How to choose the best toothpaste for your child

include antibacterial agents, fluoride, and mild abrasives. There are tons of choices when it comes to children’s toothpastes. In fact, there are so many choices that it
can make buying toothpaste a very difficult process. However, choosing the right toothpaste promotes good oral hygiene habits, and helps your child maintain a healthy smile.

There are thousands of different bacterias in your mouth. They group together and create the film on teeth that we refer to as “plaque.” When this plaque is not removed, it can accumulate and cause things like tooth decay, gum disease, and bad breath. Brushing teeth twice a day with fluoridated toothpaste significantly decreases the risk of developing these problems, helps create a lasting healthy smile, and promotes overall health and well being in general.

To help you choose the best toothpaste for your child and their teeth, consider the following guidelines:

  1. Choose a toothpaste with the ADA seal—It is important to choose a toothpaste that has been approved as safe and effective product in maintaining optimum dental health. To ensure you are buying a product that is recommended by the American Dental Association, look for their seal of approval, which can be located on the toothpaste box and tube.  The ADA seal ensures the toothpaste has been objectively tested and approved as safe by the ADA Council on Scientific Affairs. The most reliable informant for dental product recommendations is your child’s pediatric dentist. As a specialist, your pediatric dentist can provide guidance and direction in choosing the best toothpaste for your child.
  2. Dodge harsh abrasives—Choosing an age befitting toothpaste for your child is actually quite critical, because some toothpastes consist of harsh ingredients that may erode and wear away young tooth enamel, the protective outer coating of the teeth. Abrasives are key in polishing and removing plaque from the teeth, but large amounts of phosphates and alumina found in some toothpastes, for example, can be too strong for young enamel and may actually cause young teeth to become too sensitive. To choose a toothpaste that is gentle enough for you’re your child’s teeth, ask your pediatric dentist which toothpastes are age appropriate and most beneficial for your particular child.
  3. Look for fluoride—According to the American Dental Association (ADA), children of all ages should use toothpaste that contains fluoride, which helps protect teeth against cavities and plaque build up. Ingesting too much fluoride is not healthy, especially for young children, so the amount of fluoridated toothpaste used must be controlled. The advised amount for children under three years of age is a ‘smear,’ while a pea-sized amount is recommended for older kids. Children under two years of age generally are unable to spit out their toothpaste, so take caution, as kids this young may swallow small amounts of fluoride when a parent or caregiver is brushing their teeth. Ask your pediatric dentist about fluoridated toothpaste for children under three years of age.
  4. Take flavor into consideration—Though flavor may not be considered technically relevant to dental health, choosing a toothpaste that tastes good to a child helps get him or her more excited about the routine of brushing their teeth. Some kids dislike the taste of minty toothpastes, because they feel too ‘spicy’ on the tongue or make the mouth tingle. While most adults prefer these flavors, kids tend to become more willing to brush more consistently and often when ‘fun’ toothpaste flavors, such as strawberry or bubble gum are offered. Finding a flavor your child is excited about encourages them to practice good dental hygiene habits that will hopefully last a lifetime. In fact, letting kids pick their own flavors may even have them asking to brush their teeth more often!

Utah Kids Score Poorly on Oral Healthcare

Significant numbers of Utah elementary schoolchildren have experience with cavities or have untreated dental decay requiring immediate care, according to the results of a new study. Many children are also lacking dental insurance or have not received required dental care because their parents could not afford it.
These are the results of the latest survey of children between the ages of 6 and 9 conducted by the Utah Department of Health. Conducted every five years, the survey includes a parent questionnaire and a dental screening exam of each child, with the results intended to guide the state’s Oral Health Program to determine future activities, monitor trends, and improve the oral health of Utah children.

 

Untreated decay still a problem

The 2015-2016 Oral Health Survey was conducted between September 2015 and January 2016. The survey was given to parents of more than 5,100 children ages 6 to 9 in first through fourth grades in 47 randomly selected public schools in Utah.

The parents were asked to complete questionnaires focusing on the following:

  • Dental insurance coverage
  • Toothache and time since the child had seen a dentist
  • Unmet dental needs and problems accessing dental care
  • Source of drinking water
  • History of fluoride supplementation
  • Participation/eligibility for the free or reduced-price lunch program
  • Demographic information on the child

The dental screenings were performed by dental hygienists using dental LED headlights in place of dimmer, portable dental overhead lights that were used in the 2005 and 2010 surveys. The overhead lights made it harder to identify tooth-colored restorations and tooth-colored or clear sealants, according to the authors.

The following were noted during the screening:

  • Presence of cavitated untreated caries
  • Presence of treated cavities
  • Number of surfaces decayed, missed, or filled (primary and permanent)
  • Presence of sealants on permanent molars
  • Dental treatment needs

Of the parent questionnaires and consent forms handed out, 45% were filled out and returned. Of those, almost 90% of parents gave consent for their child to undergo screening. After excluding children who did not meet the study’s age criteria, more than 1,900 underwent a screening. The researchers adjusted the data to be representative of the state.

