Dental caries is the most prevalent childhood disease.1 Worldwide it has been concluded that 60%–90% of children have dental caries.1 The prevalence of caries varies by geographical region in addition to the availability and accessibility of oral health services.1 Dental pain is a negative result of untreated dental caries. Dental caries is an emerging issue in the beginning stages of life and can affect a child’s cognitive, social, emotional, language, and physical development.2 According to research, children with poor oral health are more likely to experience dental pain, perform poorly in school, and miss school because of pain.3 Students who miss school receive a lower grade point averages than other children.3
The aim of this review is to evaluate whether children who receive preventive dental care twice a year perform better in school than those who only seek dental care for emergencies.
Disparities in dental care
There are many barriers that could prevent a child from receiving routine preventive care, including lack of insurance coverage, insufficient time, lack of knowledge, and stress and fear of going to the dental office.4 According to the Centers for Disease Control and Prevention, when analyzing data of children 5 to 19 years of age, children from poor and racial or ethnic minority families have higher rates of untreated dental caries than do their peers from non-poor and non-minority families.5 Low socioeconomic families may only have Medicaid.4 Many dental offices do not accept Medicaid as a source of insurance, making it difficult to access a dental home for these children or cause problems with coverage.4 Children from lower-income families often do not get timely treatment for dental caries and are more likely to suffer from complications than children from higher income families.6 Families experience stress and diminished quality of life when ignoring oral health concerns.7 In relation to low socioeconomic status, these parents may not be able to afford to miss work for preventive appointments.4 They may perceive that taking off work for a preventive appointment does not offer any benefit and instead brings a burden for the missed hours of work.4 In Los Angeles County, California, a study was conducted showing parents averaged 2.5 absent days from work per year because of their children’s dental problems in 2009.7 Taking time for preventive dental care visits may allow individuals to avoid the higher cost treatment that accompanies a dental emergency.4
One way to maximize good oral health in children and prevent dental emergencies related to pain from caries is to encourage routine dental visits. It is highly recommended by the American Academy of Pediatric Dentistry, the American Dental Association, and the American Association of Public Health Dentistry that children have their first dental visit and establish a dental home before one year of age.8 Establishing a dental home creates the opportunity for a patient-dentist relationship, which includes comprehensive, ongoing, accessible, family-centered care throughout the child’s development.8 Having a dental home and seeking routine preventive care creates an opportunity to maintain good oral health, prevent disease, and treat disease in a timely manner. According to the American Dental Association, among parents of children under the age of 18, 64.6% reported that their children had visited the dentist every 6 months, 20.3% visited once per year, and 4.4% once every 2 to 3 years.9 Just over 1 in 10 said that their children had not visited the dentist in the last few years.9
One of the causes of childhood caries and poor oral health stems from the parents’ viewpoints and values of oral health.10 Parents/guardians must value the need for oral care to prioritize routine dental visits.10 Children mirror their parent’s actions. If the parent does not emphasize the importance of good oral hygiene for himself or herself, the child may not conduct the proper self-care.10 Likewise, if the parent does not have a dental home, there is a greater chance that a dental home will not be established for the child.10 In an article published within the Journal of the American Academy of Pediatrics, it was concluded that the role of the caregivers’ attitudes, beliefs, and perceptions were a major influence in regards to the poor oral health expectations association for their children.10 If a parent lacks knowledge about the benefits of maintaining good oral health, preventive care may not be pursued.10
The effect of dental visit frequency on learning
Dental pain may cause children to miss school. Research shows that children who go to the dentist only for emergency-based dental pain miss more school than children who go to the dentist routinely for preventive care.3 Absences that are caused by dental pain and irregular care are associated with poorer school performance, whereas absences for routine care are not.3 Untreated dental caries decreases a child’s ability to concentrate.6 The combination of missing school and being unable to concentrate may result in a lower grade point average.7 If a child’s oral health is improved, the child may miss less school due to dental pain and the child’s school performance might improve.3 According to the American Public Health Association, children with poor oral health status were nearly 3 times more likely than were their counterparts to miss school as a result of dental pain.3 Correspondingly, students with toothaches were almost 4 times more likely to have a low grade point average.7 Children who experience severe dental caries have many negative health outcomes, including underweight, poor growth, irritability, higher risk of hospitalization, disturbed sleeping, and diminished learning ability.11
