A Gap in the Mouth

Laird Harrison


July 26, 2013

In This Article

Can Primary Care Providers Help With Kids' Oral Health?

When James Schmidt, DMD, worked at the Department of Veterans Affairs, he collaborated daily with clinicians from a wide range of specialties, discussing how each one's expertise could help the patient.

But having operated a private practice as well, he knows that such collaboration rarely takes place between dentists and other health practitioners. "Dentists are in a cottage industry, and doctors are mostly employed by hospitals," he said. "And someone, somewhere took the oral cavity out of the human body."

Now Dr. Schmidt is working to break down that division by teaching oral health to family practice medical residents at the Maine Dartmouth Family Medicine Residency in Augusta, Maine.

Around the country, many such initiatives seek to expand medical providers' roles in oral health. The trend stems from multiple concerns. New research has shown that diseases of the mouth affect and are affected by conditions in other parts of the body. Healthcare policy-makers have taken an increased interest in prevention. And gaps in the US healthcare system have left many patients without access to oral healthcare.

Infants and toddlers have fallen through a particularly worrisome hole in the system. Traditionally, dentists rarely saw children younger than 3 years of age. But by that age, many children already have serious problem with caries. Whereas the rate of untreated caries has declined in most age groups, the most recent statistics showed that it has increased in children aged 2-5 years.[1] Dental caries is the most common disease among children, affecting 42% of those aged 2-11 years.[2] And it is particularly common among low-income children.

That might not sound serious. After all, children lose their first set of teeth and start over with a clean slate. But US children miss at least 51 million school hours a year because of dental disease,[3] and caries in primary teeth are associated with lifelong oral health problems.[4]

Over a lifetime, oral disease can lead to serious complications. Recent studies have linked oral disease -- particularly infections of the gums -- to potentially fatal conditions, including diabetes, stroke, and heart disease.[5]

Overall rates of dental disease are even higher among older age groups, but oral health experts began focusing on very young children as the understanding dawned that caries are an infectious disease and can be prevented.

"The cavity is the end of a process called dental caries, and that disease process can start with the eruption of the first tooth," said David Krol, MD, MPH, a pediatrician and senior program officer at the Robert Wood Johnson Foundation in Princeton, New Jersey, who works on oral health issues. "We were failing kids by not preventing this disease."


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