Lexington Herald-Leader

March 19, 2008

Protect children's dental health

By Al Smith And Lacey McNary

In a rare gesture of unity, the General Assembly moved last week toward addressing the deplorable oral health of thousands of poor children in Kentucky.

With support from the Kentucky Dental Association and some 30 advocacy groups, the Senate Education Committee unanimously recommended House Bill 186, which mandates dental screening for children ages 5 and 6 as they enter school.

As amended slightly, the bill requires exams by dentists and permits screenings by qualified physicians and nurses who will refer the children to dentists for children. The measure would be a significant step toward stopping a spiral of neglect that ends in total tooth loss among adults, a problem in which Kentucky leads the nation.

Passage by the full Senate would signal bipartisan resolve to reverse the damage that tooth decay, starting in early childhood, is inflicting on our health, educational success, economy and self-esteem.

Tooth decay is the most chronic childhood disease, and dental pain is the No. 1 cause for public school absences. Nearly half the 2- to 4-year-olds in a recent study had cavities, twice the national rate. Half the kids of any age in our state have cavities.

With nearly 500,000 Kentucky children living in or near poverty, fewer than 400 of the state's 2,300 dentists treat many of them. The government payments to dentists who will see these kids are low. But there are other reasons that a shocking two-thirds of children eligible for government-paid dental treatment seldom see a dentist.

Lack of transportation is one issue; fewer dentists in rural areas is another. And dentist office hours are often inconvenient for working parents. But the dentists who don't see poor kids cite reasons beyond low pay: adults who fail to keep children's appointments or who won't follow up treatment with home supervision of brushing and flossing and a healthy diet.

Too many Kentucky children grow up on sugared drinks and candies, followed by tobacco use, all ruinous to teeth and gums.

And then, for the very young, there may be a two-way exchange of apprehension: the screaming child who is afraid of the dentist and the anxious dentist, lacking pediatric training, who is afraid of the child.

Historically, the culture of rural Kentucky has stoically accepted the loss of teeth as a price of poverty or just growing older. But the bill enlists all Kentuckians in a positive response to the alarming new research that links an unhealthy mouth to the major Kentucky killers -- cancer, heart disease, stroke, obesity and diabetes -- as well as pre-term, low-weight babies.

"This bill will give every child a dental home at the beginning of his and her education," says Dr. Fred Howard, KDA president. It also offers an upbeat approach to saving teeth and creating healthy smiles and confidence for young people starting careers.

Howard, of rural Harlan County, has also pledged that KDA members will treat every poor child not covered by government insurance, perhaps 12,000.

Howard's commitment to this outreach reflects a new determination by private dentists to partner more aggressively with public-health doctors, school clinics and university dental colleges. It also builds on national stories by The New York Times and ABC about the efforts of two remarkable private dentists in Barbourville, Drs. Edwin Smith and Devert Owens, who are seeing nearly 60 percent of the poor kids in their county regardless of ability to pay.

The toll of poverty and neglect is found in the teeth of Kentucky's children. But a favorable vote on the bill in the Senate should begin a new story of positive public health efforts in Kentucky -- not unlike the crusades in the last century against infant mortality, child labor and the ravages of tuberculosis, typhoid, hookworm and blindness from a disease called trachoma. These scourges are almost forgotten now, but only because politicians listened to the public and found the will to fight them.

Veteran journalist Al Smith co-founded the Institute for Rural Journalism and Community Issues at the University of Kentucky. Lacey McNary is deputy director of Kentucky Youth Advocates.