New Report Highlights Racial Disparities in Oral Health of Mass. Kids

B. Alex White, DDS, DrPH, director of analytics, Catalyst Institute, and lead author of the report, "The Oral Health of Massachusetts' Children"

KINDERGARTEN
Dental caries affected:

• 39.4% of non-Hispanic Black children, 1.7 times higher than non-Hispanic white kindergarten children
• 40.9% of Hispanic kindergarten children, 1.8 times higher than non-Hispanic white kindergarten children
• 41.5%
  of kindergarten children from low-income families, 1.9 times higher
  than kindergarten children from families with higher incomes.

3rd GRADE
Dental caries affected:

• 8.2% of Hispanic 3rd graders, 1.6 times higher than non-Hispanic white 3rd graders
• 60.8% of 3rd graders from low-income families, 1.9 times higher than 3rd graders from families with higher incomes

6th GRADE
Dental caries affected:

• 49.2% of Hispanic 6th grade adolescents, 1.6 times higher than non-Hispanic white 6th-graders
• 48.4% of 6th grade adolescents from low-income families, 1.7 times higher than 6th-graders from families with higher incomes.

Source: Executive Summary, "The Oral Health of Massachusetts' Children," Catalyst Institute, Jan. 2008

A new report of the Boston-based Catalyst Institute
finds that great racial disparities exist in the oral health of
children in Massachusetts, taking socioeconomic status into
consideration, too.

Alex White, DDS, DrPH, Catalyst's director of analytics,
talked to NEWz about the report and the necessity of preventing dental
disease - starting with Mom - before the baby is born.

"Waiting until age 4 or 5 to see a dentist is going to be too late," he said.

The Boston Globe covered the report, "The Oral Health of Massachusetts' Children," on Jan. 24, 2008, when Catalyst first released the report.

NEWz interviewed Dr. White by phone on Jan. 25. Following is the edited and condensed interview.

What were some of the report's major findings regarding African American and Latino children?

There were a couple key findings. First, an overall statement is that
dental caries, or dental disease, in Massachusetts affects lots and
lots of kids, both racially and ethnically diverse as well as white
kids. It's the most common chronic childhood disease in Massachusetts.

There are significant disparities among racial and ethnic minority
children in Massachusetts. Certainly the magnitude of the disparities
among racial and ethnic subgroups is much greater than the magnitude of
the disparities by income.

We looked at subgroups by race and ethnicity - for kindergarten,
third- and sixth-grade children. Pretty much across the board for
measures of oral health and pain and preventive care, the children who
were Latino, African American or other racial and ethnic minorities had
more disease, more pain, and more impact of the disease. Also, they had
less preventive care.

What else did your report find?

About 6,000 children statewide participated in the survey. Dentists
and dental hygienists looked at their teeth that had fillings or needed
fillings. About 28% of kindergarten kids, about 41% of third graders,
and about 34% of sixth-graders had at least one tooth that had or
needed a filling. These are the percentages statewide.

But when we break down the figures, for example, 41% of Hispanic
kindergarten kids had experienced dental decay. That's almost two times
higher than the rate for white kids.

For African American children in kindergarten, the rate was about 39%.
That was about 1.7 times higher than the rate for the White
kindergarten kids.

The percentages for third graders are much higher. Almost 58% of Hispanic third-grade kids had experienced cavities.

About half of Hispanic sixth-grade kids had experienced cavities.

What recommendations do you make?

Specific recommendations about what we can do, we don't make in the
report. But we identified, for example, that racial and ethnic minority
children in Massachusetts tend to receive fewer dental sealants than
white kids.

Dental sealants are thin plastic coatings that are put on the biting
surfaces of back teeth. These surfaces have pits and fissures in them
where food get packed into. Actually the most common place where
children get cavities is on the biting surfaces of back teeth. If we're
able to seal those teeth before cavities develop, we can prevent dental
disease.

There are known effective ways to prevent disease. Yet those kids
with the most disease aren't getting sealants. So one recommendation
might be, for example, to think about different ways to bring
preventive care to racial/ethnic minority kids.

Is there anything that schools can do?

By the time kids start school in Massachusetts - be they white,
black, Hispanic or other races or ethnicities - about 28% of them, on
average, already have disease. We have to reach out to them before they
start school.

Many of the efforts in Massachusetts to prevent disease are focused
on school programs. If we're going to do something to prevent disease
before children start school, we've got to look earlier in the course
of their development. Whether that's head-start programs, nursery
schools or daycare centers, whether that's educating moms or guardians,
there's a lot of strategy about how that might happen.

What groups worked with you heavily for your research? Who funded the report?

