Some kids hate baths, others might not like having their nose wiped or their face cleaned. Does this mean we never wipe their nose or give them a bath? No, we do those things because we know it’s for their benefit, even if they hate it. Same goes with brushing their teeth,” said Dr. Furusho.
The level of decay, they added, is so severe that they often recommend using general anesthesia because young children are unlikely to sit through such extensive procedures while they are awake.
“It’s heart-breaking,” Dr. Furusho said, “because cavities are 100% preventable. Still, parents should know that using general anesthesia for dental visits is a matter of training and a dentist’s philosophy on how to best treat children. Not every dentist will insist on it, so you need to find the practice that’s right for you.”
Dr. Man Wai Ng , the dentist in chief at Children’s Hospital Boston, said she heard parents, rich and poor, make similar rationalizations about their preschoolers’ snacking, like, “I can’t ever imagine Johnny being hungry, so I’m laying out a whole-wheat spread that’s always available.”
“Everything in moderation,” Dr. Furusho said. “With my own son, there are no off-limit foods. He even has gummies now and then. But with those sugary foods, you have to brush their teeth afterwards. It’s very important.”