Public Health Policy for Early Childhood Caries - Essay Example

?Public Health Policy for Early Childhood Caries (ECC) Early childhood caries (ECC) is known as a highly prevalent but preventable tooth illness among children younger than 6 years of age. In the United States, forty-four percent of 5-year-olds have cavity experience. ECC affects low-income children more than higher income children and is more prevalent in poor African-American, Latino, and Native American children (Hirsch, Edelstein, Frosh, & Anselmo, 2012a). Streptococcus mutans have been implicated as a major etiological agent of dental caries, although there are a number of other bacteria such as Lactobacillus and Actinomyces spp that play an active role in its development. These bacteria spread throughout the oral cavity producing acidic substances, which dissolves the teeth, leading to dental infection in primary and eventually permanent teeth (Aas et al., 2008). ECC leads to an increase in expenditure for parents, Medicaid, CHIP and other insurance programs. Treatment of a single case of ECC can cost up to $10,000. This is an estimate based upon the year 2000 U. S. Surgeon General’s report on oral health that shows over 51 million hours of school are lost each year because of the dental disease. Thus, one of the Healthy People 2010 goals is to reduce the number of children experiencing dental caries on primary teeth to 11% or less. (Nunn, Dietrich, Singh, Henshaw, & Kressin, 2009). Known Risk Factors High-risk factors for ECC include; high level oral colonization of Streptococcus mutans, visible plaque, enamel dysplasia, dietary and brushing habits, breast and bottle feeding history, child’s access to pacifiers, current medications, oral care of the the mother during pregnancy, and the socioeconomic status of the family (Tinanoff & Reisine, 2009) . Other predisposing factors include parents education, ethnicity, socioeconomic status and place of birth. Studies have shown that approximately 80% of all early childhood caries are experienced by 24% of children primarily from low-income families including immigrant, and native families (Nunn, Dietrich, Singh, Henshaw, & Kressin, 2009). Preventive measures As of 1978, the American Academy of Pediatric Dentistry (AAPD) recognized that childhood caries as an important health problem. Based upon the 2003 guidelines, the AAPD developed a policy statement that ‘advocates an oral health exam of infants by a pediatrician or other qualified pediatric health care professional by 6 months of age’. High caries risk cases must be referred to a dentist within 6 months of eruption of the first tooth or by 12 months of age. The need for having a dental home is also emphasized (Jones & Tomar, 2005). Children and parents need to be educated of the potential benefits and associated risks of breast and bottle feeding. Using techniques such as wiping the baby’s gums and teeth with a damp wash cloth between feedings lowers the risk of excessive sugar intake (Nunn, Dietrich, Singh, Henshaw, & Kressin, 2009). The surgeon general’s updated report on ECC describes strategies for developing risk-assessment in preschool aged children that promotes ‘better decision making’ at the clinical level in order to attain a better understanding of the disease etiology (Tinanoff & Reisine, 2009). Popular and common preventive measures to reduce ECC development include brushing teeth using fluoridated toothpaste, prescribing systemic fluoride supplements if the fluoride content of the water is inadequate, and use of fluoride varnishes applied topically. Also, the American Dental Association recommends applying fluoride varnish to children’s teeth that are categorized as moderate risk for ECC development every 6 months and every 3 to 6 months for those children in the high-risk category (Tinanoff & Reisine, 2009). Limitations and challenges faced It is difficult to study the causes of ECC and its prevention due to; difficulty of performing any clinical trials on such a young age group, compliance issues, dropping out of participants, and ethical issues concerning untreated control groups (Tinanoff & Reisine, 2009). The supply of dental practitioners has been steadily declining over the past 20 years while the number of general pediatricians has been increasing. The investigators have found that by implementing policies where the pediatrician refers children directly to the dentist for screening, the demand for dental services would increase in high-income children by 72.6%. That still leaves the lower income children “crowded out” of dental care. However, if pediatricians were properly trained to screen and educate for ECC, it would eliminate the concern for ‘crowding out’ low-income children from accessing dental services (Jones & Tomar, 2005). A cross-sectional study conducted at the University of California regarding Caries-Risk Assessment showed that only 68% of the fourth year students were confident that they could do CRA in patients less than 5 years old. This becomes a concern as there are a limited number of dentists who specialize in pediatrics, thus appropriate education and providing skills to general dentists would in turn have a positive impact on helping to reduce ECC development (Calderon et al., 2007). III. Discussion and conclusion Current research has proven that the dental health of an individual impacts their general health because the AAPD and American Dental Association have recognized ECC as an infectious disease that can have both vertical and horizontal transmission. Therefore, we need to enforce the different aspects of this policy in order to prevent the spread of ECC. Policymakers should continue working towards programs for implementing preventative measures as well as encouraging behavioral changes in young children, parents and caregivers. For example, the project of community water fluoridation among Colorado children has led to a 6.6% relative reduction in cavity prevalence among children younger than 6 years, a 0.8% relative reduction in their untreated cavities, and 16,881 fewer affected teeth at a cumulative 10-year cost reduction of $14 million after expending $6 million on the intervention, for a total of $8 million net savings (Hirsch, Edelstein, Frosh, & Anselmo, 2012b). I believe that with the collaborative effort of the community and individuals, ECC can be controlled and most of the young children can receive timely dental care with community based participatory approaches that will allow policy makers to select interventions that have greatest potential for reducing both disease and costs. Word Count = 998 References Aas, J. A., Griffen, A. L., Dardis, S. R., Lee, A. M., Olsen, I., Dewhirst, F. E., . . . Paster, B. J. (2008). Bacteria of dental caries in primary and permanent teeth in children and young adults. Journal of Clinical Microbiology, 46(4), 1407-1417. doi: 10.1128/JCM.01410-07; 10.1128/JCM.01410-07 American Academy of Pediatric Dentistry, American Academy of Pediatrics, & American Academy of Pediatric Dentistry Council on Clinical Affairs. (2005). Policy on early childhood caries (ECC): Classifications, consequences, and preventive strategies. Pediatric Dentistry, 27(7 Suppl), 31-33. Calderon, S. H., Gilbert, P., Zeff, R. N., Gansky, S. A., Featherstone, J. D., Weintraub, J. A., & Gerbert, B. (2007). Dental students' knowledge, attitudes, and intended behaviors regarding caries risk assessment: Impact of years of education and patient age. Journal of Dental Education, 71(11), 1420-1427. 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, E66. Jones, K., & Tomar, S. L. (2005). Estimated impact of competing policy recommendations for age of first dental visit. Pediatrics, 115(4), 906-914. doi: 10.1542/peds.2004-1687 Nunn, M. E., Dietrich, T., Singh, H. K., Henshaw, M. M., & Kressin, N. R. (2009). Prevalence of early childhood caries among very young urban boston children compared with US children. Journal of Public Health Dentistry, 69(3), 156-162. doi: 10.1111/j.1752-7325.2008.00116.x; 10.1111/j.1752-7325.2008.00116.x Tinanoff, N., & Reisine, S. (2009). Update on early childhood caries since the surgeon general's report. Academic Pediatrics, 9(6), 396-403. doi: 10.1016/j.acap.2009.08.006; 10.1016/j.acap.2009.08.006 Read More