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Journal Issue: Protecting Children from Abuse and Neglect Volume 8 Number 1 Spring 1998

Eugene M. Lewit Nancy Kerrebrock


Maintaining good dental health among children in the United States today should be easy: regular tooth brushing, flossing, exposure to fluoride, and attention to good nutrition, together with visits to a dentist twice a year, should be enough to assure that a child rarely suffers the pain of an abscessed tooth, or loses a tooth to severe decay. However, many young children, especially those living in poor families, continue to suffer with mouths full of deep cavities, swollen jaws and cheeks, and episodes of around-the-clock pain. Some children regard tooth decay as inevitable and the pain associated with dental therapy as so unpleasant that they would rather have their teeth pulled than fixed.1

Maintaining good dental health in children is important not only because it prevents childhood pain and suffering and the school absenteeism that results from dental disease, but also because tooth loss in childhood can adversely affect how the jaws and teeth function as the child matures.2 Furthermore, unhealthy teeth are considered unattractive, and negative responses to the appearance of a child's teeth can impair the child's social confidence. Dental health can influence a child's overall chances for success just as do other, more frequently recognized aspects of physical health.3

This Child Indicators article reviews several measures of dental health in children and the evidence on children's dental health. While children's dental health has improved substantially over the past two decades, with large declines in the average number of cavities per child, a number of children experience a disproportionate share of dental disease.4 Poor children in particular, because they are less likely than their wealthier peers to receive dental services, are at the highest risk of suffering the pain and consequences of untreated dental disease. Although federal law requires states to provide dental services to poor children through the early and periodic screening, diagnosis, and treatment (EPSDT) component of the Medicaid program, in practice many poor children fail to receive these services. The reasons for this failure are summarized in the section on utilization of services in this article.