An Independent paper of New Zealand

Wailing and gnashing of rotting teeth
25 November 2001

It was supposed to be the first generation with perfect pearly whites. But our children's teeth are rotting faster, reports Mark Henderson.

Julie took one look in her seven-year-old daughter's mouth and panicked.

She was horrified to see a huge boil draining from a hole in the youngster's back tooth. Although the child had been complaining about sore gums, she told Julie her teeth felt fine.

Until now, mum had no reason for concern. Annual visits to the school dental therapist had gone well, and bedtime brushing was strictly enforced. "I couldn't understand how this ghastly thing had developed seemingly out of the blue," says Julie.

An emergency root canal saved the diseased tooth. But there was more bad news. Another four holes and enamel depletion were discovered on several teeth.

"The dentist was shocked at the rate of decay," recalls Julie. "I wracked my brain to find a reason. I've always diluted her fruit juice and never have sweets in the house. She never misses a visit to the school dentist."

The decay had attacked between her daughter's teeth, places where toothbrushes often can't reach.

Julie is not Maori or a Pacific Islander, the two poorest groupings and worst dental health. She's highly educated and lives in an affluent suburb.

Her heartache at seeing a child's teeth ravaged is being played out among more families.

Nina Vasan who specialises in young teeth says the rot has set in.

Children's dental health is declining after the "golden years" through the '70s and '80s.

Vasan is seeing a surge in decay from both sides of the economic fence. "This is the tip of the iceberg," she says. "The problem is escalating."

No one is immune. Dentist colleagues have sent their children to Vasan in Auckland and been embarrassed to learn their tots have problem teeth.

She has had to treat children younger than 18 months who have been allowed to fall asleep with a bottle in their mouths. Lactose in milk, particularly at night when the flow of saliva slows, is murder on young teeth.

Vasan blames modern diet for the slide in children's dental health.

Fluoride in drinking water and toothpaste, she says, have been around for decades in major population centres.

"Perhaps we are getting complacent. I'm convinced more sugar-laden snack foods for children, juices and fizzy drinks - especially ones with phosphoric acid - accelerate decay.

"And maybe parents - after working a long, demanding day - are letting kids indulge in junk food as a 'treat' and not checking teeth are properly brushed."

Even "healthy" snacks such as dried fruit, raisins and muesli bars can quickly wreck healthy teeth.

Vasan has retrieved these sticky tummy top-ups from between tiny teeth more than a day after they were eaten.

Julie now serves only water and milk as thirst quenchers. Dried fruit is no longer in the school lunch box. She helps her daughter floss every night.

But Julie despairs about so much "sneaky sugar" in foods such as baked beans, crackers and tomato sauce.

The American and Australian associations of paedodontists strongly recommend children see a dentist from the age of one.

"It gives us an early opportunity to educate parents," says Vasan. "By age 2½, teeth have already decayed."

And don't, warns Vasan, dismiss "baby teeth" as not worth looking after. It is especially important to preserve back teeth (which generally fall out between ages 10 and 12). These teeth guide the new front teeth (the first to go at around six years) into place without which expensive orthodontic work might later be required.

It's soul destroying to see two-year-olds with cavities, says Claire Caddie, president of the Dental Therapists Association, known to past generations as school dental nurses.

Caddie is seeing a surge in children needing fillings.

And she's not just talking about kids from the wrong side of the tracks.

The tooth fairy is making more frequent calls on the middle and upper income households.

Caddie says anecdotal evidence suggests the rise in junior cavities mirrors the soaring popularity of high-sugar "sipper" drinks and "grazing" between main meals.

"Kids are constantly swigging from these bottles, exposing their teeth to decay. We have become a society of snackers, eating on the run. Every morning I see heaps of children eating their breakfast in the car."

Most public primary and intermediate schools have a dental clinic, although therapists often divide their time between several schools. Many regions operate mobile clinics.

The Ministry of Health funds the service, stipulating children must be examined by a therapist every 12 months. Children can be enrolled at two years old.

Free dental treatment is available until age 18.

But, says Caddie, many families are transient, making it difficult for therapists to keep track on young mouths.

Dentists not so long ago were preparing for life without the drill screech which still haunts black-filled baby-boomers.

