Dental Professionals
Dentist and Girl

Despite the fact that dental caries is nearly 100% preventable1, it remains the most common chronic childhood disease – five times more common than asthma and seven times more common than hay fever2. Caries is a saliva-mediated infectious disease often passed from mothers to their babies when they kiss and share food3. Perinatal and young child oral health is of great significance because children who suffer tooth decay often experience a life-long struggle with chronic disease and pain. Tooth decay not only severely impacts systemic health4 but also our communities through lost school and work hours and increased healthcare costs5.

Early Childhood Caries (ECC) is a severe, particularly virulent form of dental caries that afflicts children birth to preschool age and impacts disproportionally ethnic and racial minorities and children living in poverty. Children suffering from ECC often experience pain, dental abscesses, failure to thrive, poor self-esteem, poor nutrition, lost school hours and sometimes even death6,7. Due to the developmental status of a young child, the devastating effects of ECC are typically treated with dental rehabilitation under general anesthesia in a hospital or outpatient setting. Sadly, rehabilitation of a child’s mouth under general anesthesia does not “cure” the disease and 53%8 of children have new dental decay within the next 2 years with an average of 17%9 requiring general anesthesia and rehabilitative services again. In addition to the human cost, there is a very real financial cost to society. Though regional differences occur, the cost to rehabilitate one child suffering from ECC under general anesthesia can easily approach $10,0006 with a significant portion of children requiring this type of care utilizing publicly funded dental insurance.

In order to address what the office of US Surgeon General has referred to as a “silent epidemic”, leading health organizations, including the American Dental Association (ADA), the American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP), have all agreed that comprehensive dental care should begin no later than age one10,11. These organizations strongly support the use of caries-risk assessment (CRA) tools to establish personalized oral disease prevention plans for pediatric patients and their caregivers11,12,13. Additionally, organizations such as the ADA, AAPD, the American Collage of Obstetrics and Gynecology (ACOG) and American Academy of Periodontology (AAP) have all recommended that good oral health should begin before birth and that women should obtain and maintain dental health during pregnancy11,12,14,15.

Born from these evidence-based recommendations, the Montana Dental Association (MDA) and Montana State Office of Medicaid have collaborated to establish the statewide AbCd (Access to Baby and Child Dentistry) Montana program to ensure not only that all children have a dental home by age one, but that they receive clinically proven disease preventing services. Through AbCd Montana, the MDA has a vision that more of Montana’s children will receive increased comprehensive dental care at an earlier age thereby reducing disease and suffering and improving quality of life. The AbCd Montana program accomplishes this lofty goal by pairing enhanced Medicaid reimbursement for very young children with advanced training and support for dentists and much needed case worker support for vulnerable patients and their dental health care providers.

To learn more about AbCd Montana and perinatal and young child oral health care see our links to the right!

1) The American Academy of Pediatric Dentistry. AAPD Cite ways to prevent risk for children’s tooth decay. Accessed October 7th 2012.

2) Evans CA, Kleinman DV. The surgeon general’s report on America’s oral health: opportunities for the dental profession. J Am Dent Assoc. 2000; 131(12):1721–1728.

3) Berkowitz R. Mutans Streptococci: Acquisition and Transmission. Pediatr Dent. 2006; 28:106-109.

4) Acs G. Effects of nursing caries on body weight in a pediatric population. Pediatr Dent. 1992;14 :302 –305.

5) Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits. Am J Public Health. 1992;82 :1663 –1668.

6) Tinanoff N, Reisine S. Update of Early Childhood Caries since the Surgeon General’s Report. Acad Pediatr. 2009; 9(6): 396–403.

7) Casamassimo P, Thikkurissy S, Edelstein B, Maiorini E. Beyond the dmft: The Human and Economic Cost of Early Childhood Caries. J Am Dent Assoc 2009;140;650-657.

8) Foster T, Perinpanayagam H, Pfaffenbach A, Certo M. Recurrence of early childhood caries after comprehensive treatment with general anesthesia and follow-up. J Dent Child. 2006 Jan-Apr;73(1):25-30.

9) Almeida AG, Roseman MM, Sheff M, Huntington N, Hughes CV. Future caries susceptibility in children with early childhood caries following treatment under general anesthesia. Pediatr Dent. 2000 Jul-Aug; 22(4):302-6.

10) The Council on Clinical Affairs. American Academy of Pediatric Dentistry. Policy on the Dental Home. Reference Manual 2010.

11) Section on Pediatric Dentistry. American Academy of Pediatrics. Oral Health Risk Assessment Timing and Establishment of the Dental Home. Pediatrics Vol. 111 No. 5 May 2003.

12) Council on Clinical Affairs. American Academy of Pediatric Dentistry. Guideline on Infant Oral Health Care. Reference manual 2012.

13) The American Dental Association. Caries Risk Assessment Tool for Children < 6 years of age. Accessed October 7th 2012.

14) Task Force on Periodontal Treatment of Pregnant Women. American Academy of Periodontology. J Periodontol. 2004; 75(3): 495.

15) National Maternal and Child Oral Health Resource Center, Georgetown University. Oral Health Care During Pregnancy: A National Consensus Statement—Summary of an Expert Workgroup Meeting. 2012.

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