September 2016
Volume 37, Issue 8

Before the Tooth Fairy Visits

Perhaps no group in this country is more vulnerable than our youngest children; they are less able to articulate their needs and must depend on adults to recognize and solve their every problem. Early childhood caries (ECC) is a significant concern. Five times more prevalent than asthma, ECC is the most common chronic disease during early childhood in this country. According to the most recent National Health and Nutrition Examination Survey, 42% of children ages 2 to 11 have had dental caries in their primary teeth, and 23% in this same age range have untreated dental caries.

Untreated caries is a significant concern because pulpal tissue may become infected, possibly leading to a medical emergency and subsequent extraction of the tooth. What’s more is the potentially long-term impact that the condition has on young children. These children may be more prone to have infections of the ears and sinuses, experience malnutrition or insufficient growth, have poor sleep habits, have poor attention and attendance in school, feel reluctant to speak or smile, have trouble with phonetics and articulation, have poor self-esteem, and more. Also, children with ECC may be more vulnerable to caries and gingival disease throughout life. This is due to the fact that unerupted permanent teeth can be affected if the central part of a primary tooth has an abscess. Also, if primary dentition is extracted prematurely due to decay, permanent teeth are likely to erupt in incorrect positions or could become impacted.

Add racial disparity and poverty to this mix, and caries rates increase. Hispanic, African-American, or Native-American children are three times more likely to be poor than their white or non-Hispanic peers. This is significant because the correlation with caries and poverty is strong, due to the fact that health literacy rates are lower, access to care can be difficult, and poor diets are too common. The rates for tooth decay are five times more common among children living below the poverty line. These disparities tend to increase as children age.

Historically, dentistry has approached dental caries as an acute problem needing a surgical solution. Today, we understand that caries is a chronic disease with myriad causations. Therefore, we must remain cognizant of the realities that children in lower economic thresholds face and do everything possible to help these children grow up healthy. We have an obligation as health providers to help all patients, regardless of income.

We are proud to have an article on zirconia-prefabricated crowns in primary dentition by Dr. Carla Cohn in this issue. It underscores that esthetics should not be overlooked when addressing functional needs in young children. As with all issues of Compendium, I am proud to present this content to you and appreciate your ongoing support. Please contact me with any questions or comments at


Louis F. Rose, DDS, MD

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