They believed tooth decay was licked. A weighty slab of their income was evaporating after widespread adoption of fluoride in public water.

Children, teenagers and young adults increasingly had no fillings and no tooth decay - and never would.

Cosmetic services - such as teeth whitening or bonding - would, instead, pay the "Beamer" lease.

And dentists have been increasingly exploring new areas of opportunity, such as orthodontics, and treatment of gum disease, a condition fluoride has not helped. It will become more prevalent as aging people hold on to their teeth longer.

Other growth possibilities include general medicine, such as using the mouth as a window to diagnose diabetes, heart disease and other ailments which show early symptoms there.

But the swing to creating the perfect smile is being interrupted by an ugly turnaround.

Dental health data from the School Dental Service tracks the decline.

In 1997, 56 percent of five-year-olds had no decay. Now only 52 percent of the country's 45,000 new school entrants can boast perfect teeth. In Wellington, infants with intact biters have dropped from 66 percent to 62 percent. Bay of Plenty is down to 42 percent from half, Gisborne slid five points to 37 percent.

The decline is in regions with and without fluoridation.

But as health professionals point out, these statistics don't tell the complete story.

"No one knows the real picture," says Peter Dennison, public health dentist for the Wellington region.

Averaging hides some brutal facts. For example, says Dennison, while 3 percent of European infants in the region have decayed front teeth, the incidence leaps to 23 percent (one in four) in Polynesian children.

"All we can say for sure is there is an awful lot more decay in kids who have it," says Dennison.

Many in the dental health sector are critical of population-based funding. They claim it is inequitable and ignores the massive rate of dental caries in regions such as Northland.

What is needed, says Callum Durward, a paediatric dentistry specialist working at several Auckland hospitals, is needs-based funding. Durward has to treat many pre-schoolers under general anaesthetic.

He is appalled some councils deny children the advantages of water fluoridation. Around 43 percent of New Zealanders on reticulated water don't have fluoridation.

Durward urges parents to insist children brush twice a day with fluoride toothpaste, shown to reduce decay by an additional 30 percent if teeth are not rinsed with water after brushing.

"Annual data underestimates the amount of disease present," he says. "School dentists offer only a basic service. If parents want something better they need to pay for it."

Health professionals scratch their heads at resistance to fluoridation of water. Christchurch's 350,000 residents don't have it.

Yet, there is no dispute fluoridated water helps prevent decay, says Martin Lee the principal dental officer for Canterbury's school dental service.

Figures prove it. Lee says Wellington children (fluoridated) have 30percent better dental health than youngsters in Christchurch.

Wellington dental hygienist Kirsty Jennings blames lack of education for "rampant playground tooth decay".

"There's a huge knowledge gap out there," says the president of the New Zealand Hygienists Association. "Most people haven't a clue how much sugar is in drinks and snacks and how sugar works in the mouth."

A recent survey of 20,000 New Zealanders by Colgate confirms Jennings' fears. While most people say they brush every day, 68 percent don't floss and most eat damaging sugary foods between meals at least once a day.

Findings showed New Zealanders haven't got the message about the role diet can play in increasing the risk of tooth decay.

People said they knew cola was bad for teeth but didn't think about the impact of between-meal drinks on teeth and didn't believe fruit juice was damaging to teeth.

Around 75 percent of children 10-14 years snacked on lollies, chocolate, ice cream or biscuits between meals once or twice a day. "It is not good enough to simply drill and fill," says Jennings. "We have to get back to promoting early prevention."

She says many parents complain their children are not being checked by the school dental service every year. Previous generations of school children were hauled to the dental clinic every six months.

The ranks of dental therapists have shrunk in the past 10 years from 900 to 550. "Therapists are stretched," says Jennings. "Children slip through the net."

Widespread neglect across all ages is perhaps not surprising when you factor in Kiwis' grudging reluctance to "open wide" - only 50 percent of the population visit a dentist.

Many dentists concede that this somewhat shocking statistic has a lot to do with their necessarily hefty fees.

Most professionals have to earn $200-$400 an hour from a dentist chair to pay off around $80,000 in initial training, rent, support staff salaries and whiz-bang gadgetry essential to modern dental practice.

Meanwhile, more dentists are having to go back to basics - treating toothache and filling cavities. Rinse and spit. Just like old times.