Dental Products Report® editor Kellie Nock sat down for a conversation with pediatric dentistry expert Christina Carter, DMD to discuss the link between economic downturns and poorer oral health in pediatric patients. With this concerning outlook, Dr Carter’s insight on this topic offers ways to bolster pediatric health in times of economic turmoil, and just how to manage patients who need the most help.
Kellie Nock: As we head into a potential economic downturn, are you directly seeing the effects of this link between the economy and pediatric patients’ oral health? Or is this something that is appearing in studies more than practice?
Dr Carter: It’s a combination of both. You start feeling the trends, so you say, “Hmm, is this just me? Is this just in my area?” Then you start talking to your colleagues, and you say, “Am I the only one feeling this way?” And your colleagues are starting to say the same thing. Then, you start looking past your inner circle, you start to wonder, what’s going on. Let's see the trends. Let's look at the magazines, let's look at their papers, because there is a lot of information there. That’s how it starts–it's in your belly. “Is it just me or just my practice? Is it just my area?” You start calling your colleagues or your colleagues outside of your immediate geography. Then you started looking at, you know, the real evidence
KN: How do we educate patients and parents that aren’t familiar with dental and the connection between oral health and systemic health?
CC: If you look at the older generation over 60, there's a tremendous amount of fear toward going to the dentist. Dentistry has changed and evolved, and it's not as overwhelming and awful as it used to be.
So, with parents, there's a generational past of fear and predispositions. That's the first thing we need to break–is that the dentist isn't so bad. I have a lot of parents that come into the office and will see procedures on pediatric cavity treatment, and they'll say, “Oh, I wish you were my dentist growing up, I wouldn't have such a fear.”
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I think the first thing we must do is to teach adults that teeth are important, and that it's not as overwhelmingly scary to go to the dentist. I also think pediatricians, nurse practitioners, and physician's assistants need to stress the importance of baby teeth. I know that when people go to medical school, they take about 3 to 5 minutes in their curriculum on baby teeth. We have a totally different school. So, the medical side and the medical management of teeth is important, and cavity prevention is really the most important thing. We do a lot of prevention with children. We do a lot of prevention with everything else, and it’s very important.
Now, we have a problem in this country about childhood obesity. Childhood obesity is from poor nutrition, snacking frequently, and not enough exercise. If we're constantly snacking, we have an increased risk of cavities. So, all these things are related.
What we need to do is to take dentistry and raise it to being medical, it's not just teeth. They're not just there. But it really is the medical method of dealing with things. The mouth is the gateway to the body. If we have a healthy mouth, our body will be healthy. If we put in healthy food and healthy treats, our body will be healthier. If we take care of our teeth, it's one less reason that we don't have the cavity. Also important, is early education. That's one of the biggest things. If we start with the child who's just born, after every seating wiping down the mouth by taking that bib cloth–even at a week old–on your finger and wiping the arches of the of the mouth, which don't have teeth. It's threefold. It cleans the mouth, it trains the mouth to be desensitized to brushing, and it's helpful for speech and feeding down the road, because you're stimulating the muscles of the mouth, you're stimulating the tongue. Every speech pathologist and every feeding expert loves that that is being done.
Now, when babies are born, it's overwhelming those first few months, but if you start very early, they get used to it. It makes things better down the road. Prenatal education when every parent is bright-eyed and bushy-tailed and wants to learn and do the best is really where we should be getting in there.
KN: How do we help those child patients who haven’t had strong prevention, and who don’t necessarily have the insurance coverage or money to treat serious problems?
CC: There are lots of ways now luckily, like grants, training programs, and donated services to help these patients. There is also more funding for pediatric care than there necessarily is for general.
Addressing the dental care is very, very important. What happens if the cavities–which are an active disease–are not addressed? It's possible and probable to cause pain, swelling, infection, which causes a need for antibiotics. It becomes the reason they miss school, and we don't want them in pain. Those infected teeth come out, and when baby teeth are taken out, it affects the developing adult tooth underneath it, which then sets us up for problems and weakness there. So, getting that care for children is, is essential.
KN: Going beyond treatment and prevention, how do we encourage children to have strong home care routines?
CC: In an ideal world, we all have a routine where they are little soldiers, and they brush, and they do all that. That never happens, and if it does, don't tell any of your friends that your child is that good because you'll be hated. But there are lots of motivating things that we can do.
There are free apps on phones that are for brushing, that will time them and tell a story about how long to brush and floss. On Alexa, there's an app called Alexa play “Chompers,” And it tells a story, and it changes every day. It will say top right, and you're supposed to brush on the top right, and then it will in the middle say top left, and it will move you over there. Some of the electric toothbrushes have apps connected that will track where you have brushed and where you have not brushed, and it's almost like an interactive video game. Electric toothbrushes versus manual toothbrushes is a different conversation. There are pros and cons to each, but those are sometimes motivating factors also. Sometimes you can get a rinse that will dye or discolor what's on your teeth, so you keep brushing until you get all that blue or green or red color off your teeth. That can be a visual target and motivator for brushing.
KN: What about children who prefer manual toothbrushes?
CC: There are pros and cons for each and getting off the biofilm is the most important thing. Each child is very different. Some children, whether neurotypical or atypical, like the stimulation, and some people really like that electric buzzing, but some children do not.
But the brushing technique is different for each. For example, some electric toothbrushes have a pressure gauge, so you know how hard you're pushing, which can be helpful or not helpful, depending on the person. For Special Needs patients, and even for younger children, the ergonomics of the handle can make a huge difference. It’s vital to be able to get in there with dexterity.
Again, with the electric, sometimes it's helpful just to place it and move it along and count for 5 to 10 seconds on each tooth. With manual toothbrushes, sometimes the less stimulation is better for a child. For me, I can't use the electric toothbrush in the morning, but at night, I can use an electric toothbrush. That's my little sensory quirk.
There is also the financial aspect, where the electric toothbrush can be a financial impact. A manual toothbrush is more cost efficient. There also are a lot of people very in tune to the environment, so the bamboo-based or the recyclable manual toothbrushes can be beneficial, and that's important to them, as well.
Different brands have different benefits there. I know RADIUS is one of those effective manual brands. It's very environmental, that's very good ergonomically for the hands. It's a manual toothbrush, which has its benefits too. It’s about finding the right thing for your child. If you know that they don't like the electric and they prefer the manual than that's great. It's basically about finding the best way to care.
About Dr Carter
Dr Carter, is a triple-trained dentist, specializing in pediatric dental, orthodontics, surgical orthodontics, and has devoted her New Jersey-based dental practice to helping special needs patients and kids of diverse disparities achieve optimal oral health. She is currently the NESO's Delegate Chair of the American Association of Orthodontists (AAO).
