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need for health professionals to work together was timely: On Nov. 1, the U.S. Preventive Services Task Force issued draft guidance recommending clinicians screen for obesity in children and adolescents age 6 years and older.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

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
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.


Pacifiers and Dental Health

baby-552610_1920We get asked all the time about children who use pacifiers. An important fact to note is that sucking a pacifier or finger is natural. Babies suck even when they are not hungry to comfort themselves. Some babies even begin to suck on their fingers or thumbs before being born!

However, when babies repeatedly suck on a pacifier or thumb and finger over a long period of time, you run the risk that their upper front teeth will begin to tip outward and not grow in properly.

In addition, crooked teeth and bite problems can occur with prolonged sucking, which may result in children needing significant orthodontic treatments later in life to correct the damage.

The American Academy of Pediatric Dentistry (AAPD) does recommend a pacifier over a finger or thumb, as the habit is easier to break should babies not willingly give it up.

The organization also recommends considering safety when selecting that pacifier.

The shield on the pacifier should be wider than the child’s mouth, and the pacifier should be monitored for wear and tear.

A bottle nipple should never be used as a substitute and discontinue use if the child can fit the entire pacifier in their mouth.

Don’t dip the pacifier in anything sweet, and never leave a baby with a pacifier unattended.

It is an instinct and most children will come to the point where they will give up the thumb or pacifier on their own.

If it continues past the age of 3, it is time for the parents to intervene to help break the habit. The earlier the habit is stopped, the better for their teeth in the long run.

Early visits to a pediatric dentist will help parents to help their children stop sucking their thumbs and pacifiers and hopefully prevent damage before it is too late to turn back.

The AAPD recommends taking your child to a pediatric dentist before age 1 or when the first tooth appears.

Study Finds 99% of Obese Kids Have Inflamed Gums

702px-obesidadinfantilyadolescenteThe vast majority of overweight and obese children show signs of gingivitis, according to a study in Diabetes Care. While the study was relatively small, the authors highlight the need for a multidisciplinary approach to care for children with excess body fat.

Researchers from Argentina and California wanted to see if excess body fat in children was tied to a number of inflammatory conditions. They hypothesized that overweight and obese kids may also have periodontal disease because of the inflammatory processes of other diseases associated with obesity, such as insulin resistance.

Obesity is considered a global epidemic by World Health Organization. It is a serious health problem among children and adults.

Pediatric obesity linked to gingivitis

Scientists have already established a link between periodontal disease and obesity in adults, but no such link has been explored for children. The researchers felt it was important to investigate a potential link between periodontal disease and pediatric obesity, because untreated gingivitis may progress to more severe forms of gum disease later in life.

The researchers began by evaluating rates of gingival inflammation in 90 overweight and obese but otherwise healthy Argentinean children and adolescents. The children were referred to an outpatient clinic for obesity treatment, and gingivitis incidence was evaluated using the gingival inflammatory index.

Almost 99% of obese children and 85% of overweight children had at least some gingival inflammation. The researchers also found a statistically significant correlation between children with gingivitis and insulin resistance, a condition in which cells don’t respond properly to glucose.

The evidence showed an association between insulin resistance and the development of periodontal disease. These results reinforced the importance of addressing insulin resistance and of gingivitis awareness for children with excess body fat.

A comprehensive multidisciplinary approach

The study had a number of shortcomings, including having a relatively small sample size. The sample was also homogeneous, consisting of white Argentinean children, and did not include a control to compare rates of gingival inflammation to kids with a healthy body weight.

Furthermore, because it was a short two-page study, the authors did not include details about the severity of gingival inflammation or who conducted the measurements.

Nevertheless, the study highlights the need for similar studies to evaluate the link between pediatric obesity and gingivitis. The authors believe the study findings also serve as a reminder that dentists and hygienists should be a part of the multidisciplinary team that cares for overweight and obese children.


Make Dental Care Fun Again with Time to Brush

toothbrush-571741_1920Dental hygiene has consistently been a problem for young, sugar-loving children. To make matters worse, they are usually opposed to tooth brushing. Here to help is Time To Brush.

In America, there is an epidemic of dental hygiene plaguing an unsettling number of children. In fact, the National Children’s Oral Health Foundation reported that over forty percent of children have dental cavities before they even reach kindergarten. To make matters worse, around one in every five children do not have the dental care they need to treat these occurrences. With the prevalence of this issue, it is vital that everyone, especially developing children consistently brushes their teeth. This is where Time To Brush fills its niche. The multi-functional toothbrush holder puts a new and modern spin on the traditional two minute timer, allowing young ones to actually enjoy taking care of themselves.

