Kids' Dental Decay Takes a Bite out of School Attendance

OAKLAND, Calif.--The 5-year-old Asian American boy sat in the dentist’s chair in Dr. David Perry’s Alameda, Calif. clinic for over 90 minutes, his teeth drilled without general anesthesia.

His extensive tooth decay had also taken a toll on his physical health. The dentist determined that eight of his baby molars needed to be crowned, and six other teeth had to be extracted.

His dismal oral health is not unique among kids his age or even younger, notes Dr. Perry.

After looking into the mouths of more than 21,000 California children in kindergarten and third grade during the 2004-2005 school year, Perry, then the board chairman of the Oakland-based Dental Health Foundation, and his cohort of dental hygienists, dental assistants and school nurses concluded that almost three out of four children in elementary school have a cavity, compared to about half who are not low income.

Other pediatric dentists agree. “Fifty percent of kids in kindergarten have cavities,” said Dr. David Rothman, a pediatric dentist at Oakland Children’s Hospital.

“And if you look at low-income children, one in three children suffer tooth decay,” noted Jared Fine, dental health administrator with the Alameda County Public Health Department. “We have an epidemic on our hands.” And it is taking a huge bite out of school attendance and performance.

The “silent epidemic,” which is what the U.S. Surgeon General’s 2000 report on the nation’s oral health called it, says tooth decay is the most common chronic childhood disease, five times more common than asthma and seven times more common than hay fever.

The report estimates that children between 5 and 17 years missed nearly two million school days in a single year nationwide due to dental health-related problems.

Untreated dental problems can lead to poor academic performance, as well as behavioral problems because of the pain.

Pediatric dentists say children with tooth decay don’t smile, don’t speak well and are inattentive in class. Even chewing food is an ordeal that could lead to gastrointestinal disorders. They are prone to repeated infections in their ears and other parts of their bodies “because their infected teeth are continually pouring pathogens into their systems,” noted Perry.

Karl Smith, who taught middle school in the East Bay communities of El Sobrante and Richmond for a total of 12 years, said that although he couldn’t say with certainty that the absenteeism in his classes was directly linked to his students’ dental problems, those with poor dental health “tended to be absent more frequently.”

“Their breath was noticeably foul to the extent you wanted to turn your face away,” Smith said. “Some students had blackened teeth from tooth decay. They obviously had no access to dental care for long.”

According to, a data and resource website that offers more than 300 indicators on the health and well-being of California’s children, in 2007 (the most recent data available), nearly 20 percent of children in California had no dental insurance, with the counties of Nevada, Marin and Sonoma topping the list.

However, “lack of dental insurance is an access issue, but that does not necessarily cause the cavities we see in them,” pointed out Perry. Childhood dental cavities are caused more from “diet, poor oral hygiene and lack of knowledge in preventing dental problems.”

Nadereh Pourat, director of research planning at UCLA's Center for Policy Research, said a survey she analyzed suggests that many vulnerable populations who have dental coverage may still suffer from poor oral health because of high out-of-pocket expenses. People with lower incomes find that costs of receiving regular dental care often competes with basic living expenses. The 5-year-old boy who visited Perry's Alameda clinic, is a case in point. His parents couldn't afford to pay $800 for general anesthesia while their son spent 90 minutes in the dentist's chair getting his rampant tooth decay treated.

Kidsdata also points out that nearly 13 percent of the state’s children never visited a dentist in 2007.

“Most parents think that they don’t need to bring their kids in until they are three or four years old,” observed Dr. Huong Le, a dentist of 25 years and the dental director at the Oakland-based Asian Health Services. “Some think that decayed baby teeth will fall out anyway. They don’t realize that any infection in baby teeth can affect the formation of permanent teeth.”

“Dental IQ is very low” in many of the patients who visit La Clinica de La Raza’s dental clinics, said Dr. Ariane Terlet, La Raza’s dental director. She said around one-third of the children who come to La Raza’s dental clinics have severe tooth decay, with many of those children being Hispanic.

California’s Latino elementary school children have a higher rate of cavities. According to the California Health Care Foundation, a shocking 72 percent of Latino children have cavities, compared to 48 percent of white kids.

Health care providers worry that the problem could worsen with the elimination last year of the state-sponsored Children’s Dental Disease Prevention Program. They say that more than 300,000 California students have lost the only program that provided such school-based preventive oral health services as dental education, fluoride rinses and sealants, lamented Fine.

The program, which paid about $10 per child, per school, was targeted at schools where 50 percent or more of the children were eligible for the free lunch program.

“These are the kids who have the greatest risk for dental diseases,” observed Fine, noting that unlike services provided in dental clinics, the school-based, once-a-year free service program was the only dental program that was “preventive in nature.”

The 2007 death of a 12-year-old Maryland boy from bacteria from an abscessed tooth that spread to his brain helped put children’s dental health issues on the national radar. It certainly helped influence the inclusion of a dental entitlement for the children of the working poor when the Children’s Health Insurance Program was reauthorized last year.

And even though it’s looking less likely that Washington will enact comprehensive health reform this year, “we’re encouraged by what we’ve seen coming out of both chambers,” noted Danielle Grote Erbele, senior policy analyst with the Washington, D.C.-based Children’s Dental Health Project (CDHP).

All the major Senate and House health care reform bills contain provisions that address children’s oral health issues, giving pediatric dental care a major boost.

For instance, the bills require that pediatric dental care be included in the coverage guaranteed to anyone purchasing insurance through the government-sponsored marketplace for health plans, Erbele said.

Pediatric dentists like Perry are hopeful that Washington might finally be putting teeth into health reform.

This story was made possible by a grant from the Lucile Packard Foundation for Children's Health.