As a bright-eyed, hard-working new intern in the University of Florida Health inpatient unit, I cared for many children suffering ailments that I expected to see. Treating bronchiolitis, asthma and septic joints were all part and parcel of what it meant to me to be a pediatrician.
But one recurring diagnosis surprised me: dental abscess in need of IV antibiotics.
Why were so many children in Gainesville progressing from a simple cavity to a serious medical problem? Rather than a simple cavity requiring a filling, in these children bacteria had infected and inflamed the tooth's inner pulp, then its root and surrounding tissue in the gums, face and beyond. A problem that could have been prevented or treated at an early stage was reaching the point of requiring an expensive inpatient hospital stay followed by dental surgery.
To learn more about why this was happening, I sat and talked with one mother of a child admitted to the hospital with a dental abscess. She told me that she had tried calling more than 10 dental offices over the span of three months. None of them would see her daughter because they did not accept Medicaid, and she did not have the funds to pay out of pocket for care.
Meanwhile her daughter was enduring excruciating pain every day as she developed the abscess, ending up in the hospital before anyone would care for her.
"Why were so many children in Gainesville progressing from a simple cavity to a serious medical problem?"
Primary dental care is much like primary medical care; providing preventive services is much more effective and cost-efficient than seeing patients after the damage is done. Yet access to preventive dental care can be a huge problem for patients, as I have seen countless times in both the hospital setting and my primary care office.
Our office has developed a list of local providers who will accept Medicaid and those who will deliver care on a reduced fee basis. However, getting this list to all patients in need in Gainesville is difficult. And even if every patient with Medicaid or no insurance who needed dental care called a provider on the list, they would still be in trouble, because there are only 11 total dental clinics in Gainesville that accept Medicaid or offer a reduced fee for pediatric patients. This number has improved from the past, but there is still some way to go in providing primary dental prevention for the children of Gainesville.
The problem is not unique to our area. Nationwide, nearly 52,000 people live in areas with designated shortages of dental health professionals, according to the Health Resources and Services Administration. One way to help fill this void and increase access to care when needed is to provide basic dental care services in the pediatric office. On my first clinic day as a pediatrician, I was surprised to find that we offered fluoride varnish treatments for all of our patients in clinic, starting when the first tooth appears.
My preceptor explained to me that dental caries is actually the most common chronic childhood disease in the United States. Fluoride protects teeth against cavities by helping to remineralize the enamel and inhibiting bacterial acid production. The use of fluoride varnish actually decreases the rate of decayed, missing and filled tooth surfaces by a whopping 33 percent in primary teeth and 46 percent in permanent teeth.
" One way to help fill this void and increase access to care when needed is to provide basic dental care services in the pediatric office."
The United States Preventative Services Taskforce recommends that clinicians apply fluoride varnish to patients at least every six months through age 5. The American Academy of Pediatrics (AAP) echoes this recommendation, and even suggests higher risk patients receive fluoride varnish every three months.
Reviewing the evidence on how such simple steps can have a significant impact on the dental health of children who might otherwise go without preventive care—and excited I could actually do something in my practice to prevent seeing that little girl on my inpatient unit again--I began following these recommendations for all of my patients.
Sometimes, though, increasing access to care involves getting out into community. In Gainesville, our residency program created "Healthy Smiles Day." During this popular and fun outreach event, 12 of our pediatric residents join two community dentists to provide free preventive dental care at the city's Southwest Health Clinic. This clinic is in one of the poorest areas of Gainesville, where patients face numerous health disparities.
Residents were excused for a half-day of work to run the event. After the screening, education and fluoride varnish applications were performed, and patients with more advanced dental health problems were scheduled for an appointment to return to the clinic for further evaluation. Free books, toothbrushes, toothpaste, and floss were provided to each patient as a part of the AAP's Brush Book and Bed program to promote oral health. The residents participating in the event left with "goodies," too: education about proper oral health screenings from the dentists there.
The event reinforced in my mind the impact community involvement can have on patient care, and the importance of a lifetime of advocacy for our patients. While it will take even more hard work and dedication to ensure adequate oral health care for all of our patients, I have no doubt it is achievable and work worth the effort.
The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics.
Brittany Bruggeman, a second-year resident at the University of Florida Health program in Gainesville, FL, is the American Academy of Pediatrics Section on Pediatric Trainees District X Representative.