In Honor of Halloween

Since today is Halloween, I thought I would take this chance to consider one of the most underemphasized childhood health problems: cavities. While small in size, cavities may end up having a huge impact. In industrialized nations, about 60-90% of schoolchildren are affected, damaging a child’s ability to properly learn and develop. In the United States alone, it’s estimated that about 51 million school hours are lost annually to dental-related illness. In many states, low-income communities are the most heavily impacted, due to poor nutrition and limited access to affordable healthcare. School oral health programs, subsidized health care, and tap water fluoridation programs work to reduce these issues, and have had some measure of success.

Photo Credit: Spear Education

But when it comes to developing nations, interventions such as tap water fluoridation simply aren’t enough. For one thing, many developing nations have a shortage of qualified dentists and dental hygienists. Haiti, for example, has 94 dentists serving the entire country, meaning that few individuals have access to a dentist, and fewer still are able to afford the services. In addition, interventions which have been highly successful in developed nations are less viable for isolated populations. While the United States has an established water system, many rural communities lack a similar infrastructure.

South America in particular has been heavily impacted by dental cavities. Children as young as six to seven months have been found with severe tooth decay, contributing to malnutrition and future oral health problems. Studies have found that indigenous populations the most vulnerable, due to their isolated locations and other socio-cultural factors. In addition to barriers of cost, distance, cultural beliefs, and language, many indigenous populations may be unwilling to approach medical professionals due to insensitive and callous treatment. Further, there is a lack of knowledge surrounding proper oral hygiene and nutrition. The spread of processed food products and beverages, high in refined carbohydrates and saturated fat, has introduced new health concerns into populations without the means of addressing them.

As one study notes, prior to the 1960s, when industrialized food products first began making their way to rural regions, indigenous populations such as the Xavante Indians in Brazil had extremely low rates of caries. As these products became more common, rates of dental caries also began to rise.  Misconceptions surrounding the benefits of these new modern food products encourage parents to add unhealthy products to their child’s diet. A study in Guatemala examined the dietary patterns of young infants and children, and found that many women in rural regions supplemented breastfeeding with sugary beverages such as coffee, juices, and soft drinks, believing that these products were better for children. While the higher cost of these products limit how often families may consume them, parents also mistakenly believe that the greater expense means the products are superior to traditional staples.

Urban populations aren’t exempt from the impact of dental caries either. While urban children have a greater chance of accessing dental care due to physical proximity to clinics, the barrier of cost and the availability of trained professionals also limit the number of children receiving care. Of all Nicaraguan schoolchildren, only 28% were able to visit a dentist, and the majority did so for curative rather than preventative treatment. In addition, urban populations are more likely to have access to sugary beverages and food items, making cavities more common.

To reduce the number of dental caries in regions with such diverse populations and isolated communities, governments and organizations have begun developing unique and innovative programs. In my next post, I’ll highlight some of the most effective and sustainable methods being employed, including some that have been able to reduce childhood cavities by almost 20%. In the meantime, I wish you all a happy Halloween and happy oral health!


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