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Part 3: Nothing to smile about

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This is the third installment in a series of articles focusing on oral health in West Virginia.

HUNTINGTON — The young girl didn’t want to open her mouth.

Her mother pleaded with her. Dr. Dan Brody tried to coax her, but she bit down, jaw locked. She wasn’t opening her mouth for the dentist. Not for anyone.

So Brody gently pulled her upper lip back. The girl’s mouth popped opened.

It didn’t take long for Brody to figure out the problem.

The girl’s front teeth were rotted. “Baby bottle caries” was the diagnosis. Brody would have to refer her to an oral surgeon. All of her top teeth would have to come out.

The mother confided that her daughter carried a “sippy cup” filled with juice all day. At night, the girl fell asleep with a bottle filled with milk.

“Unfortunately, dental disease isn’t like pulling a muscle,” said Brody, who estimated the extractions would cost about $5,000. “It just doesn’t get better in a couple of days.”

Brody sees oral disease in children firsthand in Valley Health’s community health centers across Southern West Virginia and here at the organization’s office in Huntington where new and expectant mothers take classes on oral hygiene. The classes are part of the federal Women, Infants and Children supplemental food program.

Dental disease is the single most prevalent chronic childhood disease — five times more common than asthma. It’s almost 100 percent preventable.

Throughout the state, children with untreated cavities, abscessed teeth and gum disease are suffering with pain, missing school, having difficulty concentrating, developing speech impediments, not eating right, not sleeping at night and not feeling good about themselves.

About 65 percent of West Virginia children have cavities by age 8, according to a West Virginia Healthy People study. About one of every three children in the state suffers from untreated decay.

Dental disease hits especially hard among poor children. About 80 percent of cavities are in 20 percent of children — mostly low-income kids.

Only 36 percent of West Virginia children eligible for Medicaid saw a dentist last year.

Although many West Virginia dentists are willing to see Medicaid children, parents complain few dentists are willing to take new patients. West Virginia has more than 200,000 kids enrolled in Medicaid, a state-administered insurance program for the needy.

“It’s mind-boggling to me that we have children in our community who struggle with that pain in their mouth every day,” said Jennifer Boyd, medical director for the New River Health Association in Fayette County. “It’s unconscionable.”

‘100 percent preventable’

Southern West Virginia children are much more likely to see a doctor than a dentist.

So Brody tries to spread the word about oral hygiene to people on the front lines of the state’s battle to improve dental health: doctors, physician assistants, nurses, outreach workers.

On a recent morning, Brody spoke at a New River Health clinic in Whipple. He urged health professionals to look in children’s mouths during routine visits. Look for plaque, decay and lesions, he said.

“The sad fact of the matter is the problems we see in the pediatric population are 100 percent preventable,” Brody said. “It’s a whole lot easier to prevent a problem than to try to cure it.”

Brody had a PowerPoint presentation. He showed a slide of a child’s mouth. The people in the audience gasped, a collective “ooh,” a few “yucks.”

“The front teeth are totally destroyed by decay,” Brody said. “How many times do we know children afraid to smile?”

Brody said there’s a misconception about baby teeth, that it doesn’t matter if they decay and fall out. Wrong, he said. Baby teeth provide space for permanent teeth to erupt. Children who lose baby teeth prematurely wind up with teeth that overlap — “teeth tusks,” Brody said.

In West Virginia, nearly 90 percent of children between ages birth and 3 haven’t seen a dentist in the past month, according to a recent survey. There are only 15 pediatric dentists practicing in the state. Brody recommends that children see a dentist around their first birthday.

“You don’t inherit bad teeth,” he said. “You inherit bad habits. You inherit bad attitudes.”

One of the oral health seminar’s participants was Teri Harlan. She runs school-based health clinics in Fayette and Nicholas counties. She’s frustrated that the clinics don’t have dentists.

They see so many children with so many cavities, children in pain.

“We tell them you really need to see a dentist, but there’s no one here to see you,” Harlan said.

Youngest most at risk

The children were getting restless, so Brody and Georgia Frye, a West Virginia University dental student, pulled out the show-stopper: “BG Roo, the Aussie Tooth Fairy.”

BG Roo is an orange stuffed toy kangaroo, a prop to show children and their parents good oral hygiene practices at Valley Health’s office in Huntington.

Brody and Frye were knee to knee, the stuffed animal on their laps. Brody held an oversized toothbrush and scrubbed the stuffed kangaroo’s oversized teeth.

“You can’t scrub a child’s teeth too hard,” Brody told the dozen parents in the room at the Valley Health office in Huntington. “Look in your child’s mouth. Pull up the lip.”

Following the presentation, mothers and children retreated to the back of the room for free examinations.

Brittani Evans, 19, held her 5-month-old son, Miles, on her lap. Evans said she used to hitchhike and hopped coal trains across the country. She was home in Huntington now, trying to find an affordable dentist.

“We’ve been looking everywhere,” she said. “We haven’t been able to find anything.”

Brody gave her instructions for caring for Miles’ teeth: Clean his gums with a washcloth; start brushing when his first tooth erupts; nothing but water at bedtime; don’t forget to look in his mouth.

“The more he gets used to this, the better off he’ll be when he gets older,” Brody said. “He’s not going to fight you and give you any problems.”

Brody has had children throw up on him. They’ve bitten his finger. He’ll finish his lecture, then watch a mother give a child a lollipop. It’s the young children that worry him most.

Across the nation, cavity rates are decreasing among children ages 6 to 19, but increasing among kids ages 2 to 5. Decay in infant teeth increased from 24 percent to 28 percent from 1988 to 2004, according to a federal report released last week.

“If your child has a mole on his butt, you’ll know where it is,” he said. “But so many people don’t know their child’s mouth.”

To contact staff writer Eric Eyre, use e-mail or call 348-4869.

Tips to prevent cavities in children

Clean the mouth: Clean the mouth of your baby soon after birth by wiping and massaging the gums with a wet cloth or gauze. Begin brushing with a soft-bristled, small-head toothbrush as soon as the first tooth erupts. Floss your child’s teeth as soon as the teeth begin to touch. You should brush your child’s teeth until they are 9 years old.

Examine your child’s teeth: Lift your child’s top lip and look for decay. If you see a white chalky spot on the surface of the tooth or black or brown stains, take your child to a dentist.

Maintain healthy feeding and eating habits: Diets that contain sugary foods, soft drinks and fruit juices are most likely to promote cavities. Drinks high in sugar should not be given in a bottle or “sippy” cup. Never let your child go to sleep with a bottle filled with anything other than water.

Make sure to get fluoride: If you have well water or non-fluoridated drinking water, ask your dentist about fluoride supplementation. Fluoride helps make teeth more resistant to decay.

Make oral health your priority: The bacteria that causes tooth decay is passed from parents to their children. Brush your teeth at least twice a day for two minutes. Floss daily. Have your teeth cleaned by a dental professional every six months.

Sources:

Valley Health Systems and rush2brushwv.com

On Monday, the series concludes in the Gazette with a look at fluoridated water in West Virginia.


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