The UN Convention on the Rights of the Child which has been ratified in all countries belonging to United Nation (UN) except for USA (and also incorporated in national law in some countries) states that all children shall have the right to best possible health and access to health care.
This includes good oral health and access to dental care.In Scandinavia, all children have right to free dental care and it is the responsibility of all regions to provide dental care for children and adolescents. This includes both preventive treatment and rehabilitation such as for example filling therapy, extractions and orthodontic treatment if needed.Oral health in children and adolescents has improved over years. In Scandinavian countries, there are many children with good oral health. For example, 95% of Swedish 3‐year‐olds and 73% of 6‐year‐olds are caries‐free (data from Swedish National Board of Health and Welfare).
Even though the proportion of caries‐free children and adolescents decreases with increasing age, large proportions of the child population have no problems with their teeth. However, there are children which extensive caries lesions and where dental care does not reach with preventive methods. One large proportion of children who are referred to a specialist clinic in paediatric dentistry for dental treatment in Sweden are very young children with extensive treatment needs—that means extensive caries lesions.
Often these children receive dental treatment under general anaesthesia and sometimes up to 8‐10 teeth have to be extracted due to extensive caries lesions. In addition to suffering for the child, it also entails great costs for the society.There is a clear connection between socio‐economic factors and social vulnerability and oral health. Having low‐educated parents, single parents, unemployment in the family or parents coming from countries outside of Europe increases the risk for the child to have caries.
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These connections are stronger the younger the child is. There is also a strong connection between caries at young age and continued caries development
—once you have caries, it seems difficult to turn the ship around. Early childhood caries (ECC)—caries in early stage of life—can result in both pain and infections and problems to eat and chew.The Swedish National Board of Health and Welfare
reported in 2013 a connection between parent´s and children´s oral health and their attendance to dental care. The poorer the dental health of the parents, the greater the risk that the children would have caries. Caries in parents also resulted in lower attendance to dental care for the children.Unfortunately, there is little evidence of which preventive methods that are effective. Water fluoridation has been shown to have good preventive effect on dental caries but does not occur in all countries, such as the Scandinavian countries. Daily toothbrushing (twice a day) with fluoride toothpaste has been shown to have a good caries‐preventing effect on young permanent teeth and this certainly applies to primary teeth. Parents have to brush the child´s teeth up to school age and after that supervise the brushing until the child is able to take full responsibility—usually around age 10. Despite the dental care's attempt to convey this seemingly simple way to prevent caries, not all families are reached or absorb the message. The reason for this can be lack of knowledge and resources, traditions, norms and so on.It is important to reach families in vulnerable areas early, well in advance of the children developing caries. An early example of this was the ‘Rosengård project’ in the city of Malmö in southern Sweden. The children were called at age 2 and the parents received individual counselling on tooth brushing habits and dietary habits with focus on sugar‐containing products. The children also received a toothbrush and fluoride tablets. In comparison with a reference group, these children had a lower incidence of caries at 5 years of age.
Parents' daily assistance with toothbrushing and administering fluoride tablets was significantly better in the intervention group than in the reference group. This project turned out so well that similar activities started up elsewhere.Another way that is highlighted more and more is a close interdisciplinary collaboration where several actors, for example the Child Health Services and Social Services work together, in order to give the families increased support to care for the children. Seeing the mouth as part of the body and that children's dental health can affect both general health and future caries development is an important message to convey.The study in this issue described an attempt to rectify the problem.
The idea that several actors work together has been around for a long time and is tested in this study. First‐time parents in a disadvantaged area received six home visits by different actors, at the fourth visit (8 months of age), information on oral health was given and the children received a toothbrush fluoride toothpaste. The children were examined at ages 18 and 36 months. In comparison with a reference group, they had a lower incidence of caries at 18 months. At 36 months, the differences were not so pronounced.This study showed that these home visits were effective in the short run, but the study also indicates that continuous efforts are needed. Working to ensure that young children in vulnerable areas have as good dental health as children living in areas with better conditions is a constant challenge and must be taken seriously by both the dental care itself but also by decision‐makers. The right of all children to good and equal health must not only be a vision but also an important goal to strive for.
CONFLICT OF INTEREST
The author has no conflict of interest to declare.