Preventing Toothache in Primary Care
Preventing Toothache in Primary Care
Lewis C, Stout J
Arch Pediatr Adolesc Med. 2010;164:1059-1063
On the basis of a nationally representative sample, about 7.5 million children in the United States had a toothache in the past 6 months (95% CI, 7.1-7.8 million). At least 88% of children with a recent toothache had at least 1 well child care visit in the previous year.
In their recent article, published in The Archives of Pediatric & Adolescent Medicine, Lewis and Stout suggest that because children visit physicians more often than they visit dentists, there is enormous opportunity to intervene and influence the incidence of toothache in vulnerable children (eg, poor, minority, or special needs). This includes placement of fluoride varnish, oral screening, assessment of chief dental symptoms, and dental referral.
Lewis and Stout reported prevalence of children's toothaches from data obtained from the 2007 National Survey of Children's Health, a telephone survey of 91,642 households with children younger than 18 years. The survey was conducted from April 2007 to February 2008, and information was collected in all 50 states and Washington, DC. Parents/guardians were asked whether their child had a toothache in the previous 6 months. Of 86,730 children whose parent/guardian responded, 10.7% (95% CI, 10.2%-11.3%) of children aged 1 to 17 years had a toothache in the past 6 months.
Geographic differences among children with toothache were reported, with Massachusetts having the lowest reported incidence (6.9%) and Mississippi the highest (16.2%). Among children with toothache, more than half (58%) had concurrent dental caries. Among children aged 6-12 years, rates of reported toothache for the previous 6 months were high, at about 14.1% (odds ratio, 1.94; 95% CI, 1.67-2.25). About 1 in 7 children aged 6 to 12 years were affected by toothache. From an analysis of data by race, ethnicity, income, special needs, and functional limitations, disparities were found in the number of reported toothaches, according to race, special needs, and presence of functional limitations.
I applaud Drs. Lewis and Stout for their study and conclusions. As an urban family physician in Massachusetts, I am confronted with children in pain from untreated tooth decay on a daily basis. Although the investigators found that Massachusetts has the lowest incidence of toothache, a state study concluded that this equates to almost 1 child in every classroom (1 in 20 children in kindergarten and grades 3 and 6) having oral pain. Furthermore, in our state, untreated tooth decay is twice as common in Hispanics and 2.5 times as common in blacks. Clearly, this is unacceptable.
The investigators concluded that primary care practitioners must play a role in preventing toothache in children. A child is brought to a physician or other primary care provider for well baby and child healthcare an average of 6-10 times before ever seeing a dentist. To assist pediatricians and family practitioners, the American Academy of Pediatrics (AAP) has prepared a curriculum for physicians, and a similar one is available from family medicine educators Champions of these 2 efforts are working with national medical school administrators (eg, the Association of American Medical Colleges [AAMC]) and the appropriate residencies to help educators incorporate these modules into practical teaching settings. These and other modules are available for online continuing medical education and are offered at many state and national AAP meetings.
I propose that, as clinicians, we need to go even further. We need to join others in broad-based oral health coalitions to combat toothaches in our towns and cities, our counties and our states. In this way we can meet our families where they gather — at prenatal classes; Women, Infants and Children programs; Head Start programs; and in schools. We can join to offer screenings and fluoride varnish programs and help expand efforts for preventive education and early diagnosis for referral. The timing is right for the medical profession to take this on — the curricula are available; the AAMC and residency educators are taking up the cause; and states are now looking for inexpensive, creative means to solve difficult health problems. Together, we can end the silent, but painful, epidemic of toothache among children in our country.
Abstract
Toothache in US Children
Lewis C, Stout J
Arch Pediatr Adolesc Med. 2010;164:1059-1063
Study Summary
On the basis of a nationally representative sample, about 7.5 million children in the United States had a toothache in the past 6 months (95% CI, 7.1-7.8 million). At least 88% of children with a recent toothache had at least 1 well child care visit in the previous year.
In their recent article, published in The Archives of Pediatric & Adolescent Medicine, Lewis and Stout suggest that because children visit physicians more often than they visit dentists, there is enormous opportunity to intervene and influence the incidence of toothache in vulnerable children (eg, poor, minority, or special needs). This includes placement of fluoride varnish, oral screening, assessment of chief dental symptoms, and dental referral.
Lewis and Stout reported prevalence of children's toothaches from data obtained from the 2007 National Survey of Children's Health, a telephone survey of 91,642 households with children younger than 18 years. The survey was conducted from April 2007 to February 2008, and information was collected in all 50 states and Washington, DC. Parents/guardians were asked whether their child had a toothache in the previous 6 months. Of 86,730 children whose parent/guardian responded, 10.7% (95% CI, 10.2%-11.3%) of children aged 1 to 17 years had a toothache in the past 6 months.
Geographic differences among children with toothache were reported, with Massachusetts having the lowest reported incidence (6.9%) and Mississippi the highest (16.2%). Among children with toothache, more than half (58%) had concurrent dental caries. Among children aged 6-12 years, rates of reported toothache for the previous 6 months were high, at about 14.1% (odds ratio, 1.94; 95% CI, 1.67-2.25). About 1 in 7 children aged 6 to 12 years were affected by toothache. From an analysis of data by race, ethnicity, income, special needs, and functional limitations, disparities were found in the number of reported toothaches, according to race, special needs, and presence of functional limitations.
Viewpoint
I applaud Drs. Lewis and Stout for their study and conclusions. As an urban family physician in Massachusetts, I am confronted with children in pain from untreated tooth decay on a daily basis. Although the investigators found that Massachusetts has the lowest incidence of toothache, a state study concluded that this equates to almost 1 child in every classroom (1 in 20 children in kindergarten and grades 3 and 6) having oral pain. Furthermore, in our state, untreated tooth decay is twice as common in Hispanics and 2.5 times as common in blacks. Clearly, this is unacceptable.
The investigators concluded that primary care practitioners must play a role in preventing toothache in children. A child is brought to a physician or other primary care provider for well baby and child healthcare an average of 6-10 times before ever seeing a dentist. To assist pediatricians and family practitioners, the American Academy of Pediatrics (AAP) has prepared a curriculum for physicians, and a similar one is available from family medicine educators Champions of these 2 efforts are working with national medical school administrators (eg, the Association of American Medical Colleges [AAMC]) and the appropriate residencies to help educators incorporate these modules into practical teaching settings. These and other modules are available for online continuing medical education and are offered at many state and national AAP meetings.
I propose that, as clinicians, we need to go even further. We need to join others in broad-based oral health coalitions to combat toothaches in our towns and cities, our counties and our states. In this way we can meet our families where they gather — at prenatal classes; Women, Infants and Children programs; Head Start programs; and in schools. We can join to offer screenings and fluoride varnish programs and help expand efforts for preventive education and early diagnosis for referral. The timing is right for the medical profession to take this on — the curricula are available; the AAMC and residency educators are taking up the cause; and states are now looking for inexpensive, creative means to solve difficult health problems. Together, we can end the silent, but painful, epidemic of toothache among children in our country.
Abstract
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