On March 1, 2017, both the ADA and the AAPD reaffirmed preventive dentistry for children and toddlers under the age of two years with a unique press release.
Here in Orlando, at Dentistry For Children, we also endorse childhood dental visits as early as 12 months. We routinely treat babies much younger. In fact Dr. King thoroughly examines the development of mouth, tongue, gums and palate, even in children who are only a few days or weeks old.
Preventive Dental Care Under Fire?
With “fake news” stories all over the Internet, we must be cautious about what we read and believe. This is especially true of medical matters, dental issues, and our children’s wellbeing.
Preventive Dentistry Makes News in 2017: Reality Vs. Research
In case you were not aware of it, a research story broke at the end of last month concerning early preventive dentistry in children under age two. The stories sensationalized the idea that early trips to the dentist did not have a beneficial outcome. Furthermore, some online articles intimated that the act of going to the dentist before age two would set a child on a course of more tooth decay, caries-related treatments and dental visits, and more parental expenditure.
Many articles cited a Feb.27th, 2017 research study by the University of Alabama, by Justin Blackburn, Ph.D., of the University of Alabama at Birmingham School of Public Health. He and his team compared tooth decay-related treatment, visits and preventive dental care expenditures for children receiving care from a dentist or primary care provider and those children receiving no preventive dental care.
The Study itself, was published in JAMA Pediatrics Journal. The research scientists and authors of the study stated, “Adding to a limited body of literature on early preventive dental care, we observed little evidence of the benefits of this care, regardless of the provider. In fact, preventive dental care from dentists appears to increase caries-related treatment, which is surprising.”
Research Goes Full Circle: Does Preventive Dental Research Create New or Vice Versa?
The misleading or misunderstood nature of the study is the reason that, on March 1, 2017, the AAPD and the ADA issued a special joint press release. Both organizations reinforced their stance on early childhood visits for babies and toddlers. They reiterated the importance of taking your baby to the pediatric dentist. And they re-emphasized the establishment of a dental home before age 2, to prevent “early childhood tooth decay.”
The press press answered the controversy imposed by Dr. Blackburn’s study. Likewise the act of the press release repudiated several little articles online that exaggerated, misunderstood, and cloaked Dr. Blackburn’s study in the appearance of a national one.
Dentistry for Children checked out the study firsthand to understand what provoked the Internet buzz. Why would parents suddenly be reluctant to take 1-4 year olds to the dentist?
Results of Research and Rumors
It turns out that the authors researched only an Alabama Medicaid group of patients. “Among 19,658 eligible children, 25.8% (n = 3658) received early preventive dental care…” So only 3648 children who had preventive dentistry were compared with the remainder of the 19,00658, who did not have it.
We could understand the alarmed parents who read the quote that the authors “observed little evidence of the benefits of preventive care…” Shocking news, indeed!
How a Localized Study Caused National News in Preventive Dentistry
We also found the research to be based on older cases, using the years 2008-2012. It focused on children who received preventive dental care prior to turning 2 years old versus the same age-group of children with no preventive care.
They claimed some preventive dentistry statistical discoveries that inspired controversy, especially at a surface glance: The study claimed children who had received early preventive dental care returned for more treatment later.
“Compared with matched children without early preventive dental care, children with dentist-delivered preventive dental care more frequently had a subsequent caries-related treatment.”
Problems With Proof!
Parents and Readers, once more, we repeat that the researchers were using all Medicaid patients from one state. Medicaide patients always have a higher rate of caries (tooth decay) than the general populace. Thus the children might have had caries-related problems before they before they even went to the dentist in the first place!
The research also listed a “higher rate of visits (0.29 vs 0.15 per child-year, P < .001), and greater dental expenditures ($168 vs $87 per year, P < .001),” for those children who had seen the dentist before age two.
Then they made a statistical leap. They concluded that “Dentist-delivered preventive dental care was associated with an increase in the expected number of caries-related treatment visits by 0.14 per child per year (95% CI, 0.11-
0.16) and caries-related treatment expenditures by $40.77 per child per year…”
In our eyes, even if the surface meaning of these statistics is true, that is a small price to pay for a lifetime of good oral health which reflects the overall good health of the child.
However, again we point out that the patients were studied in accordance with billing documents from Medicaid payments and codes.
“Little is known about the state of oral health of the children seen by dentists at the time of the first visit and it is unclear if the children studied were referred to a dentist because they showed signs of cavities or if they already had tooth decay upon their first visit,” stated Paul Casamassimo, D.D.S., M.S., director of the AAPD’s Pediatric Oral Health Research & Policy Center. ”
He added, “Studies of this nature are important in advancing our knowledge about early childhood cavities and their prevention and treatment, but these findings are not definitive, and further study is critical, in view of other findings supportive of early care and the epidemic nature of early childhood caries.
The Appeal from Children’s Dentistry in Orlando
We take issue with the validity of the study also because, by their own admission, they ignored evaluation of several factors in their study: diet, genetic predisposition, the use of fluoride toothpaste, previous disease, frequency of brushing and flossing, and drinking fluoridated water.
According to Mia L Geisinger, D.D.S., M.S., “All of these are crucial in reducing the risk of cavities.” Dr. Geisinger is Department of Periodontology, University of Alabama at Birmingham and member of the ADA’s Council on Scientific Affairs.
Preventive Dentistry: Dental Associations Prepare a Proper Point of View
Likewise, the JAMA released an editorial which refuted Dr. Blackburn’s conclusions due to many of the issues outlined in this blog.
Research scientists, professional organizations and clinical practitioners can all agree on one point: “Studies of
this nature are important in advancing our knowledge about early childhood cavities and their prevention and treatment, but these findings are not definitive, and further study is critical, in view of other findings supportive of early care and the epidemic nature of early childhood cavities,” declared Paul Casamassimo, D.D.S., M.S., director of the AAPD’s Pediatric Oral Health Research & Policy Center.
By the way, some of the over-reactions to this over-publicized research reminded us sharply of last year’s controversial fake news stories concerning flossing.
Meanwhile, we at Dentistry For Children believe common sense must rule. For example, we don’t need to step out in the rain, to know we will get wet.
Happy Brushing, and thank you for reading the Dentistry for Children Blog!