Running Dental Disease, and Access to Care in

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Oral Health, Dental Disease, and Access to Care in Children and the Implications for their Overall Health and Quality of Life
Sujata Barnard
NURS 318
November 14, 2017
UNBCOral Health, Dental Disease, and Access to Care in Children and the Implications for their Overall Health and Quality of Life

Oral health and hygiene is an important and sometimes overlooked aspect of childhood development and wellness. Much like adequate nutrition, the impact of appropriate dental care goes far beyond preventing tooth decay (Carter, 2009). In fact, the effects of childhood oral health reach well into adolescence and adulthood, far beyond the life span of a child’s “baby-teeth (Chow, Ateah, Scott, Ricci & Kyle, 2009).” Bacteria and oral diseases have been linked to numerous health problems in older children and adults including respiratory infections, nutritional deficiencies, diabetes, cardiac disease and oral cancer (Carter, 2009). Women who have suffered from oral disease throughout their lives have shown increased rates of low birth-weight babies, preterm deliveries and iron deficiency (Carter, 2009; Petersen, 2003). 
Oral health is known to influence not only a child’s physical health but their social, psychological and emotional health as well (Pahel, Rozier & Slade, 2007). Barriers that effect access to dental care will also decrease the likelihood of a child being able to utilize regular health care services, adequate nutrition, and other contributing resources for a healthy childhood (Sischo & Broder, 2011). It is likely that this could lead to high-rates of hospital admissions for illness as the child ages and may lead to a less healthy adult as well (Petersen, Bourgeois, Ogawa, Estupinan-Day, & Ndiaye, 2005).
Proper dental care begins very early in a child’s life (Chow,, 2009). Appropriate care is not only essential for the development of health teeth, but it is an important part of the overall health and quality of life for a child (Pahel, et. al., 2007). Some public health efforts such as fluoridated water, fluoridated toothpastes, and wide-spread public health campaigns regarding diet and dental care seek to aid parents in providing appropriate care to their children, however, more is required to ensure ideal oral health (Bagramian, Garcia-Godoy & Volpe, 2009). 
As children develop, they can be taught healthy dental routines (Kwan, Petersen, Pine & Borutta, 2005). Parents can use soft cloths to wipe their infant’s gums and introduce the idea of oral cleaning (Chow,, 2009). At 9-15 months of age children can have their first visit to the dentist. This will prepare the child for their oral care as teeth come in (Chow,, 2009). Parents should brush their children’s teeth twice daily with fluoridated toothpaste, decrease the use of sugar based juices and drinks and begin to bring their children in for regular dental check-ups (Carter, 2009). For school age children, reinforcement of oral care, including proper tooth cleaning leads to the development of health promoting behaviours that should carry through to adulthood (Kwan,, 2005; Pahel, et. al., 2007). Cognitive development at this age will also help school-age children to understand dental diseases and the importance of preventing caries (Chow,, 2009). Furthermore, they are capable of understanding the social impacts of dental health, and are at an age where absence from school and issues with self-image will have a significant impact on their lives (Kwan,, 2005).
This understanding of dental health is further developed during the adolescent years (Chow,, 2009). In pre-adolescents, 90% reported some sort of disease with an impact on oral health (Sheiham, 2005). Dental health during this age is important for overall health as well as the development of self esteem (Petersen, 2003). Teenagers are affected not only by their own beliefs and education regarding appropriate oral care, but by the practices and beliefs of their friends (Chow,, 2009; Petersen, 2003). They may also take in information from media and social networking sites (Petersen, 2003). This is also an age where there is an increased introduction to alcohol and tobacco, and decreased parental control of diet (Petersen, 2003; Sheiham, 2005). Furthermore, increases in risk-taking behaviours may lead to increased traumas to the face and mouth (Chow,, 2009). 
Oral diseases are extremely common (Carter, 2009). Over 80% of schoolchildren in some countries are effected by these diseases (Kwan,, 2005). In fact they are considered the most common of the chronic diseases (Sheiham, 2005). Other oral diseases include tooth loss, lesions, cancers, HIV/AIDS related diseases and trauma (Petersen,, 2005). They are a frequent cause of pain, and can lead to an overall decrease in quality of life for the infected individual (Pahel, et. al., 2007). They can also result from genetic defects, bacterial infection, environmental exposures, physical trauma, nutritional defects, infections elsewhere in the body and also simply from poor oral hygiene (Petersen, 2003). Furthermore, they may be present for an extended period of time before a child complains of pain or any other symptoms leading to care-seeking only after a significant problem has developed (Weinstein, Harrison & Benton, 2004). 
