- The Washington Times - Sunday, March 4, 2001

Five-year-old Henry Leadbeater is on the way out with a goodie bag full of neon dental floss, a Nickelodeon toothbrush and a freshly baked cookie. As the Skaggsville, Md., boy leaves, other children are choosing from the fluoride menu they can have marshmallow, grape, chocolate or banana split, among other flavors, today. There are toys in the waiting room and stickers at checkout.

Beneath the birthday-party trappings, though, it is serious business at Dr. Robert Camps' Silver Spring office. Dr. Camps is a pediatric dentist, and the accouterments make dental care pleasant for the children. A relaxed child, naturally, will make a better dental patient, he says.

"We like our patients to be treated like they have never been treated when they go to a dental practice," Dr. Camps says. "A pediatric dentist trains two years beyond dental school to deal with children's special needs, similar to a pediatrician. We learn how to deal with children with medical problems, emotional problems. Of course there are general dentists who can do a good job, but they only spend a few weeks learning to deal with children."

Though there is little scientific proof children need a specialized dentist, the anecdotal evidence can be found in the waiting rooms of the more than 4,000 pediatric specialists nationwide, says Dr. George Acs, chairman of dentistry at Children's National Medical Center in the District and a spokesman for the American Academy of Pediatric Dentistry.

"You have to treat a lot of children to understand them," he says. "It is different what you need to do for an adult compared to what you need to do for a child. Most of the time pediatric dentists are dealing with a patient who is frightened."

Bernadette Williamson, a Rockville mother of two, agrees.

"My kids think going to a pediatric dentist is great," says Mrs. Williamson, who recently took her children Anthony, 5, and Laura, 3, to Dr. Camps' office for an exam.

"When my son was 2, I took him to my dentist, and he was horrified. Then I took him to a pediatric dentist, and he was great. The hygienists really know how to talk to kids."

To quell some fears, pediatric dentists and their assistants take the "tell-show-do" approach during an exam. They tell the patients what the dental instrument is, show them how it works, then use it. Making things easier are child-friendly nicknames for some of the tools. At Dr. Camps' office, for instance, the tooth polisher is Mr. Tickle. At some other offices, the suction device is known as Mr. Thirsty.

Starting young

Whether a parent takes a child to a general dentist or a pediatric specialist, the child should go around the time of his first birthday and be seen at least twice a year, says Dr. Mary Hayes, a Chicago dentist and a spokeswoman for the American Dental Association (ADA).

Though that may seem young some children have only a few teeth at that age it gets them on course for good dental hygiene, Dr. Hayes says.

"It is a learning experience for the children," she says, "but also, an important part of my job is screening. If 20 to 25 percent of 3-year-olds have tooth decay, you know that it started before age 3."

Despite the ADA's recommendation, Dr. Camps estimates that fewer than half of his patients come in for an exam that early. A more typical age would be around 2.

Some parents wait longer. Mary Leadbeater says she did not take her son Henry to see a dentist until he was 5. She reasoned he was not mature enough to sit still in the exam chair. When Henry eventually went, several cavities were found.

"In hindsight, we should have gone earlier," Mrs. Leadbeater says. "I guess I was thinking, 'It's just teeth.' I'm normally so good about taking my children to appointments."

At a typical first visit, parent and child will get some instruction in oral hygiene, Dr. Camps says. Parents should assist a child in brushing and flossing teeth until about age 6 or 7, Dr. Acs says.

An office visit usually includes professional teeth cleaning and a fluoride application. The dentist will look for signs of tooth decay, and if he finds any, he likely will apply fillings and sealant, a clear plastic coating placed over a tooth that is starting to show decay. The sealant acts as a barrier, protecting teeth, particularly molars, from bacteria.

"We don't just say, 'Brush your teeth,' " Dr. Acs says. "We show them how to brush and floss. We talk about diet and baby bottles. We try to give them a general idea about how to prevent dental disease. We feel that is our purpose."

