Oral Disease: A crisis among children of poverty

Oral Disease:
A Crisis Among Children of Poverty
Almost 52 million school hours are missed annually by children because of oral problems. Extensive tooth decay, pain, or infection can cause eating, learning, and speech problems for
children. Many adolescents with oral problems such as decayed or missing teeth suffer embarrassment and diminished self-esteem.
Preventable oral diseases still afflict the majority of America’s children. This is especially true for children from families with low incomes, children in minority groups, and children with special health care needs. These children experience greater levels of disease and unmet need, and bear most of the burden of unnecessary pain, suffering, and compromise to their total health.
In the United States, 25 percent of children and adolescents—typically, the most vulnerable—experience 80 percent of all dental decay occurring in permanent teeth.

“Bleeding gums, impacted teeth, rotting teeth are routine matters in the children. . . . Children get used to feeling the constant pain. They go to sleep with it. They go to school with it. . . . The gradual attrition of accepted pain erodes energy and aspiration.” Jonathan Kozol

An estimated 5–10 percent of preschool-age children have baby bottle tooth decay/early childhood caries, a severe form of tooth decay. The percentage is even higher in certain populations: Survey results show that 20 percent of children from families with low incomes and 43 percent of children in some American Indian populations have baby bottle tooth decay/early childhood caries.
Baby bottle tooth decay/early childhood caries increases a child’s risk for future tooth decay. Children as young as age 1 experience untreated dental decay. Among children ages 6–8, 72
percent of American Indian/Alaskan Native children, 50 percent of Hispanic children, 34
percent of black children, and 31 percent of all children experience untreated dental decay. More than half of all children ages 6–8 and two-thirds of all 15-year-old adolescents experience
dental decay. Sixty percent of adolescents have gum disease.

Access Vulnerable populations of children (especially children from families with low incomes, those who are homeless, those in families without dental insurance, and those with special health
care needs) have more oral problems and less access to dental care than the general population.
These children suffer from frequent—often urgent—oral problems and generally receive
inadequate dental care. Serious facial swelling from a tooth abscess resulting from decay. Grossly decayed teeth require extensive treatment.

Oral Health Status
This publication has been produced by the National Maternal and Child Oral Health Resource
Center supported at the National Center for Education in Maternal and Child Health under its
cooperative agreement (MCU-119301) with the Maternal and Child Health Bureau, Health
Resources and Services Administration, Public Health Service, U.S. Department of Health and
Human Services, in collaboration with the Children’s Dental Health Project. May 1998.

The Cost of Care Individuals with the greatest need for oral health services are also the least likely to have dental coverage or to have the personal resources to purchase dental care. Inability to pay is the main barrier to visiting a dentist. Only one-fourth of all children ages 8
years and younger have private dental insurance, and the number of publicly financed dental
programs has not kept pace with the demand—and, in many cases, has declined.
In the United States, 30 percent of all children’s health expenditures are devoted to children’s
dental care—a spending rate more than 10 times that of the 2.3 percent expended by
Medicaid for children’s dental care.
The new State Children’s Health Insurance Program (CHIP) provides an opportunity to
expand health services for children. However, some states are not including dental services as
part of their plans, despite the fact that children from families with low incomes have the
least access to dental care and the greatest unmet need.