Baby Teeth

On a recent Friday morning, Dr. Dwight Jones awaited his patients.

The toddlers were preoccupied with fresh fruit, gift bags with dental goodies and a variety of games about healthy food set up around a room at Del Norte Community Health Center transformed into a children’s wonderland to keep them busy.

After a name was called by the receptionist a few times, each child jumped into the chair, mouth open wide.

Most seemed to know the drill.

Jones explained to the kids the reason for the bright light coming from his dental magnifying glasses as he did a quick survey of their teeth.

The first Friday of every month, the Community Health Center holds the Dental Well Child free clinic, open to all children.

“Today is probably the healthiest day,” Jones said. There have been other days when 80 percent of the kids who sat in his chair had tooth decay.

There also have been days when no one shows up, evidence that some parents may not realize baby teeth do matter and that there are services here to prevent and treat tooth decay.

Health officials are trying to spread the word that not caring for baby teeth can lead to big problems, even hospitalization.

Del Norte County has a serious problem with tooth decay.

In fact, the problem is spread across California — a recent study found that two-thirds of the state’s children have some form of tooth decay.

The problem stems from too much sugar and insufficient cleaning of children’s teeth — the root of which is a lack of parent education, local health officials said.

Dentists here in Del Norte are seeing kids as young as 2 with multiple cavities, sometimes in every tooth, setting them up for a lifetime of problems.

In Jones’ long career as a dentist, “this is the worst I’ve seen it.”

Prevalence of decay

When Albina Leon brought her son David, 15, and daughter Lieanna, 1, to the Community Health Center for David’s scheduled dental check-up, the receptionist told her about the free clinic. Leon thought, “I might as well bring (Lieanna) in.”

Her pediatrician had already suggested Leon take Lieanna to the dentist as a baby to prevent tooth infections.

“It’s better to prevent than to deal with a situation like that,” Leon said.

Jones didn’t find any problems with Lieanna’s teeth this day, but this is not always the case at the clinic.

He is one of two dentists at the Community Health Center — the vast majority of patients are on Medi-Cal. He and Dr. Susan Wellman see kid after kid with cavities — some as young as 2.

“I see a lot of kids with a large number of cavities,” Jones said. “Twenty-five years ago most had a few cavities, but now we have some that have a few and some that have 20.”

The non-profit California-based organization Center for Oral Health’s report, “Mommy, It Hurts to Chew,” found that tooth decay affects two-thirds of children in California by the time they’re in third grade.  Fifty percent of children go into kindergarten with tooth decay. About 28 percent have untreated decay, 19 percent have rampant decay and 4 percent need urgent dental care due to pain or infection.

Nationwide, the numbers are just as bad. The National Health and Nutrition Examination Survey found that the prevalence of tooth decay in children has been on the rise since the mid-1990s.

Starting with baby teeth

The problem is so huge in Del Norte that Jones and Wellman can barely scratch the surface of children suffering from tooth decay, he said.

They’d prefer, he said, to “prevent the cavities.”

Patti Vernelson, the executive director of First 5 Del Norte, the focus of which is on the development of children 5 and younger, agrees that prevention is the key.

Many parents may think there’s no reason to fret about baby teeth because they’re just going fall out, but Vernelson said it’s time to dispel that myth.

“They’re the first teeth that set a pattern for your whole lifetime,” she said. “It’s also setting that lifetime of care. You want your beautiful 4-year-old to have good teeth, not rotten teeth.”

Permanent teeth are forming beneath the baby teeth, Jones said. If an infection gets deep enough it can affect the development of the permanent tooth and cause a child years of problems. If baby teeth are lost early, that can affect how permanent teeth come in and cause crowding, he said.

Jones said that once the baby teeth start to come in, it’s time for a child to see the dentist.

“I like to see them at 2, 3 years old when the teeth are starting to come in. Even if it’s just two teeth, it gets them used to seeing me.”

The key is education, Jones said. Parents need to understand that a good diet, proper brushing and regular check-ups are needed for healthy teeth, he said.

But the difficult part is getting that message to the parents who don’t know better and aren’t bringing their children to the dental clinic.

“The ones who are not coming here are the ones who need to hear us,” Jones said.

