Dental Decay

Dec. 18, 2000 -- When her son David was just 1 year old, Linda Van Meenen saw the first signs of decay on his teeth. But when she took him to the dentist, she was told he was too young to be treated, that he wouldn't sit still, and that she should bring him back when he was 2. A year later, she took David to the same dentist, who looked in his mouth and said she had waited too long, and that the teeth were in such bad condition, he wouldn't be able to treat him.

David eventually was referred to another dentist and diagnosed with an uncommon problem: he had been born with no enamel on his teeth. This caused them to start decaying almost from the moment he began to eat. Before he was 5, the boy had received root canals, had all eight front teeth removed, and had most of the remaining others either capped or filled. With both parents unemployed at the time, David's treatments -- costing thousands of dollars -- would have caused them untold financial hardship if not for a state insurance program covering pediatric dentistry. "We could never have afforded all of that if not for the help," says the Lewisville, Ohio, mother.

The Cost of Care

The Van Meenens were lucky: Many state and government aid programs offer minimal dental coverage. Because of this, as many as one in five American children don't receive regular dental care, according to Francisco Ramos-Gomez, DDS, an associate professor of pediatric dentistry at the University of California at San Francisco.

In San Francisco, for example, there are hundreds of practicing dentists, but "if you are under Medicaid and you are looking for a pediatric dentist, there are only three clinics that will accept you as a patient," Ramos-Gomez says. "Less than 1% of dentists in private practice in this country take children that are insured by federal programs. It is a social disparity of tremendous impact."

Over the past few decades, oral health has improved significantly in the United States. Fluoridated community water supplies, healthier diets, and better dental care have combined to dramatically reduce tooth decay and other serious problems. But not everyone has benefited from these gains. And some of those to benefit the least have been kids without dental insurance.

The Office of the U.S. Surgeon General this year released its first comprehensive study on the nation's oral health, and called this lack of dental care a "silent epidemic." Among the report's findings, uninsured children are 2.5 times less likely to receive needed care than children who have dental coverage. And less than 20% of children covered by Medicaid (or Medi-Cal, as it's called in California) had seen a dentist within the preceding 12 months. The report also says tooth decay is the most common chronic childhood disease -- five times more common than asthma. Left untreated, dental decay can impair a child's ability to eat, speak, sleep, and learn.

"Oral health has improved for most people, but now there is a smaller group with much worse problems," says Paul Casamassimo, DDS, MS, president of the American Academy of Pediatric Dentistry and a professor of pediatric dentistry at Ohio State University in Columbus. "While it used to be that all children had some low level of dental problems, today most of the kids are fine, but about 25% of the kids have pretty bad dental problems."