Disease is down, but not out

Most city water supplies contain fluoride. Stores are stocked with cartoon-character toothpaste and fancy toothbrushes. Preventive care such as professional cleaning and the application of sealants has paid off in making Americans' oral health the best it has ever been, according to the third National Health and Nutrition Examination Surveys, a report issued by the Centers for Disease Control and Prevention and published in the Journal of the American Dental Association (JADA).

The 1999 report, which looked at children in more than 13,000 households, analyzed the number of untreated decayed permanent teeth among American children ages 6 to 18. The report showed a nearly 77 percent drop when compared to children in the same survey done 20 years earlier.

The study found dental disease was still very much a problem among disadvantaged people in the United States, however.

"No doubt, if you look at the overall situation, everyone is healthier," Dr. Acs says. "but a lot of disease burden is borne by the same kids. About 20 percent of all kids have 80 percent of the cavities."

Even children with poor access to dental care are benefiting from fluoridated water, however. More than 144 million people in the United States have fluoridated public water supplies, but about 100 million people do not, the ADA reports.

Fluoride is a naturally occurring mineral that makes teeth stronger and more resistant to decay. The use of fluoride over the past 40 years has reduced cavities by 50 percent and has saved $40 billion in oral health care costs, according to the ADA.

Most toothpaste contains added fluoride, too, and there is some risk that children who swallow too much toothpaste while brushing can get fluorosis. Fluorosis is light spotting of the permanent teeth that develops while the teeth are still forming.

To avoid this condition, small children should brush with pea-size amounts of toothpaste, Dr. Hayes says. By about age 4, children should be adept at spitting out toothpaste, she says.

Dr. Hayes says parents are taking better care of their children's baby teeth than they did a generation ago.

"There is better awareness of oral health," she says. "Patients take baby teeth more seriously. People now realize that decay will spread from tooth to tooth. When I started [20 years ago], 50 percent of 3-year-olds had decay. Now, that is between 22 and 29 percent, depending on the demographics. It could go down even more if people took early intervention seriously."

Coming in and falling out

Sucking the thumb or a pacifier might seem like a good way for a toothless infant to calm down. However, a toddler with a full set of teeth may be setting himself up for dental problems if he still relies on either, Dr. Acs says.

Sucking habits that remain as the permanent teeth prepare to grow in can lead to improper growth of the mouth and tooth misalignment, he says. The pacifier probably is less damaging than the thumb, Dr. Acs says.

"If I had to choose, I would take the pacifier any day," he says. "They tend to be less associated with the way teeth grow in, and children usually give up a pacifier habit quicker than the thumb."

Either habit may interfere with the alignment of permanent teeth if continued into the years around age 5, when those teeth are trying to erupt, Dr. Acs says.

Parents should not be fooled that one pacifier is better than another, Dr. Acs says. Some pacifiers are marketed as orthodontically correct, but Dr. Acs warns parents that that does not mean the pacifier is good for the child's teeth.

Dr. Arthur Nowak, a University of Iowa professor of dental medicine, has studied the effects of pacificers and serves as a consultant to Gerber, which markets the Nuk orthodontic pacifier. He says long-term studies have shown the Nuk pacifier distributes even pressure on the jaw, something that the thumb and regular pacifiers do not do.

" 'Orthodontically correct' means that when it is used appropriately, it will not contribute to crooked teeth," says Dr. Nowak. "I have studied this since the early 1980s, and I don't believe it is bad for teeth."

By the early grade school years, some children may have all their adult teeth and others may not yet had a visit from the tooth fairy. It is a waste of time to worry that your child is delayed in some way, Dr. Acs says.

"Don't start comparing your kid to your neighbors'," he says. "The range for losing the first tooth is so big, with the earliest being about 4 1/2 and the latest being about 8 1/2. My oldest is 14. He is 6-foot-1 now. In second grade, he was the only kid who had not lost a tooth. There is no rhyme or reason to it."


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