Two-and-a-half-year-old Santiago would scream in terror every time his parents tried to brush his teeth. Santiago's autism makes him fearful of many everyday activities. 

"His mother and grandmother had to encircle the boy and hold him tightly each time they tried to brush his teeth, and he would pinch and bite and kick," says Lisa Haney, manager of the Anderson Center for Dental Care at the Children's Hospital and Health Center in San Diego. Needless to say, Santiago's teeth were in bad shape.

So the Anderson Center sent a dental hygienist and a dental educator, both of whom spoke Spanish, to Santiago's home in Chula Vista. During their two-hour home visit, the dental team learned that Santiago loved to blow bubbles. They were able to get Santiago to open his mouth and associate tooth-brushing with bubble-blowing.

Dental health outreach

The nonprofit Anderson Center was set up five years ago at Children's Hospital to promote dental health practices for children from infancy to age five. "Dental cavities are the single most common chronic childhood disease-five times more common than asthma," says Haney.

Many parents make the mistake of thinking that baby teeth don't need to be cared for, since the kids will lose them anyway, she adds. "But kids with bad teeth can develop infections, speech problems, and problems eating," she says-dental health should be an important priority for young children.

Besides home visits, the Center for Dental Care

• sends dental health teams to preschools and child care centers to screen children for signs of dental disease and teach parents how to prevent it
  
  
• refers parents to pediatric dentists who accept their type of insurance
  
  
• teaches dentists how to care for children with disabilities.
  
  

"A neglected epidemic"

Dental disease is a "neglected epidemic" among California children, says Dr. Larry Platt, executive director of the Oakland-based Dental Health Foundation. The foundation's 1993 survey reports that cavities affect seven out of 10 school-age children. Between 12 and 14 percent of all preschool children had severe cavities in their front teeth.

Nine years later, these statistics still apply, says Platt. "It doesn't have to be this way," he adds, "because with the right treatment, tooth decay is entirely preventable." Meanwhile there are "a lot of little kids who are ashamed to smile and are in pain."

California elementary school children and preschoolers have twice as much tooth decay as children nationwide, Platt says. In part this is because less of the state's water has been treated with fluoride-a chemical that can prevent tooth decay.

In addition, "the prevalence of early childhood [cavities] is particularly high among some racial and ethnic minorities and low socioeconomic groups," says Dr. Jane Weintraub of the School of Dentistry at the University of California, San Francisco (UCSF). For example, a 1999 UCSF study found that 33 of every 100 children in Head Start programs had cavities, with even higher rates among Asian American children (44 of every 100) and Latino children (39 of every 100).

Developing new programs

UCSF recently received an $11 million grant from the National Institute of Dental and Craniofacial Research (NIDCR) to study how to improve the dental health of very young children. Now UCSF is creating new kinds of outreach programs aimed at children in communities with a high incidence of dental problems. Weintraub says the lessons learned will point the way to helping all young people maintain healthy teeth.

In one of these efforts, in the San Ysidro Community Center near the Mexican border, UCSF has developed a program for 500 pregnant women. "The idea is to counsel pregnant women before they have kids about oral health and hygiene," says UCSF's Dr. Francisco Ramos-Gomez, a pediatric public dental health specialist.

The San Ysidro program will also

• identify children at risk of cavities
  
  
• offer dental health counseling to parents and guardians
  
  
• provide fluoride treatment for infants
  
  
• offer oral antibacterial treatments for new mothers.
  
  

Preventing tooth decay: Tips for parents of young children

• Make sure that your children get a dental exam twice a year starting at age one or when their first teeth come in.
  
  
• Help your child to brush their teeth for two minutes twice a day-making sure that one of those times is at bedtime. Use a soft toothbrush.
  
  
• Steer your children away from candies and sweet snacks that stick to their teeth, such as caramels. Keep plenty of raw fruits and vegetables on hand for snacking.
  
  
• Consult your dentist if your local water supply does not contain cavity-fighting fluoride. A fluoride supplement might be advisable for your family.
  
  

Baby bottle tooth decay

Baby bottle tooth decay is one of the main threats to the oral health of young children. Here's how it happens:

• Sugars in the milk or juice in the baby's bottle cause bacteria in the mouth to produce acids.
  
  
• The acids break down the enamel on the tooth.
  
  
• This breakdown of the enamel allows cavities to form.
  
  

To prevent baby bottle tooth decay, dentists recommend:

• Always hold your baby when bottle-feeding and remove the bottle when the baby falls asleep. After regular feedings and snack times, wipe the child's teeth and gums with a damp washcloth or gauze pad to remove plaque.
  
  
• Wean your baby from the bottle by about one year of age. Begin by offering a cup at six months; gradually reduce drinking from the bottle and increase drinking from a cup.
  
  

Prevention policies being considered

• Requiring children entering California elementary schools to have a dental exam before admission. Dental Health Foundation is studying whether and how to get that to happen, says Executive Director Larry Platt.
  
  
• Fluoridating more communities' water supplies. There's progress on this one-Los Angeles and Sacramento began fluoridating last year, Platt says. Still, California has only 30 percent fluoridation-the national average is 60 percent.
  
  
• Requiring tooth sealants for third graders and seventh graders. Sealants are a kind of plastic coating that prevents cavities from forming on molars (chewing teeth in the back of the mouth).
  
  

Resources

• San Diego Children's Hospital, 858-576-1700
  
  
• Dental Health Foundation, 510-663-3732
  
  
• UCSF Dental School, 415-476-2557