It’s a difficult task to reach those parents who aren’t already getting dental care for their children, said Hilda Yepes-Contreras, the manager of the Del Norte Community Health Center.

“Even though we have the well child checks every month, it’s just a little piece of the population that we’re getting to,” she said.

Sugar: an enemy of teeth

Leon pays attention to her daughter’s health by keeping her off a bottle and limiting how much sugar she eats by giving her a fruit or vegetable instead of sweets.

Jones wishes he encountered more parents like Leon.

He sees a direct correlation between sugar and tooth decay.

“My theory is the kids that have the most cavities are the ones who drink the most soda,” he said.

Sugar essentially rots the enamel off teeth, Jones said.

When carbohydrates like sugar sit on teeth, the bacteria already present in the mouth turns it into acid, which helps plaque to form. The plaque then corrodes the enamel, causing cavities. Once the enamel is worn away, bacteria and acid eat through the teeth into the innermost layer called the pulp, which contains nerves and blood vessels. This can become infected causing severe pain and possibly a tooth abscess.

It’s not recommended for babies to sleep with a bottle because milks turns to sugar, Jones said.    Once a child has teeth, it’s time to start drinking primarily water, he said.

Hospital dentistry

A number of children have dental problems so bad they have to go to Sutter Coast Hospital to be treated for tooth decay under anesthesia.

“One of the things that concerns me the most is that we have a few kids that have to have hospital dentistry,” Yepes-Contreras said. “It doesn’t happen just once, they have to get hospital dentistry again. “It’s really tough on the child.”

Last year, 84 children in Del Norte underwent dental surgery because of tooth decay, according to the Community Health Center. Of those, 65 were under age 5.

Most went to Sutter Coast Hospital, where Dr. Wilmer Hechanova performed the surgery. Some families had to travel to Pediatric Dental Initiative Surgery Center in Windsor, near Santa Rosa.

A child needs hospital dentistry if he or she has a number of cavities that have been left untreated, Jones said. It’s too difficult a process for a children to sit through in a conscious state.

“Sometimes a small cavity can be easily treated even if the child isn’t that cooperative,” he said, “but if you have major treatment that requires cooperation and if the child is too young to cooperate, they have to go to the hospital.”

Untreated decay can cause a child to need a root canal.

The decay can get into the core of a tooth and kill the nerve; when it gets down to the bone the decay can cause an abscess and  “then a lot of rotten stuff has to come out” and the tooth has to be filled and capped, Jones said.

The mouth has more nerves than other part of the body, he said, adding there are children in severe pain from tooth decay. This affects their ability to learn in school, Yepes Contreras said.

 Accessing dental services

Laura Wilson brought her sons Matthew, 4, and Harley, 2,  into the dental clinic after hearing about it from a friend.

This was their first time seeing the dentist.

The walk-in clinic for kids opens the door to regular dental check-ups, Yepes-Contreras said.

“It’s a way to get them comfortable to see the dentist,” she said. “One of the big things is the parents are afraid of the dentist so the kids are automatically afraid of the dentist.”

And, if Jones or Wellman happen to catch cavities, the kids are set up with a future appointment for treatment.

The majority of the Community Health Center’s patients have Medi-Cal, but some have Healthy Families, private insurance or pay for services themselves, Yepes-Contreras said. Children can still receive dental services from Medi-Cal, but in 2009 the state legislature decided to cut services for people 21 and older due to the budget crisis.

Wilson has had trouble getting a dental appointment for her boys because the Community Health Center is the only place in Del Norte that takes Medi-Cal, she said.

“I’ve been wanting to bring them in since they were 1,” Wilson said, and this was a good opportunity to get signed up for regular cleanings.

They’ve had no problems with their teeth so far, she said. Wilson brushes their teeth each day and lets her boys have only a small amount of juice and sweets.

“Little boys don’t drink soda do they?” she asked her sons, who were busy eating grapes and drinking Capri Sun juice.

Some families with insurance other than Medi-Cal see the dentists at the Community Health Center because some other dentists in town won’t see children, Jones said, adding that there isn’t a pedodontist, a dentist who specifically cares for children, in Del Norte.

