Araceli Torres, left, watches her daughter, Dayani Antonio, have her teeth cleaned Saturday by Pat Chang at Weideman Professional Dental Corp. in Citrus Heights. • See additional images Sacramento Bee/Hector Amezcua

State's kids face crisis of cavities

California is ranked near the bottom in survey on children's dental health

By Jocelyn Wiener -- Bee Staff Writer
Published 2:15 am PST Monday, February 6, 2006

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The teeth of California's children are decaying at epidemic levels, according to a report released today by the Dental Health Foundation. Painful cavities and abscesses are causing children to miss school and, in the worst scenarios, end up hospitalized. Nearly 6 percent of the state's poorest children are in so much pain, or have such bad infections, that they need urgent treatment, the report says.

Of 25 states surveyed, California ranks 24th, second only to Arkansas in the frequency of dental decay among children. By third grade, nearly two-thirds of California children are affected by dental disease. The report's authors say that makes tooth decay - not obesity or asthma - by far the most prevalent children's health problem in the state.

What's particularly frustrating, they say, is that it's almost entirely preventable.

"They're in pain as little kids, and for no good reason," said Wynne Grossman, executive director of the Dental Health Foundation. "It could be taken care of. That's what's sad."

Grossman, dental health advocates, dentists and educators across the state say California must address the crisis. Solutions lie in better prevention and education programs, improved state public health programs and expanding access to care, they say. Of the 25 states that have conducted surveys on the subject, they say California is the only one where a private nonprofit - and not the state health foundation - is footing the bill. It is the first such survey in the state in more than a decade.

During the 2004-05 school year, the report's authors surveyed more than 21,000 children in kindergarten and third grade in nearly 200 schools across the state. Their report puts a framework around something Patricia Culleton, a nurse at Ethel Phillips Elementary School in Sacramento, is all too familiar with.

Children come to her a few times a week with dental pain, sometimes crying because they hurt so much.

"It's a tremendous problem," she said. The mouths of some kindergartners are so full of cavities, it appears as if a volcano erupted inside, she said. Many suffer from decay caused from sleeping with bottles of milk or juice in their mouths as babies, bathing their teeth in sugar all night long. Sometimes children don't realize they are in pain, because they don't know what it means to be free of it.

The report says children of all income levels experienced decay. But those whose families were poor, or who had no insurance, were significantly more likely to have decay and less likely to have seen a dentist.

"It's a matter of access," said Francisco Ramos-Gomez, an associate professor of pediatric dentistry at the University of California, San Francisco. For every child who has no medical insurance, there are 10 who have no dental insurance, he said.

Culleton's school is 57 percent Latino, the ethnic group that had the highest risk of dental disease, according to the study. Latino children were nearly twice as likely as white children to have dental disease. Seventy-two percent of those surveyed had tooth decay, 26 percent had cavities in seven or more teeth, and 30 percent were in need of treatment.

"It's a disgrace," said Guillermo Vicuna, a dentist whose organization, Su Salud, provides treatment to migrant families in San Joaquin County. "On one side, we are so advanced, and on the other side, yes, we are so advanced, but for whom?"

The families Su Salud works with face several obstacles to care. If they're undocumented, they're afraid to seek help.

"They hide, and they wait until they can no longer support the pain," Vicuna said. They also lack transportation to travel to a dentist who might be willing to see them, he said.

Su Salud preaches prevention as the best answer to the problem. The authors of the report support this philosophy.

Waiting until children reach preschool or kindergarten is too late, they say. By then, children often have severe decay. According to the report, more than half the state's kindergartners had decay, and nearly 20 percent had cavities in at least seven teeth.

Kathy Phipps, an oral epidemiologist who did analysis for the California report - as well as the reports of the other 24 states - said Oregon and Washington have done bigger educational campaigns and have put more money into programs to put sealants on kids' teeth. In California, 23 percent of third-graders have dental sealants. The federal goal, by 2010, is 50 percent. California's prevention efforts have been fractured, Phipps said, partly because the state is large and diverse and partly because it has no dental health director to provide oversight.

David Nelson, a consultant with the state Department of Health Services' Office of Oral Health, acknowledges the crisis is real but highlighted a number of advances the state has made in recent years. By next year, he expects 65 percent of Californians to be drinking fluoridated water, up from 17 percent a decade ago and nearing the federal benchmark, set for 2010, of 75 percent. He noted that the state provided dental sealants to 8,500 children last year and has made it a goal to enroll all children who are eligible in government insurance.

Some dentists say they have little incentive to accept that insurance, though, because they get reimbursed so little for it.

Stan Rosenstein, the state's Medi-Cal chief, said the state Legislature traditionally has chosen to spend money on making more people eligible for services, rather than paying higher rates. Spending more money on reimbursements likely would mean serving fewer people, he said.

Dr. Cindy Weideman, who has been in dentistry in Sacramento for 30 years, said she used to accept Denti-Cal clients. But the paperwork and X-ray requirements cost so much, she'd usually take a loss, she said. She stopped accepting Denti-Cal but sees 80 to 100 low-income children at no charge.

Once a year, Weideman and other dentists in the Sacramento region provide free care to children who have no other form of dental coverage. The program, called Smiles for Kids, started 15 years ago and has helped more than 7,500 children. On Saturday, some 800 children received fillings and cleanings from 160 dentists and more than 300 assistants, hygienists and community volunteers. A few hundred of those who need follow-up care will be adopted by local dentists, orthodontists and oral surgeons.

Grossman, of the Dental Health Foundation, says such services are welcome, but they alone won't solve the problem. With the right resources and attention, she said, prevention and early intervention could.

"There's no reason they have to go through this pain," she said.

About the writer:

• The Bee's Jocelyn Wiener can be reached at (916) 321-1967 or jwiener@sacbee.com.