Caries prevention during routine preventive dental appointments
Fluoride is a common prevention measure that can be delivered several ways to the teeth.5 These include community-based and self-administering options, such as water fluoridation, fluoride supplements, toothpaste, mouth rinses, and professionally applied fluoride varnishes and gels.8 Two or more professional applications of sodium fluoride varnish each year are effective in preventing dental caries in children of all ages with a high caries risk.8 According to the American Academy of Pediatrics section on oral health, it was made clear that fluoride varnish should be applied at least every 6 months to the teeth of all infants and children and every 3 months when teeth are first erupting until the time that a dental home is established.11 Without frequent preventive dental visits, children lack the opportunity to receive this professional application of fluoride treatment. Dental sealants are another caries prevention measure. School-based dental sealant programs provide care in areas of low socioeconomic status at little or no cost.12 Programs like these allow more children to receive sealants and prevent dental caries from developing.12 Providing sealants to 1,000 students prevents about 485 restorations and a little over one and a half disability-adjusted years of life.12 These programs save money and are cost-effective.12 Dental sealants are also applied at routine dental visits.
After reviewing the research, it was concluded that children who receive preventive dental care twice a year are more likely to perform better in school than children who only seek dental care for emergency cases. Children who go to routine preventive dental appointments may experience less dental pain and improve their quality of life.
Integration into practice
Educating parents on the significance of implementing daily brushing habits and nutritional tips to improve their child’s oral health and initiate oral care routine is a crucial service for dental hygienists to deliver. This may be performed during the parent’s preventive appointments. It is a convenient time and free education to complete. During this appointment, certain objectives may be initiated, such as demonstrating proper toothbrushing methods and healthy nutritional counseling to better their child’s oral home care. Dental auxiliary aids may be distributed to parents with children to provide them with supplies to encourage healthy oral habits.
In addition to dental professionals providing education, school-based oral health promotion programs may be implemented with the help of teachers, school nurses, and other health professionals. Family workshops presented at schools may be offered during parent-teacher conferences, open houses, school-based activities, or other events. Local dental hygienists could participate and volunteer to present information alongside teachers to increase awareness and preventative measures. This will be convenient, accessible, and free to all parents/guardians. This may influence teachers to incorporate lesson plans over dental care during in-class activities. This allows integrating oral health behavior into the children's learning environment. There are dental cooperations that may provide grants, dental supplies, and other resources for educational purposes to help promote good oral hygiene.
Increasing the delivery of affordable preventive services outside of the dental office may increase access to preventive care. Dental hygienists are capable of playing an important role in expanding affordable access to oral health care. Some examples include participating in university-based dental clinics, mobile bus system, and becoming advocates for public dental health. Schools allowing transportation to university-based dental clinics, or having dental hygienists go to schools via a mobile bus may allow for the twice yearly preventive treatment that can help increase academic performance. Another preventive measure that may be included is a free dental day specifically for children. Presenting information to the dentist about the high incidence of dental caries among children will raise awareness and promote preventive measures for community-wide involvement. School and community oral health programs are needed in areas of low socioeconomic status to provide preventive measures like sealants and fluoride to those who cannot afford it.
The authors would like to express their gratitude to their professor, Emily Holt, for her mentoring and editing of this manuscript.
Coradriana Lopez is a recent graduate from the University of Southern Indiana majoring in dental hygiene. She plans to practice dental hygiene in Dale, Indiana after completion of licensure requirements.
Breanna Hampton is a recent graduate from the University of Southern Indiana majoring in dental hygiene. She plans to provide dental hygiene care in a clinical setting in Indiana.
Kylee King is a recent graduate from the University of Southern Indiana majoring in dental hygiene. She plans to practice dental hygiene in a pediatric setting in Bloomfield, Indiana.
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