Dentists battle decay in poor young children

By Jenifer B. McKim
August 13, 2002

Jasmine Morales is a vision of health and beauty -- clear cocoa skin, silky black hair, trim body.

But her smile tells another story. Her top front teeth are streaked with black. Molars look like bombed-out craters.

She is only 3, but when Jasmine showed up at a clinic for low-income families in Buena Park last month, dentists found half of her 20 teeth decayed and rotting.

The nation is struggling to meet the needs of thousands of young children like Jasmine who, because of poverty, ignorance and lack of affordable care, end up with mouths full of decaying teeth.

As many as 10 percent of young children have early childhood caries, or baby-bottle tooth decay, national studies show. This severe form of tooth decay, seen more in poor and minority communities, is often caused by parents who let children sleep with a bottle or drink sugared liquids all day.

Every day, dentists say, they see children with mouths full of decay, often their front teeth disintegrated to black stubs. In some cases, infection swells and inflames their faces. Some children scream and cry; others suffer silently.

"I've seen kids with every tooth in their mouth rotten and they are only 3 years old,'' said Julie Wilhelmi, a pediatric dentist who works at clinics in Orange and San Juan Capistrano. "The attitude is that the baby teeth don't matter. It does matter, because they have to go to all the trauma of extractions.''

Local clinics try to meet the need by pulling teeth and scheduling fillings on different days to accommodate fidgety children who can't sit quietly in a dentist chair for long procedures.

But some need to be sedated for serious procedures. For that, there are few places to send them.

"These children have been in pain so much they think it's normal,'' said Don Duperon, chairman of pediatric dentistry at the University of California-Los Angeles School of Dentistry, where children wait six months for low-cost care.

A 2000 Surgeon General's report called dental and oral diseases a "silent epidemic'' among certain populations and showed that tooth decay is the most common chronic childhood disease, five times more common than asthma. Poor children experience more dental decay and are less likely to have treatment, the report said.

Medicaid, the government's program to help low-income families, has not met the need, the report said, partly because many dentists decline to take such patients. Reimbursement rates are low.

Like many low-income parents who show up in clinics, Jasmine's mother, Jovita Morales, said her daughter's diet is high in sugar.

"They eat a lot of candy; they're all day drinking Coke,'' Morales said, adding that she's cutting down.

Dentists say prevention is the easiest way to resolve problems. But getting parents to brush children's teeth and change their eating and drinking habits is a challenge. Some pediatricians do not give parents enough information about how to care for their children's teeth.

They struggle with parents from Mexico and Central America where toothbrushing traditionally doesn't begin until children are of school age, said Dr. Harris Done, an Anaheim dentist and University of Southern California professor. And many think baby teeth are dispensable.

The American Dental Association recommends parents take their child to a dentist no later than the baby's first birthday before onset of decay and infection that can cause young children unneeded pain. Extractions, they say, can make permanent teeth come in crooked.

Yet many parents, even with dental insurance and higher incomes, aren't informed. Poorer populations struggle with the cost of care and transportation.

"These people are struggling to survive,'' said Dr. David Noel, chief dental program consultant for the Department of Health Services. "Dental visits? Where is that on their list? They tend to go when they hurt, and it is heart-wrenching.''