The Time To Brush itself features a small screen guiding children through the process of brushing their teeth. The screen is dim enough to not hurt their eyes late at night, making it perfect for low-light evenings and mornings. Users are shown the correct toothbrushing techniques by a lively and hygienic duo: Bobby Brush and Fiona Floss. As children brush their teeth in front of the Time To Brush holder, the screen displays exactly which areas they should be brushing and for how long. Best of all, the animation lasts two minutes, ensuring that children get the recommended level of tooth care. In this way, users can look forward to their nightly routine without worrying whether or not they are ‘doing it right’.

Apart from the electronic display, the Time To Brush system works as a toothbrush holder. There are six toothbrush slots, four for traditional and thin brushes and two for thicker, electronic toothbrushes. As a side benefit, there are two floss holders as well as a toothpaste compartment, storing all the tools necessary for a healthy nightly routine. Unfortunately, a product of this quality requires massive funding for its first round of production. To remedy this issue, the Time To Brush team has launched a crowdfunding campaign on Kickstarter. Donors will receive anything from Bobby Brush stickers to a first edition Time To Brush toothbrush holder. With the support of readers, toothbrushing does not have to be like pulling teeth; instead, it will be a process children actually enjoy.

To learn more visit the Kickstarter campaign page.

Bedtime Use of Media Devices Doubles Risk of Poor Sleep in Children

shutterstock_336928517A Cardiff University study has found that children using screen-based media devices at bedtime have over double the risk of inadequate sleep duration compared to children without access to such a device.

The study, which comprised a systematic review of 20 existing observational studies, involving 125,198 children, also found that sleep quality and day-time sleepiness were affected to a similar magnitude.

“Our study is the first to consolidate results across existing research and provides further proof of the detrimental effect of media devices on both sleep duration and quality,” said Ben Carter from Cardiff University School of Medicine.

“Sleep is an often undervalued but important part of children’s development, with a regular lack of sleep causing a variety of health problems. With the ever growing popularity of portable media devices, such as smartphones and tablets, the problem of poor sleep amongst children is set to get worse. Our findings suggest that an integrated approach involving parents, teachers, and healthcare professionals is necessary to improve sleep habits near bedtime.”

Currently 72 percent of children and 89 percent of adolescents have at least one device in their sleeping environment and most are used near bedtime. Such devices are thought to adversely impact sleep through a variety of ways including displacing, delaying or interrupting sleep time; psychologically stimulating the brain; and affecting circadian timing, sleep physiology and alertness.

Sleep disturbance in childhood is known to lead to adverse physical and mental health consequences. Short and long term detrimental health outcomes include poor diet, sedative behavior, obesity, reduced immunity, stunted growth and mental health issues.

The results of the study, “Association between portable screen-based media device access or use and sleep outcomes” are reported in JAMA Pediatrics (Carter B, et al, 2016).

Alternatives to Halloween Candy

Trick-or-treating, school halloween parties, even just the extra bag of you bought for rewards. The extra treats kids are enjoying throughout October can really take a toll on their teeth.


Throughout the month, there are $9 billion spent on candy and sweets. Not only is there a lot of money being spent, there will be roughly 41 million trick-or-treaters out. There are some things that parents should remember when choosing candy and treats for their children:

  1. There are better treats, and there are bad treats. Dental friendly types of treats include chocolate. It melts away pretty quickly and doesn’t stay on teeth as long.
  2. Think of non-food items – glow sticks, small trinkets, or even a toothbrush!
  3. Bad treats stick to your child’s teeth. Dark chocolate and sugar-free gum are better than gummies or bubble gum.
  4. Sour candies are especially bad. Not only do they have sugars, but they also have acidic properties. Both those things are terrible for teeth!
  5. “Healthy” treats aren’t always better. For example, a granola bar has honey in it – another sticky substance that takes extra scrubbing to remove from teeth.
  6. Brush teeth after eating any candy. And if you find “bad candies” in your kids Halloween haul, think about taking it to the nursing home or someplace like that.

As always, we encourage our patients to enjoy the holiday without over-indulging or having a dental issue later on. Be safe, wear reflective clothing, and have fun!


