For a lifetime

The cornerstone for oral health is laid during childhood, says Cindy McKane-Wagester. A new Surgeon General's report shows the challenges ahead.

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by Cindy McKane-Wagester, RDH

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In 1997, Donna Shalala, the U.S. secretary of health and human services, commissioned the office of the surgeon general to conduct a study on the status of oral health in the United States. A comprehensive report on the surgeon general's findings was published in May 2000. In the report, Surgeon General David Satcher confirmed what dental practitioners have long known:

  • The mouth is indeed connected to the body.
  • Neglecting oral health can be hazardous to overall health.
  • Oral health care in this country has much room for improvement.
  • Oral health care for children is the cornerstone for adult oral health.

Too many adults have oral health problems, and most can be traced to poor habits acquired in childhood. Poor oral health, according to the surgeon general's findings, can promote the onset of cancer, kidney disease, diabetes, and heart disease. Seventy-five percent of adults have some form of periodontal disease, a condition which can be directly linked to premature births, respiratory ailments, blood clots, cardiac arrest, and a variety of other serious and life-threatening ailments.

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One of the most frightening findings in the surgeon general's report is the prognosis for the oral health of the current generation of American children. The report states that our children see dentists too late and too seldom. Dental home care is not adequately reinforced by professionals or by parents. Since habits formed in childhood often carry over into adulthood, this finding alone should be a matter of great concern. Dental habits learned in early childhood can make a significant difference in the way adults perceive dental health and overall health later in life. The surgeon general's recommendation to the nation at large, to the medical and dental communities, and to parents in particular is to take immediate steps to remedy this situation.

While it is true that oral health in adults and children has improved significantly in the last 50 years, it is important to note that these improvements are relative and that many problems remain. The concept of preventive care in oral health care, for example, has not been universally accepted as standard operating procedure. Preventive care in other health fields, meanwhile, has long been recognized as a fundamental necessity. This leads to the neglect of basic preventive steps that should be a national norm.

There is, for example, an almost universal misconception about fluoride. Most people understand that fluoride kills bacteria associated with plaque, reduces new caries, and is helpful in preventing the spread of periodontal pathogens to soft tissue. What is not generally known is that fluoridation of municipal drinking water, a policy introduced to this country in 1945, is not universal. Fifty-five years later, only half of all U.S. water supplies are fluoridated, leaving about 40 million children in this country prone to dental decay that could have been prevented by fluoridated drinking water.

This is only one of a multitude of reasons why children should start their visits to dentists as early as age two or three. There are many other reasons, and one of the best is that a hygiene appointment can pick up more than dental/oral health problems. During an examination, a hygienist checks much more than just a patient's teeth. A thorough examination will include a comprehensive review of gum tissue and jaw structure. It will take into account facial symmetry, pallor, tissue recession, abnormal coloring, and occlusal performance.

When completing the intraoral examination, hygienists can easily detect physical manifestations that are symptomatic of other problems. A hygienist will notice irregularities or abnormalities that may be exclusively related to oral health, or may suggest systemic problems or other serious conditions that need to be addressed by a medical or dental practitioner.

A mottled tongue with white patches, red cheeks or ear lobes, dark circles under the eyes, congestion, labored breathing, or a runny nose should raise a warning flag. The patient exhibiting these and similar symptoms may be suffering from allergies, structural bone problems, or chronic ear infections. Left untreated, these problems could result in loss of hearing and speech-and-language problems.

Some children as old as six or seven use a pacifier or bottle because they have chronic ear problems or developmental behavior problems. This causes the teeth to mal-align, anterior open bites, and even dry mouth, which will make the anterior tissue very puffy. Breathing through the mouth is a problem, and so is xerostomia in children who are congested.

Allergies can be triggered by preservatives, dyes, and sugars found in many foods. Many children are sensitive to sweeteners and other additives in chewing gum and toothpaste. For this reason alone, most children should be brushing with a natural toothpaste that contains no preservatives, no sugars, no dyes, and no additives.

Gingivitis in children can point to something as simple as a reaction to chewing gum or toothpaste additives, or it can be a sign that something is very wrong. The condition, easily spotted by a competent hygienist, can signal systemic diseases such as leukemia or genetic disorders that can be directed to the attention of an appropriate medical specialist.

Children also may have immune problems related to food and diet. These problems often are signaled by inflamed or puffy gingiva. Acidic tooth decay can be related to reflux problems caused by improper or inadequate diet and nutrition. Young adults and teens in our country have a horrible diet and can suffer from dental problems ranging from gum disease to erosion of enamel from chronic vomiting. Periodontal disease in teens can be triggered by malnutrition caused by ascorbic acid deficiency. The hygienist can also check for signs of bulimia and anorexia, for puberty-associated gingivitis, and for gingivitis associated with the menstrual cycle.

As children grow, their occlusion should be checked often to ensure the lower and upper teeth are properly aligned for chewing. Structural problems can impede their dental health, which is indeed the window to total health.

Children who are considered management problems and will not sit well for hygiene appointments may be merely frightened. Some, however, may be physically uncomfortable during the examination because of structural problems. The muscular and skeletal system - custom designed to fit around the organs, the circulatory system, and the nervous system - may be at fault. If the custom design doesn't "fit" properly, things don't work properly. When the bones and muscles of the cranial area and the mouth become mis-aligned or if their movement is inhibited, problems can arise. This can result in physical discomfort, but also can cause changes and alterations in behavior, concentration, and overall personality.

Children with attention-deficit disorder (ADD) and other related ailments snore, grind their teeth, and want to suck constantly. This can lead to bone deformities, poor occlusion, and other oral health problems, including severe and chronic congestion and earaches. It can also lead to mood swings and tantrums.

These and many other oral health problems can be detected during a hygiene examination. A comprehensive program of better oral health, preventive health regimens, and prompt measures can ensure a lifetime of good oral health. Programs for children should be designed not only to correct existing problems, but to provide guidelines for a lifetime of good health habits. It is, above all, essential to inculcate in children the importance of early detection of problems that can remain minor with early intervention. If these procedures become a national standard, America's children will be healthier and happier. They are our most precious resource and deserve nothing less than the best that modern dentistry can offer.

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