They found that 66% of children ages 6 to 9 have experienced cavities, compared with the national Healthy People 2020 target of 49%. This year’s results represent a significant increase from 52% of children having experienced cavities in the 2010 Utah survey.

Untreated tooth decay was found in 19% of children, up from 17% in 2010, yet better than the national target of 26%. Urgent care admission caused by oral pain and infection was needed by 2% of respondents.

The presence of dental sealants improved from 26% in 2010 to 45% in the current survey, well ahead of Healthy People 2020 goal of 28%. The lack of dental insurance improved to 18% from 22% in 2010. Also, 17% had not visited a dentist in the past year, and 2% had never been. Unmet dental needs were found in 4% of children, which was improved from the previous survey, with 46% of those saying that they could not afford it, and 30% that they lacked dental insurance.

The researchers found disparities in care and insurance coverage among children of Hispanic origin compared with other children, as well as in children of racial minorities. Children who qualified for the free and reduced-price lunch program also had substantially higher rates of cavities and untreated decay.

Access to care by race and ethnicity

Greater access to care needed

The authors reported some limitations of the study’s results:

  • The questionnaire for parents was based on self-reporting, subject to recall bias, and could reflect underreporting or overreporting.
  • The overall survey response rate was below 50%.
  • Dental screening results could not be reported for each racial minority group because of small numbers.

They recommended several strategies to improve the oral health of children in Utah:

  • Increasing access to dental insurance and care
  • Enhancing the public’s understanding of the importance of oral health and its benefits to overall health and quality of life
  • Improving coverage by educating families about Children’s Health Insurance Program (CHIP), Medicaid, and other dental insurance
  • Expanding access to community water fluoridation
  • Expanding school-based caries prevention activities, such as fluoride varnish and sealant programs in elementary schools
  • Providing better incentives and reimbursements to dental practitioners who see low-income people
  • Focus on closing the dental care access gap by increasing awareness of existing community resources

 

Pediatric Dentists and Childhood Obesity

When it comes to tackling the growing epidemic of childhood obesity, dentists are in a unique position to start a conversation with parents.

downloadThey already talk about the dangers of sugar-sweetened beverages, the importance of not letting babies go to bed with bottles— so why not take it a step further and talk about obesity?

This was just one of the solutions proposed at Healthy Futures: Engaging the Oral Health Community in Childhood Obesity Prevention. The Nov. 3-4 conference brought together 125 dentists, hygienists, physicians, nurses, educators, researchers and dietitians to discuss ways the professions can work collaboratively on prevention.

According to the Centers for Disease Control and Prevention, childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. And because obese youth are more likely to be obese as adults, this can put them on a path to heart disease, type 2 diabetes and many other serious medical conditions as adults.

It’s a problem no one profession can solve singlehandedly, which is why words like interprofessional and collaboration were stressed repeatedly during the two-day event.

During the conference, presenters shared studies, evidence-based recommendations and advocacy efforts already in motion. They also discussed new ways to engage parents, educators, communities and insurers on the importance of the issue.

This need for health professionals to work together was timely: On Nov. 1, the U.S. Preventive Services Task Force issued draft guidance recommending clinicians screen for obesity in children and adolescents age 6 years and older.

While proposed solutions such as oral health curriculum in schools, increased chair-side screenings and dentists providing nutrition guidance were favorable received, so were the existing barriers. For every potential game-changer exists the sobering reality that everyone—be it a solo practice, dental school or hospital — needs more time, money and training. The issues of reimbursement — would insurance cover this? — and mostly incompatible relationship between medical and dental electronic health records were also discussed.

In addition to talking solutions, presenters and participants alike talked evidence, and the need for more of it.

Healthy Futures was organized by the ADA, National Maternal and Child Oral Health Resource Center, American Academy of Pediatric Dentistry, American Dental Hygienists’ Association and Santa Fe Group. It was supported by the Robert Wood Johnson Foundation and its commitment to eliminating young children’s consumption of sugar-sweetened beverages and ensuring children enter kindergarten at a healthy weight. A reception was provided by the DentalQuest Foundation.

Disparities in Access to Dental Care Narrow Among U.S. Kids

cartoon-1099727_1280The number of U.S. children receiving dental care significantly increased from 2000 to 2014, according to a new study in Pediatrics. Even more positively, the researchers found a steep narrowing of coverage disparities in race/ethnicity and income. However, they are concerned about the future of treatment coverage under the new U.S. administration.

The authors knew from previous studies that insurance coverage had improved as pediatric enrollment in public health insurance through Medicaid and the Children’s Health Insurance Program (CHIP) increased. However, they didn’t know whether that translated to increased utilization and what the difference was among children of different races and ethnicities, as well as between poor and better off children.

“The expansion of Medicaid and CHIP financing for children from lower socioeconomic groups has made it easier for them to access these services,” said study co-author Andrew Racine, MD, PhD, in an interview with DrBicuspid.com.

Dr. Racine is the system senior vice president and chief medical officer at Montefiore Medical Center and a professor of clinical pediatrics at Albert Einstein College of Medicine in New York.