The Effects of Sugar Guidelines on Teeth

sugar-1514247_1280The American Heart Associating recently released new, easier to follow guidelines to help Americans limit their sugar intake. American citizens have a serious sugar addiction. In fact, the average American eats over 130 pounds of sugar each year. Children eat an average of 20 teaspoons (80 grams) of sugar daily! Now, the new guidelines state children ages 2-18 should consume no more than 25 grams – or 6 teaspoons – daily. Children under two should not have any added sugar in their diet.

Our office is constantly talking to patients and their parents about what sugar can do to teeth. Unfortunately, sometimes we are too late and children come in for their first visit (at 1 to 2 years old) with multiple cavities. A child’s first dentist visit should be before their first birthday, or when the first tooth starts to come in. Tooth decay is the leading childhood illness.

Our teeth are a reflection of our overall health. It’s difficult to examine you blood vessels or liver, but you can look in the mirror and examine your teeth! If your teeth aren’t healthy, there’s a good chance the rest of your body is unhealthy, too. Filling and dental sealants are a short-term fix for a larger issue. Sure they take care of the problem, but a better solution is to examine diet and make healthier choices.

It’s been known for years that “low-fat” diets aren’t the healthiest. Instead, recent studies have shown that a “low-sugar” diet is more beneficial and critical for overall health. Low-fat diets were once very popular. Manufacturers removed fat from their food, but added sugar and salt to make it taste better. These moves caused rates of obesity, type II diabetes, and heart disease to grow exponentially, especially in children.

The added sugar sneaks into our diet through processed foods and sugary drinks. Be careful with feeding your children sugary cereals and breakfast bars. Check the sugar content of yogurt or other dairy products. Avoid packing cookies, chocolate milk, fruit juices, and even ketchup (which contains a surprising amount of sugar) in your child’s lunch. Organic, “no sugar added” apple juice contains a huge amount of natural sugar. For example, 12 ounces of apple juice has more added sugar than almost every 12 ounce soft drink. Sodas contain around 40 grams (ten teaspoons) of sugar for every 12 ounces. By drinking one soft drink, your child is already over their sugar limit for the day. Water is your best friend for your dental and overall health.

Healthy Teeth Affect Your Child’s Future.

apple-1370924_1920Our children are our future. Everyone has heard that saying. But think of it in these terms – our country’s economy, educational system, and culture is contingent upon the health and well-being of our children. Not only that, but our our actions to support them define that future too.

We have only just begun to focus on oral healthcare in a manner appropriate for something that dictates the outcome of our children’s health and happiness.

High-quality dental care affects so much more than your child’s smile. Healthy teeth can promote a confident attitude. Children who suffer from tooth pain and decay are more likely to have lower grades, miss school, and suffer in areas like eating, sleeping, and speaking.

Preventative dental care is important for a child’s success in school and in life.

This isn’t just about ensuring our children have healthy, strong teeth and pretty smiles. It will give them a confidence boost, sure. But the vast majority of dental disease is preventable.

All children deserve access to the complete range of care they need to live healthy, productive lives. Oral health is a strong predictor of overall health. It is important that parents give their children access to quality, preventive dental care.

Helping Your Child Feel Comfortable at the Dentist

dentist-1437430_1920Both children and adults should be visiting the dentist for an exam and a cleaning every 6 months. The problem is, many children don’t make their first visit until after the age recommended by dentists.

The American Academy of Pediatric Dentistry recommends that a child go to the dentist by age 1. Unfortunately, a survey by Delta Dental Plans shows that the average age of a child’s first dental visit is 2.6 years.

If you are worried about how your child will respond at their first dental visit, you can take the following steps to make them feel more comfortable and ensure that the visit goes smoothly.

  1. Children learn by example, so be a positive role model. Be diligent about dental care, and your child is more likely to embrace oral hygiene.
  2. Take your child to the dentist when his or her first tooth erupts. This will help your child get used to going to the dentist. It will also help prevent problems that could get worse over time.
  3. Play dentist and read children’s books that describe dental visits. The extra information will help alleviate your child’s fears.
  4. Be supportive and instill trust in your child, but avoid telling him or her that everything will be ok. If a procedure is necessary, telling your child it will be ok could affect the trust he or she has in you. It will also make the dental office an even greater source of anxiety. Instead, offer a hand to squeeze or a hug.
  5. Use positive phrases like “clean, strong, healthy teeth” to make the visit seem upbeat rather than scary.

Using these techniques will make your child’s dental visits more pleasant for everyone and will pave the way for a lifetime of good oral health.