Most Common Chronic Disease Among U.S. Children
Prevalence and Risk
Severity
Unmet Treatment Needs
References

Among the many dental conditions affecting children, dental caries (tooth decay) is the preeminent concern in the context of Medicaid services because of their substantial prevalence in the low-income population. Tooth decay continues to be the single most common chronic disease among U.S. children, despite the fact that it is highly preventable through early and sustained home care and regular professional preventive services.

The prevalence and severity of tooth decay in U.S. children has changed considerably over the past several decades. Once a disease of nearly universal occurrences for nearly all children, tooth decay is now generally distributed in the pediatric population to the point that roughly 80 percent of caries in permanent teeth is concentrated in 25 percent of U. S. children. ¹ Also, minority and low-income children disproportionately experience decay in their primary teeth. The high-risk, high-prevalence, high-severity group, which currently represents nearly 20 million children, is largely comprised of low-income children (nearly all of whom are eligible for Medicaid or SCHIP), with higher levels of caries found in African-American and Hispanic groups at all ages. ²

Dental caries generally is considered to be reversible or capable of being arrested in the earliest stages through a variety of proven interventions. Beyond the early stages, the decay process generally tends to advance and become more difficult and costly to repair the longer it remains untreated. Hence, treatment initiated early in the course of dental caries development will almost always be easier for both child and dentist, less expensive, and more successful than treatment begun at a later time.

Prevalence and Risk

Data from recent national surveys reaffirm the persistence of dental caries as the single most prevalent chronic disease of childhood. Roughly half of U. S. children experience dental caries by age nine; and the proportion rises to about 80 percent by age 17. Overall, national epidemiological surveys show that nearly one-in-five (18.7%) U.S. children two to four years of age have visually evident tooth decay. Since these surveys are conducted without the aid of dental radiographs (xrays), typically used as part of dental diagnostic examinations to help detect decay in hard-to visualize areas (e.g., between adjacent teeth), the actual prevalence is undoubtedly higher. Tooth decay is closely tied to socioeconomic levels, with children from low-income families more likely to develop caries. Preschoolers in households with incomes less than 100% of the federal poverty level (FPL) are three to five times more likely to have cavities than children from families with incomes equal to or above 300 percent of the FPL. The Third National Health and Nutrition Examination Survey (NHANES III) ³ found visible decay in 30 percent of two to five year-old children in poverty and 24 percent of near-poor children (100%-200% of the FPL). Caries was present in only 12 percent of middle-income youngsters and 6 percent were from families with the highest income

Severity

Within the highest-risk, lowest-income group, roughly one-quarter or four to five million children experience more severe levels of the disease, often with associated pain, infection and disruption of normal activities. These children generally acquire the disease early in childhood and often present as infants with multiple teeth in advanced stages of decay (a condition now referred to as "early childhood caries" or "ECC," and known previously as "baby bottle caries"). Children living in households below 200 percent of the poverty level - roughly half of U. S. children - have three and one half times more decayed teeth than do children in more affluent families.

Unmet Treatment Needs

Dental care is the most common unmet treatment need in children. ⁴ Lower-income children have more untreated dental disease than more affluent children who obtain care on a regular periodic basis. Reasons for this disparity include the fact that low-income children are more likely to experience dental disease and frequently only access care on an episodic or urgent basis when decayed teeth cause pain or swelling. NHANES III, the most recent national survey, found that nearly 80 percent of the decayed teeth of poor two to five year olds and 40-50 percent of the decayed permanent and primary teeth in 6-14 year olds were unfilled (untreated).

Consequences

The consequences of severe, untreated dental disease and poor oral health in millions of American children are evident in many dimensions. Biologically, untreated dental disease can lead to pain, infection and destruction of teeth and surrounding tissues with associated dysfunction. Untreated tooth decay may lead to delayed overall development among young children affected with severe forms of the disease. Dental diseases have been shown to be associated with systemic health conditions. Socially, affected children have problems with school attendance and performance, and are often stigmatized because of their appearance. Potential consequences to the health system as a result of poor dental health care would include: frequent visits to emergency departments (often without definitive resolution of the presenting problem); hospital admissions; and treatment provided in operating rooms for conditions that are either largely preventable or amenable to less costly care had they been treated earlier.

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2. Vargas C, Crall J, Schneider D. Sociodemographic distribution of pediatric dental caries: NHANES III, 1988-1994. J Am Dent Assoc. 1998; 129:1229-1238.
3. Vargas C, Crall J, Schneider D. Sociodemographic distribution of pediatric dental caries: NHANES III, 1988- 1994. J Am Dent Assoc. 1998; 129:1229-1238.
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