Public and clinical policy considerations in maximizing children's oral health

"Tooth decay remains the single most common chronic disease of childhood-fi ve times more common than asthma," announced US Surgeon General David Satch er standing before 21 grinning first-graders in a Washington, DC, grammar s chool at the May 2000 release of his report, Oval Health in America.(22) Th e first Surgeon General's report to focus on a single organ system covers a wide range of topics of interest to pediatrics, from lack of insurance to shortcomings in Medicaid, from oral lesions to issues of care coordination, from public health infrastructure to health professional workforce. In add ressing children, the report substantiates that dental and oral diseases ar e common, often severe, consequential, and ironically overwhelmingly preven table. Dental problems, like the one described by "our nation's doctor" also are w ell known to parents and communities. The federal government's National Hea lth interview Surveys report that I in 18 children has an unmet need for de ntal care according to their parents. This need is three-fold greater than the unmet need for medical care and five-fold greater than the unmet need f or eyeglasses and prescriptions.(15) The unmet need for dental care rises t o I in 4 children with special health care needs who are uninsured.(16) Com munities also frequently rank dental care as their primary pediatric health problem, but public perception and common experience among many people in the United States is that children enjoy remarkably good oral health and de ntal care. Indeed, the prevalence of dental caries has decreased markedly o ver the past 30 years and is now, on average, at its lowest recorded levels ,(5) and the use of dental services by affluent children is high.(8) What explains these seeming contradictions between disease prevalence on th e one hand and common observations of excellent health on the other? Why is there a paucity of dental visits for many children and ready access for ot hers? Are oral conditions consequential and deserving of our attention? I-l ow do their persistence reflect the larger pediatric health care environmen t? What approaches might finally resolve this "silent epidemic"? What are t he potential roles for pediatricians? These questions are addressed in this article.