Diseases of the teeth and mouth cause millions of lost school and work hours each year (Petersen,, 2005). Children affected by oral diseases may not meet growth milestones, and they may have increasing behavioural problems (Chow,, 2009). They may be further impacted by difficulties with communication, loss of sleep, social isolation and decreased self-esteem. They are also at an increased risk of hospitalization (Sheiham, 2005).  
One of the most common, and preventable issues that affect children’s teeth are caries (Weinstein,, 2004). In industrialized countries they may affect 60-90% of school-aged children (Petersen,, 2005). According to reports from the United States Centres for Disease Control and Prevention, tooth decay is 5 times more common than asthma in children ages 5-17 (Rowan-Legg, 2013). Caries are considered one of the most frequently occurring chronic disease of the oral cavity (Bagramian,, 2009). They have numerous causes including environmental, physical trauma, and bacterial disease. They are also highly influenced by the social determinants of health (Petersen, 2003). One primary cause of caries in infant and toddler aged children is lack of education regarding bottle-feeding at bedtime, and the consumption of juice and sugary drinks. Another cause of dental caries is through the vertical and horizontal transmission from parents to children and between siblings or other children within a child care setting (Rowan-Legg, 2013). This expounds the importance of hygiene for everyone involved in the child’s life not just for the demonstration of good habits, but to prevent the transmission of disease (Rowan-Legg, 2013). 
Caries consist of any lesion, including a simple white-spot lesion, that exist on the enamel or tooth. This may be a small divot, or in later stages it can become a large hole or cavity in the tooth (Weinstein,, 2004). The bacteria that are present in these cavities may, if left untreated, spread into the root of the tooth and from there into the jaw leading to abscess and the potential for severe infection, including sepsis. If a tooth must be removed, there is an increased risk of infection, gastrointestinal problems and issues with self-image and self-esteem (Bagramian,, 2009). These caries can not only lead to pain and discomfort, but will also make it difficult to eat. Decreased intake of hydration and nutrition may lead to failure to thrive (Weinstein,, 2004). In preschool children with caries who are nursing, their weight will be, on average, 1 kg less than those without disease. Sleep disturbance may lead to distress as well as gluco-steroid production problems and the suppression of haemoglobin and erythrocyte production (Sheiham, 2005). Pain may also lead to trouble focusing on school tasks and may contribute to learning difficulties (Chow,, 2009). Furthermore, visible tooth decay in a child’s mouth and the presence of bad breath, as well as speech impediments can lead to bullying and social isolation (Bagramian,, 2009). In these ways, a seemingly small dental issue can have wide-spread negative impacts on both a child’s overall health and quality of life, and this can continue to effect them into adulthood. 
In previous years treatment would generally consist of a filling in the primary tooth. If a cavity has formed that damages the root, a root canal may be necessary, or if the mandible or maxilla have been affected, other dental surgeries may be necessary to clean out abscesses (Weinstein,, 2004). In some cases, teeth may be extracted (Petersen, 2003). These procedures are costly and traumatizing to the child, and may lead to avoidance of treatment as the child ages. Dentists now focus on preventative care, intervening in the cavity formation process before a filling is needed(Weinstein,, 2004). Generally these treatments include simple “spot treatments” utilizing fluoride, sealants, cements, and antimicrobial agents. Diet and brushing changes can also be recommended to prevent further tooth decay (Weinstein,, 2004). This is much less traumatizing to the child overall and will also increase the chances that parents and children will seek out dental care in the future (Weinstein,, 2004). 