The national organization Children Now found that statewide, low-income families are under-utilizing Medi-Cal and Healthy Families’s dental services. Only 31 percent of children enrolled in Medi-Cal saw the dentist in 2007, while 56 percent enrolled in Healthy Families went to the dentist in 2008.

However, some statistics show the trend is improving for Del Norte. Children Now’s 2010 report on Del Norte children’s well-being found that 91 percent of children ages 2-17 saw a dentist in the last year — that’s up 13 percent from 2009.

Still, children’s dental care is especially challenging in relatively poor areas such as Del Norte.

Tooth decay greatly affects low-income children — three in four of them had cavities, the Center for Oral Health found. And, a third of those cavities were going untreated. The NHANES also found that tooth decay is most common among black, Hispanic and low-income children.

Worrying about a child’s teeth is just one more thing on a long list of concerns for people who struggle to pay for the most basic necessities in life.

“If somebody has numerous problems in their life which causes them to be in poverty,” Jones said, “it’s difficult to hand them a toothbrush and say, ‘Here, brush your teeth three times a day and all your problems will go away’ — they have so much on their plate already.”

In order to combat dental problems, “there really has to be an effort to lift the person in every area of their life.”

‘Desperate for toothbrushes’

This was the second check-up at the children’s dental clinic for Seeanna Floyd, 2.

“She gets excited to come here,” said her mother, Rwen Scott. “She says, ‘Momma, can we see the tooth doctor today?’”

After looking at Seeanna’s teeth, Jones said there were spots on her back molars that could turn into cavities and advised Scott to focus on those hard-to-reach areas and come back in three months.

Seeanna “loves” to brush her teeth, Scott said. “She wants to do it herself.”

As a mother of five children ages 21 to 1, Albina Leon still reminds her older children to brush and floss their teeth every day — “it’s a mother thing,” she said.

Her youngest daughter Lieanna is already an avid tooth-brusher and isn’t shy about showing off her smile.

“She wants to brush her teeth more than twice a day,” her mother said.

First 5 gives out toothbrushes to children at the annual Youth and Family Fair. There have been parents who wanted them for older children even though they weren’t the appropriate size, Vernelson said.

“People were desperate for toothbrushes,” she said. “There were some kids that said they didn’t have a toothbrush.”

First 5 and the Community Health Center are trying to get the word out about the dental clinic each month through advertisements, and have gift bags of toothbrushes and toothpaste to give out at events, Vernelson said.

‘Totally preventable’

Education on the importance of early oral health needs to be focused on parents of young children, Vernelson said, so that children go to kindergarten with no cavities.

The Rethink Your Drink campaign to encourage drinking water instead of soda and sugar-laden juice started by the Network for a Healthy California, a statewide initiative on promoting a healthy lifestyle, could be focused more toward the parents of kids 5 and younger, she said.

The Community Health Center works with the federal program WIC (Women, Infants and Children) and child-care providers to spread the message of early oral health, Yepes-Contreras said. It’s something that pediatricians are talking to parents about as well, she said.

Vernelson suggested that community leaders get together and figure out how to coordinate getting the word out to parents.

“We have the resources,” she said. “It’s really deciding if this  is the next big effort to coordinate. So everybody is taking to parents, whether it’s a family practice doctor or a pediatrician, saying, ‘You need to pay attention to your children’s teeth,’ or, ‘Oh, now it’s time we get an appointment with the dentist.’”

Vernelson said schools need to play a role as well. She suggested that students be encouraged to brush their teeth after lunch, which some preschools are already doing.

Through its Building Healthy Communities initiative, the California Endowment is funding a mobile dental clinic that will visit Del Norte schools.

Parents will decide whether their children can get services and then a dentist will examine students and do whatever work they need on their teeth, such as cavitity-filling, dental sealants or root canals, said Barbara Davis, mobile dental coordiator for Open Door Community Health Centers.

Open Door, which operates the Del Norte Community Health Center, is currently securing a vehicle and recruiting a dentist; the mobile clinic should be in schools by the fall, Davis said.

Open Door already does this in Humboldt County, where 400-500 students are getting services, Davis said.

“The big message is: (tooth decay) is totally preventible,” Vernelson said. “The challenge is for our community to say it’s not acceptable, we need to say it’s all of our responsibility.”

Reach Kelley Atherton at katherton@triplicate.com.