Measuring changes in access

The health insurance coverage gains for U.S. children seen in recent years are expected to have improved access to healthcare services, particularly for vulnerable populations. Nonetheless, few studies have analyzed children’s healthcare access trends, including by race/ethnicity and income, and whether the magnitude of disparities has diminished.

“The expansion of Medicaid and CHIP financing for children from lower socioeconomic groups has made it easier for them to access these services.”

— Andrew Racine, MD, PhD

For future healthcare policy decisions, it is important to assess insurance coverage rates and also access to healthcare and disparities in access, the authors wrote (Pediatrics, November 15, 2016). Millions of children may become ineligible for public or subsidized coverage by 2019 if funding for separate state CHIP programs expires or states are allowed to roll back Medicaid and CHIP eligibility thresholds to statutory minimums.

Therefore, the researchers examined data from 173,038 children up to age 17 from the 2000 to 2014 National Health Interview Survey (NHIS), a nationally representative, cross-sectional survey of U.S. households. Within each household, a sample child was chosen. An in-person interview was conducted with a parent or adult knowledgeable about the child’s health and healthcare.

They were asked about whether the child had health insurance and the type. They were also asked whether the child had visits with any type of dental professional (including dentists, oral surgeons, orthodontists, or hygienists), well-child visits, and doctor’s office visits and also about usual sources of care and unmet health needs, which included dental care, within the previous year. The dental care question was asked only for children ages 1 to 17, with the sample size therefore smaller for that question.

Children were classified into three income categories:

  • Poor (less than 100% of the federal poverty level)
  • Near poor (between 100% and 199%)
  • Not poor (200% and above)

The lack of a dental visit within the previous year dropped by half from 2000 to 2014 in Hispanic children and by 37% in black children, nearly eliminating disparities with white children, as shown in the table below.

  No dental visit within the previous year,
2000-2014
2000 2014
Hispanic children 43.2% 21.8%
Black children 32.8% 20.7%
White children 25.1% 19.5%

For unmet healthcare needs, the higher rates seen in children in poor (12.8% in 2000 to 8.5% in 2014) and near-poor families (13.0% to 7.2%) narrowed compared with those from all other families (4.8% to 4.2%).

The rate of uninsured children dropped significantly from 12.1% in 2000 to 5.3% in 2014, representing an additional 4.9 million children receiving coverage. At the same time, public coverage among the children in the study increased from 18.9% to 38.9%, and private coverage decreased from 69.0% to 55.8%. Increases in public coverage and decreases in private coverage were found across all racial/ethnic and income groups.

The uninsured rate narrowed for Hispanic children compared with white children and was eliminated for black children compared with white children, as shown in the table below.

  Uninsured rates in children, 2000-2014
2000 2014
Hispanic children 26.1% 9.3%
Black children 11.7% 3.3%
White children 8.2% 4.0%

Steeper declines in uninsured rates were seen for children in poor (22.2% to 5.9%) and near-poor (21.2% to 8.8%) families compared with others (6.0% to 3.5%).

“We have managed to satisfy a pent-up demand,” Dr. Racine said regarding the increases seen in accessing dental care, in conjunction with increased rates of insurance. “We may not have reached the limits of what health insurance expansion can produce. Even if we did nothing and kept things the way they are, we might expect to see continued improvement.”

Future public insurance coverage unknown

Gains in health insurance coverage appeared to explain some but not all of the increases in access to care, the authors wrote. Some states have quality monitoring programs with performance improvement programs targeting goals, including increasing dental visit rates, while some have worked to improve dental provider availability by increasing dental service reimbursement rates. And states are now required to provide dental services to all children enrolled in Medicaid and CHIP.

The Patient Protection and Affordable Care Act (ACA) had the effect of bringing more children who had previously been eligible for public insurance coverage into the system, Dr. Racine said.

In a separate commentary in the same Pediatrics issue, Stephen Berman, MD, a professor of pediatrics at the University of Colorado School of Medicine and School of Public Health, wrote that the study’s findings have important implications for future child healthcare policy decisions.

“First, all children should have coverage, and strong efforts must be made to reach the 5.3% who remain uninsured,” he wrote. “These efforts should target the near-poor and Hispanic families because the gap is greatest for these populations. Second, the reauthorization and continued funding of the Children’s Health Insurance Plan, due to terminate in 2019, is essential and should be addressed sooner rather than later.”

He also recommended that ACA exchange plans become more affordable to near-poor and middle-class families.

The study’s strengths were its use of nationally representative NHIS data with consistent measurement over time and the ability to link health insurance and healthcare access data, according to the study authors. A limitation, though, was its reliance on parents reporting the use of health services not validated against medical records.

Dr. Racine noted that the availability of public health insurance, the willingness of dental practitioners to provide care to those with this coverage, and the willingness of our society to ensure that rates paid to practitioners are in line with the cost of providing them will determine if the rates of children receiving dental care increase in the coming years.

“Depending upon the policy responses of the new administration to these programs, we could see a complete reversal of these funds,” Dr. Racine said regarding the incoming Trump administration’s position on funding for children’s health insurance through Medicaid and CHIP.