It's not uncommon for Dr. Sandra Bennett to shine a light into the mouth of a child from a low-income community and find cavities so large they can be spotted with the naked eye – an indication that they've been there for a good two or three years.
She has also seen young children who had 16 to 18 of their 20 teeth requiring fillings.
Bennett, a program and standards adviser in dentistry at Ontario's Ministry of Health, works with Ontario's Children in Need of Treatment (CINOT) program, a provincial initiative that provides basic treatment and prevention for children and teens with urgent dental conditions whose families have no dental insurance or other coverage.
As part of public health’s Child Health Program, CINOT is administered by Ontario’s 36 public health units on behalf of the ministry. Children receive care in private dental offices, public health clinics and hospital operating rooms. In 2011 alone, the program paid for basic dental care for 40,360 children and youth with serious oral health conditions.
“We find low-income families don't realize that children have oral health problems and wait until the child complains of pain, which is a late indicator when it comes to dental disease,” says Bennett. “By that time, the problem is really quite advanced and costly to fix.”
Dr. Rosamund Harrison, the University of British Columbia’s chair of paediatric dentistry, says a significant predictor of cavities is economic status.
She has promoted accessible, community-based oral health programs for hundreds of babies and toddlers in B.C.'s Lower Mainland. The Children’s Dental Program at UBC offers free basic dental and preventive services to low-income school-aged children from the Lower Mainland who are not eligible for existing government-funded programs.
“One of the issues with this demographic is that these families already have many challenges from finding housing and jobs as well as the stress of immigration,” says Harrison. “Looking after dental health is often not their first priority.”
Bennett says transitioning from another culture can also have an affect on your oral health.
“When immigrants transition from the diet of their home country to a Canadian diet, they often don't understand that because our diet is often higher in carbohydrates and sugar, they need to be more diligent with brushing,” she says.
According to the Canadian Oral Health Measures Survey, 2007-2009, twice as many lower-income Canadians have cavities that need a filling compared to Canadians from the higher income group.
For children, a decline in oral health can affect other areas in their life, including their overall health, education and social life.
“We've worked with inner-city communities where teachers have noticed kids are not doing well in school because they have a toothache,” says Harrison. “If they're in pain, they can't concentrate, which affects their progress in school. Or they'll stay home because they have sore teeth. Also, if a child's teeth don't look good, it can affect their self-esteem.”
Harrison and Bennett also spend time teaching parents how to promote healthy oral care at home.
Dr. Irwin Fried, director of the division of paediatric dentistry at McGill University in Montreal, shares in this mission. As part of the undergraduate teaching clinic, part of McGill's dentistry program, he busses in low-income students for checkups and dental work.
He says one of the biggest mistakes he sees parents make is putting babies and toddlers to bed with a bottle of milk.
“It's good not to get into the habit of doing this because milk sits on the teeth and causes cavities,” he says.
Fried also says it's wise for parents to brush their children's teeth for them.
“Let them brush by themselves first and help them afterwards,” he says. “Many kids don't have the dexterity to properly brush on their own.”
Flossing is also an important factor to proper oral health, which Fried says should be introduced to children as soon as the teeth appear to be touching.
“The easiest way to floss a child's teeth is to get them to lie down on a bed and sit behind them or have their head on your lap,” he says. “That way you're working with direct vision.”
Limiting sugary, in between-meal snacks is also important, says Harrison, as well as making sure children eat a healthy diet, including crunchy fruits and veggies.
Bennett also warns against putting juice in a toddler's sippy cup because all the sugars found in juices can eventually rot their teeth.
“If you're going to give your child juice, give it to them in a cup,” says Bennett. “Children shouldn't be sipping juice for a long period of time.”
She also advises families to use toothpaste with fluoride. If they can't afford to buy some, they should contact their local public health unit because they often have samples on hand. And if that's not an option, “the other thing they can use is baking soda,” says Bennett. “It's good at removing stains but it's doesn't taste great.”