The economics of little teeth
Many large population studies from the United States and the United Kingdom indicate that there is a strong association between socioeconomic status (SES) and the risk of dental decay in preschool children.
The pattern tends to be that children from less well off families have the highest burden of untreated disease. Sadly this is also reflected in other chronic diet related diseases such as obesity and type II diabetes.
It is interesting to ask why this is and if it is true for Irish children?
In recent years there are new patterns of decay emerging in middle class children that have not yet appeared in the public health literature but which will be familiar to most wet fingered dentists treating children.
In America dental insurance serves as a strong indicator of socioeconomic status and is a powerful predictor of dental decay.
In the UK dental insurance is not common for children and the National Health Service provides care for the majority people over a lifetime. In the United Kingdom post codes and income are used more to determine socioeconomic status.
These systems have little in common with how dental care works in Ireland. Dental Insurance is a relatively new product in Ireland.
Since the embargo on recruitment the HSE only limited aspects of dental care for children. Unless there is dental emergency preschoolers have little contact with the public dental service. Yet this is a high risk group because decay is common and the effects of decay may be challenging and therefore costly to treat.
Whether you agree or disagree with the water fluoridation, it has been shown in large population studies to reduce the gaps in inequality in children's dental health by reducing levels of decay irrespective of socioeconomic status.
Whilst water fluoridation is widespread in the United States, it only reaches a small proportion of children in the United Kingdom.
Where Irish children have been exposed to fluoridated water significant reductions in dental disease are evident.
Studies about socioeconomic status often refer to maternal education, access to dental care services, maternal dental health and other indicators such as smoking to predict the risk of development of early childhood caries.
It is not that these facts are inaccurate but the question is: what is happening in middle class households that causes children to continue to develop tooth decay?
A difficulty that arises for many parents is confusion from food labelling driven by clever retail marketing; driven of course by economics. On the one hand parents are encouraged to ensure children get "the 5 a day" of fruit and vegetables.
Fruit juices may seem like a convenient way to achieve this. Many fruit flavoured beverages are advertised as having no added sugars and this is very difficult because they seem like good options to health conscious parents. Gummy vitamins and jellies that say no added sugar are the same.
They create confusion for parents who are doing their best to make healthy choices.
Many parents feel they need to try to get children to have enough fresh fruit.
Yet snacking frequently even on fruits can cause tooth problems due to the presence of natural sugars and acid. Dried fruits are actually more damaging to teeth than chocolate because of the way they stick to tooth surfaces and contain so much natural concentrated sugars.
Dental wellbeing can have a lot to do with economics but the picture may be less clear than we once thought. This highlights the importance of professional preventive advice tailored to your child's needs.
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