Pediatricians and Children's Oral Health

It's not just patients who confuse the similar-sounding words caries and cavities, accordingto Dr. James J. Crall, DDS, at Sunday's NCE plenary session. He has had dental students of his call acavity a carie.

Dr. Crall, a professor at UCLA's School of Dentistry, stressed the importance of thinkingabout oral health for children not in terms of cavity prevention but early prevention. The "drill andfill" school of dental care is being replaced by a risk assessment philosophy, one in whichpediatricians can play their part.

Caries are a transmissible disease, often passed by the mother, which can exist in a baby'smouth well before any teeth do. Crall said to think of caries similar to diabetes - a diseasewhich will progress with the wrong lifestyle choices, which is diet-related, and which when pervasive cando damage beyond the teeth.

The focus on caries, instead of tooth decay and cavities, means a dual focus on both riskfactors and protective factors. Risk factors include sugary drinks, bacteria left in the mouth due toinfrequent brushing, and a lack of saliva. Protective factors include fluorides, proper plaquecontrol, saliva, and antimicrobials.

In very young children, caries will cause white spots on the teeth and gums. If not treated,the caries can eat through the enamel layer into the dentin, and sometimes down to the pulp. The factthat this happens to primary teeth does not make it okay.

Caries do not affect all children equally. There has been a 14% increase in caries in urbanchildren over the past decade. Up to three quarters or more of children with caries are fromeconomically disadvantaged or minority homes. Over half of California kindergartners show up fortheir first day with caries.

The children with advanced lesions get attention, Dr. Crall said, but attention has to bepaid to children at high risk but without cavities yet. Proper oral health can be maintained, butonly with vigilant attention from pediatric dentists - and pediatricians.