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Humboldt County Children’s Oral Health Report:
Crisis with Our Children

Writing and editing by Susan Clemens, MPH
July 2001

Background and Magnitude of the Problem
The nation is experiencing a crisis in oral health and dental disease status, most evident in uninsured and underinsured children. Although recent research is rapidly proving that oral health is a critical component of overall health and well-being, oral health is not appreciated to the same degree, or given the same priority, as physical health. A recent Surgeon General’s report identified dental care as children’s most common unmet health need, two times greater than unmet medical or surgical care needs.
Advances in oral health care can greatly reduce and even eliminate dental caries (tooth decay), yet thousands of children in Humboldt County still suffer from this single most common childhood disease, a disease five times more common than asthma and seven times more common than hay fever. 2 More shocking is the disparity that exists in oral health, with 80% of untreated decay being experienced by only 25% children, predominantly from low-income families.2

The dental situation for children in Humboldt County is at least as grim as in the rest of the nation. Although there has not been a comprehensive survey of children's dental health in Humboldt County, several local data sources indicate that untreated oral disease is remarkably prevalent and is a significant unmet health need for Humboldt County children.

In the spring of 2001, 57 school children from an isolated community received a dental examination. Ninety-one percent required further treatment and 85% have untreated cavities, with an average of 4.75 teeth affected per child.
Oral screens performed at various sites by a dentist in the fall of 1999 reveal that 26% to 39% of children suffered from untreated decay or some immediate oral health care need. Twenty-six percent of Humboldt County Head Start children enrolled in the 2000-01 school year required dental treatment. Head Start spent over $35,000, or almost $350 per child, for dental treatment this school year.
Children with advanced dental decay, beyond what can reasonably be treated in a dentist’s office, must receive hospital-based dental services. These children have an average of nine teeth restored (range one to 19 teeth) or an average of four teeth removed. Three to five children per week are referred for hospital-based dental services and there is a waiting list of over 25 children.
The pressing need for dental care for Humboldt County children is compounded by a shortage of dentists in general and especially of pediatric dentists who will care for children who are underinsured. The community clinics are frequently booked three or more months in advance so no new patients are currently accepted. Willingness and ability to absorb the costs and to handle the special needs of these patients limits care from private practitioners.

Conditions in California are worse than in the rest of the nation for many indicators of oral health. While the proportion of children without cavities nationwide has more than doubled in the last 20 years, California has performed below the national average on several indicators of oral health according to the California Oral Health Needs Assessment of Children, 1993-94. California children had more untreated cavities and had experienced more dental decay than their national counterparts. In addition, fewer California children age five had visited a dentist in the past year than the national baseline. 6

There are differences in oral health based upon income, education level, and where a person lives. Nationally, children from low-income families endure more untreated cavities, experience more restricted activity days due to dental pain, and are less likely to have an annual dental visit.2 Humboldt County also experiences income-based disparity in oral health. The survey of untreated cavities conducted by local pediatricians revealed striking differences among children based on income with five times more children on MediCal or CHDP medical insurance suffering from untreated cavities compared to their peers with private medical insurance.
Baby Bottle Tooth Decay (BBTD) are cavities that occur when newly erupting baby teeth are frequently exposed to sugar. This exposure occurs when a child uses a bottle all day long or when he sleeps with a bottle or at the breast all night. BBTD is more prevalent in children from low-income families and from families with less education. BBTD causes severe pain and often results in early tooth loss. Children with pain and oral disease may suffer impaired speech, poor nutrition and growth, absences from preschool, an inability to concentrate, reduced self-esteem, and other psychosocial problems.
In California, preschool children from low-income families (less than 200% of the Federal Poverty Level) have 10 times BBTD than children from families above 200% of the FPL.2 BBTD is worse in preschool children from rural non-fluoridated regions and in children from families with less education. 6
Having access to fluoridated water significantly improves oral health. Community water fluoridation has been shown to safely reduce dental decay by 30% to 60% in children and 20% to 40% in adult teeth., The California Oral Health Needs Assessment found that children from non-fluoridated regions had significantly more untreated caries and had experienced more dental decay than peers from fluoridated urban areas.

Oral health is a critical component of overall health and well-being. The oral tissues provide a barrier from pathogens entering the body making good oral hygiene important for overall health. Recently, poor oral health has been associated with heart disease, such as arteriosclerosis, and poor pregnancy outcomes, such as low birthweight and preterm labor. Oral tissue can indicate other health conditions such as nutritional deficiencies and some viral or bacterial infections. In addition, oral health can be affected by certain chronic health conditions, such as diabetes, or can be affected by treatment for health conditions, such as chemotherapy or radiation therapy.

Good oral health is critical for quality of life and psychosocial health. Oral pain limits an individual’s food choices and affects normal functioning such as the ability to concentrate and sleep. Poor oral health is associated with avoiding social contact such as laughing, smiling, and conversation, and leads to social isolation. 2 Nationwide, approximately 3.1 days of school per 100 students are missed due to acute
dental pain.2 In some vulnerable populations
dental disease has even caused difficulty doing
jobs and can cause an inability to work at all.


“The fact is that I started out as somewhat skeptical and cautious about fluoridation. But then I became a firm believer as proof was assembled by scientists that fluoridation of a water supply will reduce the production of tooth cavities (our most prevalent disease) by 60%, and, just as important, that no disease or defect is caused by this procedure. What particularly allayed my early doubts about adding a chemical to public water supplies was learning that fluoride has always occurred naturally in water supplies.” Dr. Benjamin Spock
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