By Vernon Freeman

School is back in session. It’s the perfect time for a fresh start with a healthy, bright smile. Unfortunately, that is not the case for some. According to the Centers for Disease Control and Prevention (CDC), tooth decay, also known as cavities, is the most common chronic childhood disease in the United States and the leading cause of missed school among children.

Left untreated, cavities can not only have a significant impact on your child’s overall health, but their grades and learning as well, according to Jeffrey Johnson, D.M.D., chair of the Department of Pediatric Dentistry at Virginia Commonwealth University School of Dentistry.

“Pain and suffering associated with unmet dental needs can lead to problems with learning, eating and social development. You could have pain, you could have an infection, you may be out of school, but, even if you're in school, you're not able to concentrate. All of those things combined take away from the learning experience,” said Johnson, who has more than 20 years of experience in pediatric dentistry.

Johnson spoke with VCU Health News about the impact of dental cavities and what parents can do to help their kids develop good oral health habits.

According to the CDC, on average, 34 million school hours are lost each year because of unplanned or emergency dental care. What are some of the ways this can affect a child’s learning and school performance?

Unaddressed oral health problems can have long-term effects on children outside of just health and wellbeing. If you're sitting in a classroom and you can't concentrate on what you're doing, you can't participate because you don't feel well or you felt so bad you couldn't be there, data shows you will fall behind and have to play catch up on your studies.

When kids are hurting, their quality of life is lower. When kids are hurting and they can't eat, they can even become malnourished or undernourished. Not only can it lead to lower participation in school, but it can also hold them back in social settings like play at recess, sports teams or church youth groups. These social activities are important for childhood development in terms of building self esteem and establishing relationships.

More than half of children aged 6 to 8 have had a cavity in at least one of their baby teeth. How can establishing healthy oral habits at an early age prevent chronic absenteeism?

Data has shown that children with established dental homes have better oral health outcomes. Whether here at VCU or at a community provider, children should start seeing the dentist by 12 months of age, or within six months of their first tooth. Being proactive instead of reactive, will help ensure that their oral health will not impact their academic wellbeing or their overall health. Dental emergencies can also place a great deal of strain on the lives of children’s parents or caregivers.

As dentists, we hope that what we teach a kid also teaches their parents and caregivers. We want them all to understand the importance of good oral hygiene, brush twice a day with fluoride toothpaste and floss daily.

One thing that isn’t commonly known is that dental cavities are contagious and can spread. How does this happen and how can it affect a whole household?

Most people have no idea that cavities are caused by bacteria. This bacteria can be passed to other kids through things such as bottle use, pacifier use or sharing of utensils. Just as you would spread a common cold, you can spread the bacteria that causes cavities.

Research shows us that parents and caregivers that don't have good oral health can spread that bacteria to their kids. Just like we protect ourselves from spreading germs through handwashing, the best way to protect ourselves and others from spreading oral bacteria is through good oral hygiene, overall healthy habits and limiting the sharing of items that go in our mouths.

Parents play an important role in their child’s dental care. What are some tips they can follow to help their kids develop good oral health habits?

It takes a partnership for kids to have good oral health involving children, their caregivers and the oral health professionals.

First, we want to get rid of the stigma of embarrassment. Just because you don't know something or you don't have good oral health yourself, it doesn't mean that your child can't have good oral health. Second, it's important to meet parents where they are. If parents don't understand something, have limited resources or have trouble getting into dental clinics, we try to help eliminate some of those barriers. At VCU School of Dentistry, we do that by establishing relationships and talking with parents and caregivers as well as coordinating events with local schools and other community-based projects. We also collaborate with our pediatrician and physician colleagues so everybody is reiterating the same message about dental caries and the importance of good oral hygiene and oral health.

Lastly, not everyone grew up going to a dentist, and some people have only sought emergency dental care – that's a hard paradigm to change. When we teach kids good oral hygiene habits, it’s important that those lessons make their way to the parents and caregivers as well. However, it’s important that oral health professionals do this in a compassionate, respectful manner, and that we tailor that message to each individual or family. We have to have a cultural sensitivity and make sure that we tailor our message to each patient and family.

Ultimately, we want oral hygiene and good oral health to be fun. If it's fun, it's more likely going to be replicated. And if it's replicated, it's going to be more likely to actually have an impact.

What are some of the school-based and community-based projects in which VCU School of Dentistry participates?

We try to make sure that we provide educational services in schools across the Richmond area and Virginia. If we can reach kids in schools they can share that information with their families and then sometimes we reduce a barrier to care or eliminate a barrier to care just by providing the information. Another thing we do is we try to make sure our pediatric dentistry residents participate in community events, like the Special Olympics Special Smiles, community health fairs and Give Kids a Smile event — a day of free dental care for underinsured families.

It’s important to make connections with families and caregivers. We want our clinic and VCU School of Dentistry to be safe havens and we want people to feel that they're protected, nurtured and they receive compassionate care. Sometimes it takes events like these to get people in the door and get them coming back for routine care.

What are some specific things the VCU Dental Care Pediatric Clinic does to improve access to care for families?

The science says that if kids can be healthy growing up, they're much more likely to be healthy as adults. I am proud to say that our clinic is one of the largest providers of dental care to kids enrolled in Medicaid. In instances where children aren’t covered by Medicaid or cost is a barrier to care, VCU Dental Care Pediatric Clinic works with families to find solutions. If that means helping them connect with a case manager or social service organization to get enrolled in Medicaid, we will do that for them.

Aside from payment, other major barriers to care include language and transportation, and we work to address those as well. We have bilingual staff, faculty, students and residents, in addition to translation services. Through VCU Dental Care, we also offer Uber and Lyft rides for people in special circumstances, particularly if those appointments include needed surgeries.

We have also tried very hard to ensure our team members are representative of the communities we serve. I think it's really important that people see providers who look like them and may share a common background or story with them.