Tooth decay — the most common childhood illness in the United States — is multiplying for the first time in 40 years, the Centers for Disease Control and Prevention says, and Iowa is in lock step with the rest of the country.
“I have noticed that there is more rampant decay in the patients that I see,” said Dr. Ritu Bansal, director of St. Luke’s Hospital Dental Health Center in Cedar Rapids, which treats low-income children and developmentally disabled patients.
Tooth decay in 6-year-olds at St. Luke’s is more than four times the national average for that age, said Bansal. “I’m not talking a cavity here or there,” said Bansal. “In our unit, 42 (percent) to 60 percent of kids who come in have significant decay.”
Dr. Rebecca Slayton, head of pediatric dentistry at the University of Iowa College of Dentistry, said it is common to treat children with cavities afflicting every tooth in their mouths. The UI treats children on Medicaid, private insurance and those who are uninsured. “The problem has become greater in the past five to 10 years,” Slayton said.
Sapphire Miller, 11, of Cedar Rapids, made nine visits to St. Luke’s for cavities that had spread to all her teeth. “My daughter is a candy-aholic,” said Sheila Miller, Sapphire’s mother. “She’ll earn money from doing work around the house or helping the neighbors, and she’ll go to the gas station and buy Twizzlers.”
All of Miller’s seven children have had extensive cavities. Miller said she tries to keep candy and sugary drinks out of the house and to take her kids to the dentist for regular checkups, “but because I have so many,” said Miller, “I take them in pretty much whenever they start complaining of their mouth hurting.”
Miller is a stay-at-home mom and her husband drives a taxi at night. The family is covered by Medicaid and are regular patients at St. Luke’s. When the family moved two years ago — for a short stint in an isolated town in Nebraska and then in South Dakota — Miller said she didn’t have access to a dentist.
“Sapphire was constantly complaining of her teeth hurting and of problems chewing her food,” said Miller. “A couple of the teeth, the cavities had gotten so far down in, it exposed the nerve whenever she would eat or drink.”
Bansal said there are many reasons parents should be concerned about cavities in kids, most importantly discomfort.
“No child should be in pain,” Bansal said.
Both doctors said they fight the misconception that cavities in baby teeth don’t matter, pointing out that untreated cavities can cause infection. They also explain to parents that pulling baby teeth affects how permanent teeth grow in.
When the Miller family moved back to Cedar Rapids in November, one of the first things they did was to take Sapphire to the dentist.
Miller said the nine appointments it took to fill every cavity and root canal left Sapphire exhausted.
“It took so much out of her,” Miller said. “Every time she came out she looked like she was half doped up from the laughing gas.”
When Sarah, another of Miller’s daughters, was 6, she had to go into surgery under general anesthesia to have caps put on all her teeth. Bansal said general anesthesia is necessary in these cases because young kids are not as cooperative.
“You cannot expect a 2-year-old to sit and get a shot in the mouth,” Bansal said.
Slayton said the University of Iowa dental clinic blocks off time in a hospital operating room every week for such procedures.
Bansal and Slayton emphasized that surgery and drilling are avoidable with proper care. They recommend helping children to brush their teeth with fluoride toothpaste, regular dental visits starting before a child’s first birthday and serving healthy food and drinks.
“Most kids I see are on Kool-Aid, sodas and juice all day,” Bansal said.
Sippy cups are also to blame, she said, causing long hours of exposure to sugary drinks, sometimes all night.
“Diet is very important and is probably under emphasized,” said Slayton, who recommends a diet high in fruits and vegetables but worries that they’re less accessible to low-income families. “Everybody knows sugar is not the best thing for teeth, but it’s hard to avoid because it’s in so many things.”
Slayton said she sees worsening cavities in children across all income levels but said low-income families have more barriers to access.
“A lot more kids are living under the poverty level,” said Slayton. “That affects dietary choices and ability to go to the dentist. Some kids don’t even have a toothbrush.”
According to Dr. Bob Russell, dental director at the Iowa Department of Public Health, even children who are enrolled in Medicaid may not be able to find a dentist to treat them.
He said that although roughly 88 percent of dentists in Iowa are registered Medicaid providers, in actuality less than half accept new Medicaid patients.
“The real test is if a mother has a child who is Medicaid-enrolled and she picks up a phone book and calls a dentist, will they help her?” said Russell. “She may have some difficulties getting care.”
Russell said that if people get turned away more than once, they often stop trying.
“We end up like many other states, where the emergency room is the main place where low-income families get dental care,” Russell said.
In 2011, 40 percent of the roughly 294,000 children on Medicaid saw a dentist, according to state records.
Russell said dentists cite various reasons for turning away Medicaid patients, such as lower reimbursement rates than private insurance, paperwork or too many broken appointments.
“I think it’s safe to say that a dental practice is a business,” said Russell. “The higher amount of revenue you can generate, the better your practice is working.”
Iowa’s Medicaid program pays 46.8 percent of what dentists charge patients, roughly 10 percent less than the national reimbursement rate of 60.5 percent, according to a 2011 Pew Center report.
Russell said not all practices look at Medicaid as a burden, though, and some are amenable to helping the community.
Slayton said she tries to instill a sense of duty in her students to accept Medicaid and uninsured patients.
“Part of our teaching philosophy is that they should plan on providing care to people who have needs,” said Slayton. “…We don’t just tell them; we actually also participate ourselves. … We don’t turn anyone away.”