We worked with the New England Research Institutes, a company in
Watertown, Mass. We also partnered with colleagues at Boston
University, whose dentists and dental hygienists did the exams.

Delta Dental funded it entirely.

Why did you choose grades 3, 6 and kindergarten?

Third grade is a key grade. We wanted to make estimates of
third-grade kids because (dental health of children in) third grade is
(what) was studied in 2003 (by the Oral Health Collaborative of
Massachusetts). We wanted to compare our study with that 2003 one.

Third grade is also the age that most other states use for these kinds
of surveys. Third grade is also a time when we can look at whether kids
have dental sealants on their first permanent molars.

We looked at kindergarten because that gives us a sense of how much (dental) disease kids have when they begin school.

We looked at sixth grade because that's when kids are getting their
second permanent molar. It erupts at around age 12, before the wisdom
teeth do, and we wanted to see how many sixth graders were getting
dental sealants.

We collected information for each of the 14 counties in Massachusetts.

Which counties stood out in terms of racial disparities?

Our data encourages comparison of counties to the state average, not to each other.

Broadly speaking, the counties that tend to have more diversity were
the counties that had the most disparities. For example, Suffolk County
- and Boston schools were in our sample - had more disease than many
other counties.

Hampden County, where Springfield is located, had more disease than the state did.

What correlations did you see regarding socioeconomic status of families?

Disparities stood out for counties that have higher percentages of persons of color and
kids in low-income families. Low income in this study meant families
who were earning less than 185% of the federal poverty level. The exact
dollar amount depends on the family size.

For kids who qualified for the free lunch program, families
had to earn less than 130% of the federal poverty level. In 2007, that
meant $26,000 or less for a family of four.

For reduced (price) school lunches, kids' families had to earn less
than 185% of the federal poverty level. In 2007, that mean $37,000 for
a family of four.

Lack of dental care leads to infections and cavities, but so what?

First, we know how to prevent this disease. It's hard to reconcile
this level of disparities in oral health, in a condition that we can do
something about. This is not to suggest that the answer is to get kids
to the dental office.

Second, dental caries (the bacteria that lead to cavities) aren't
without consequence. Many minority children have a significant amount
of untreated disease; that is, cavities that need to be filled.

Without treatment, these cavities continue to progress. When they get
advanced enough, they begin to cause pain and swelling. For very young
children with extensive disease, it requires often that they be sedated
or hospitalized.

If the disease gets severe enough, costs and risks are involved for
these kids. General anesthesia for kids is not without its own risks.

Is dental care of kids given too little priority?

We're really obliged to think of oral health as part of general health. Kids that have dental cavities aren't healthy.

It's important to note that this is an infectious disease; it's caused
by bacteria transmitted from the primary caregiver, often the mother.
We're all infected with this bacteria. It's transmitted through
families just through, for example, kissing or tasting (a child's) food
to see if it's too hot or cold.

To the extent that we can reduce the disease burden in expectant
mothers and new moms - around the time when the baby's teeth are first
coming in - there are opportunities to influence the mom's health and
reduce the virulence of the bacteria. That is, if we can bring the
bacteria under control in the mom, then when the kid gets that bacteria
from his or her mother, it might be less strong or aggressive.

For kids, It's that transmission from mom to child that's more
(crucial) than the systemic diseases. Waiting until age 4 or 5 to go
see a dentist is going to be too late.

What advice do you have for parents of limited financial means who want their children to have good dental health?

From my perspective, it's important to know that good dental health
doesn't come from the dentist. The dentist or dental hygienist helps in
that process, but there are lots of things that we can do as parents,
uncles or aunts, or grandparents.

It's about good diets, limiting sugar, asking questions about what to expect about kids' teeth. Baby teeth are important.

Build good habits early about brushing teeth. It's important to brush using toothpaste that has fluoride.

SEE ALSO IN NEW ENGLAND ETHNIC NEWS:

"Mass. Secretary of Health JudyAnn Bigby, MD, on the Persistence of Racial and Ethnic Health Disparities," Dec. 6, 2007

SEE ALSO:

Executive Summary of Report of "The Oral Health of Massachusetts' Children," Catalyst Institute, Jan. 2008

Full Report: "The Oral Health of Massachusetts' Children," Catalyst Institute, Jan. 2008

En Español: "Dental Minutes" (IN SPANISH), American Dental Association

"Access to Dental Care," American Dental Association

"Children and Dental Health" (various topics), American Dental Association

"Are You Feeding Your Kids Tooth-Friendly Foods?" Columbia Univ. College of Dental Medicine

Source: EthnicNewz.org

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