Desaray Frey relaxes back into the chair in the Blue Mountain Health System's Healthy Smiles, Happy Kids mobile dental van, chatting with dentist Sheila Smith as she examines the eight-year old's teeth.
"I like when they clean my teeth because it feels funny," Desaray says.
She's never had a cavity, says Desaray's Mom, Becky Tindula of Andreas. Tindula started her daughter on the path to good oral health early, being conscientious about cleaning her baby teeth, limiting candy and soda, and taking her for her first visit to the dentist when she was three years old.
Desaray is lucky. According to the U.S. centers for Disease Control in Atlanta, Georgia, the numbers of cavities in 2 to 5 year-olds jumped by 16.6 percent, from approximately 24 percent to 28 percent, between 1999-2004 the first rise since the 1960s.
Overall, the prevalence of cavities in baby teeth increased from about 40 percent among children aged 2 to 11 between 1988 and 1994, to 42 percent between 1999- 2004, the study found.
Untreated cavities can be deadly
Worse, the numbers of untreated cavities in children's baby teeth has also increased, according to the study.
That cavities in baby teeth can be deadly may come as a shock to those who believe that those first teeth are not worth caring for because they will fall out anyway. When cavities are left untreated, they can lead to infections that can spread throughout the body.
"A few children in the United States have died from dental infections in the last few years despite thorough and aggressive hospital care by infectious disease physicians," said Dr. Eugene J. McGuire, D.D.S., a board certified pediatric dentist and an associate professor of pediatric dentistry at the Kornberg School of Dentistry at Temple University. These children were healthy and had no contributing medical conditions that would have exacerbated the systemic spread of the tooth related infection.
"These children were given multiple intravenous antibiotics and still did not survive. The antibiotics that physicians and dentists use to treat head and neck infections are becoming alarmingly ineffective because of developed microbial resistance."
McGuire says that statewide water fluoridation "would most assuredly decrease the possibility of another child dying from a dental related infection that has spread throughout the body. The cost for placement of fluoride in the communal water supplies statewide is approximately an average of one dollar per person per year. The highest reported cost per person per year is three dollars. Adults also benefit from water fluoridation with a significant decrease in dental caries that occur on roots of teeth."
Prevention is the best method
The spike in baby tooth cavities is not something dentist Smith and dental hygienist Karen Kroboth, who work from the mobile dental van, are seeing among their young patients. The van, which brings dental care and checkups to local schools, has been operating in the Carbon/Schuylkill area since 2007.
The prevalence of cavities has decreased in children who regularly use the van's services, Kroboth said.
Smith, a dentist for 25 years, says that more frequent consumption of fruit juices and soda have probably helped contribute to the CDC's findings of increased cavities.
Rarely does one see a baby or toddler without a sippy cup, as ubiquitous as Mom's or Dad's travel coffee mug.
The sugar and acid in the drinks wreaks havoc on baby teeth, she says.
"Kids today get a lot more soda, Kool-Aid and juice," Smith says. "They are constantly bathing their mouths with that, all the time. It's a constant exposure."
She recommends offering water, with soda only very occasionally, as a treat.
In addition to making sure she saw a dentist at age 3, Desaray's Mom brushed and flossed her daughter's baby teeth. As Desaray grew older and more capable, Tindula taught her how to clean her teeth by herself, while closely supervising.
She recalls peppering the dentist with questions at Desaray's first visit, asking about types of brushes for very young children. She also keeps a records of dental health, including when Desaray's first tooth came in and when the first baby tooth fell out.
McGuire recommends that parents establish a child's "dental home" by age 1.
"Earlier intervention with instructions in nutrition, oral hygiene, and preventive care have proven to render the dental disease burden in children to be more manageable," he says. "Medical providers should refer their infants and young children to dentists by age 1."
Strengthening teeth from within
The lack of fluoride deprives children of the cavity-fighting protection, says McGuire, a spokesman for the American Academy of Pediatric Dentistry.
He believes fluoridation is one of the main weapons in the war on cavities.
"Water fluoridation was found, upon extensive scientific investigation, to be the safest and single most cost effective solution to this crisis," he says. "Seventy percent of all communal water supplies in the United States are fluoridated; however, the state of Pennsylvania does not have statewide fluoridation.
"Despite rigorous lobbying efforts on behalf of the Pennsylvania Dental Association, this mandate for improvement of public health has not passed in the legislature in Harrisburg despite the full endorsements by the American Medical Association, the American Dental Association, the American Academy of Pediatrics, the American Association of Family Practitioners, the American Congress of Obstetricians and Gynecologists, the Institute of Medicine (IOM), the Centers for Disease Control, National Institutes of Health, and the World Health Organization."
Surprisingly, mothers can transmit bacteria that cause dental infections to their babies.
"The most recent science indicates that dental disease is an infectious and transmissible disease," McGuire says. "Children are not born with the bacteria in their mouths that are associated with the development of dental disease.
"These bacteria are transferred from the mouths of the primary care givers, usually the mothers, in the first month of life. Any contact between the mother and the child will cause an inoculum bacterial transfer. The bacterial composition and the number of inoculations is the single most important variable in the determination of the oral health of children throughout life."
The American Academy of Pediatric Dentistry recommends that pregnant women have an oral examination as early as possible in the pregnancy.
"The safest time during pregnancy to have treatment performed is between the 14th and the 20th weeks," McGuire says. "Preventive care can be performed at any time, but is most important during the last trimester to reduce the bacterial count in the expectant mothers mouths."
Teaching parents good oral hygiene
Smith and Kroboth both say that educating parents is one of their primary missions.
"Parents need to be on top of things by taking care of their children's teeth and helping them brush," Smith says. "You can't hand a 2-year-old a tooth brush and expect them to understand how or be able to brush their teeth. I don't think it's intentional, but it happens. They just don't know that they need to do it."
Tindula says Desaray's first dental visit brought some unexpected knowledge.
"One of her favorite treats were fruit rollups. The dentist told us that's the worst thing to do, because they are gummy and stick to teeth," Tindula says. "You hear that fruit snacks are supposed to be good for children, but they're not."
She switched to fruit as a sweet treat.
"We don't do the candy and gum and sweets," she says.