In families of lower socioeconomic status, studies show that children have much higher rates of dental caries (Thomson, Poulton, Milne, Caspi, Broughton & Ayers, 2004). This is especially true in developing countries (Petersen,, 2005).  They are more likely to live in rural areas without access to fluoridated water, live in areas with increased environmental exposures, and they may be uneducated in proper tooth brushing. They may also have inadequate nutritional intake and possible food insecurities (Thomson,, 2004). It is further recognized that these children are more likely to have significant cavity development before their parents seek care. This may be the result of a number of factors including cost, lack of education, being an immigrant or an ethnic minority, and lack of dental care within a reasonable distance (Petersen, 2003). 
Children who have early childhood caries and are part of populations affected by barriers to access are shown to have a much greater likelihood of cavity formation in the future. This also applies to other health conditions (Thomson,, 2004). In fact, in the life-course approach to studying health within populations, the presence of socioeconomic disadvantages throughout childhood, from gestation to adolescence, correlates with increased disease risk later in life (Thomson,, 2004). This occurs through a process of risk accumulation, where advantages and disadvantages are tallied leading to overall increase or decrease in quality of life and in an individuals health (Thomson,, 2004). 
In Canada, there are extremely high rates of dental caries in children, with notably higher rates in Aboriginal communities, children with lower socioeconomic status, children with disabilities, and children of new immigrants (Rowan-Legg, 2013). In the 2010 Canadian Health Measures Survey, it was reported that 57% of Canadian children between 6-11 years have had a cavity. Of these children 2.5 teeth on average were affected by decay (Rowan-Legg, 2013). One of the most common surgeries on preschool children in Canadian hospitals are rehabilitative surgeries to correct early childhood caries. While many preschool aged children in Canada have prevalence rates of early childhood caries of 6-8%, this rate of decay exceeds 90% in some of the most disadvantaged Aboriginal communities (Rowan-Legg, 2013). The children of lower income families are, in general, 2.5 times more likely to have dental disease. Not only do the parents make less socioeconomically, but they are also likely to have lower education levels leading to lack of job prospects and lack of understanding of the risks of poor oral care (Rowan-Legg, 2013). 
Currently many in Canada, especially those known as the “working poor” have extensive barriers to the access of oral care for their children. While some provinces do provide some subsidization for care, particularly for those on welfare or assistance, there are many who do no qualify for this due to their employment status (Rowan-Legg, 2013). Over 50% of Canadians in the lower income brackets do not have dental insurance, and these are the families with the highest rates of untreated dental diseases. This means that families will wait until they can receive publicly funded care which is generally based on emergency status, and through a hospital (Rowan-Legg, 2013). In fact, Canada is rated as second-last in public financing of dental care, yet it is considered one of the most costly diseases in Canada, even when compared to cancer and heart disease. Dental surgeries due to emergency situations that develop from lack of care are extremely expensive and require use of antibiotics and a hospital stay, and for some children these surgeries may be required more than once (Rowan-Legg, 2013). Within Canada another major barrier to care is a lack of access within remote communities. These communities may simply have no dental clinic or dental practitioner present. This means it may be necessary to travel to a larger city centre in order to access care (Rowan-Legg, 2013).
Because dental health and oral hygiene play such a significant role in a child’s overall health, development, and quality of life, it is important to acknowledge the need for policy changes, especially in industrialized countries like Canada (Rowan-Legg, 2013). While health professionals can aid families through education regarding hygiene practices, use of fluoride, nutrition, and the signs and symptoms of oral disease, more needs to be done (Pahel, et. al., 2007). Provision of travelling clinics, further subsidization and publication of care, widespread public dental health insurance, and general changes in federal policy to include dental care within the public health framework could all lead to a decrease in barriers and an overall improvement in childhood oral health and quality of life (Petersen, 2003; Rowan-Legg, 2013).
Oral health is more than the maintenance of strong and healthy teeth. It influences general health, nutrition, development, behavioural and social development, and a child’s overall quality of life (Sheiham, 2005). Education of healthy diet, hygiene, and habits will also prevent oral disease and will decrease the risk of other systemic chronic diseases as well (Sheiham, 2005). Healthy oral hygiene habits and and the provision of accessible care will effect a child through every stage of their development and well into adulthood (Kwan,, 2005). For these reasons, proper education, increased accessibility, and the provision of universal and comprehensive dental care increase quality of life and should be considered a child’s right (Rowan-Legg, 2013). The impacts of this will effect them throughout their lifetime.References

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