Tooth decay in children: a true “silent epidemic”, deplore pediatric dentists who are unable to meet demand

Diabetes, decayed mouths, fatty liver disease, concentration or memory problems: excessive sugar consumption ravages the health of thousands of Quebec children every year. Omnipresent in the food supply, sugar in all its forms is too often trivialized, deplore experts who call for better education and better control to limit the harmful effects. Today: the epidemic of dental caries.

Tooth decay in children is a true “silent epidemic”, deplore dentists who treat more than 8,000 suffering little patients each year, forced to undergo general anesthesia to treat their decayed mouths.

“Children arrive at 3 and a half, 4 years old, and they have 6, 8, 10, 12 cavities. We see them every day,” underlines the D^D Annie Marleau, head of the dentistry department at the Montreal Children’s Hospital (MUHC). I could fill the operating room every day, all year round!”

The observation is implacable: Quebec children have far too many cavities. Several dentists describe the situation as a true “silent epidemic”. Some little patients under 10 years old even have their entire mouth rotten, i.e. all 20 teeth.

Even if low-income and immigrant families and children with special needs, such as those with autism spectrum disorder, are more represented, dental caries affects all profiles, specialists note.

At least 8000 cases

Every year, at least 8,000 Quebec children undergo general anesthesia to treat their cavities, show data compiled by The newspaper. Added to this are dozens of hospitalizations to treat children, particularly with intravenous antibiotics.

There is no recent exhaustive data on the prevalence of early childhood caries in Quebec, but all the dentists interviewed by The newspaper have not observed any improvement in recent years, on the contrary.

However, socio-economic conditions are improving and children have access to good toothbrushes and toothpaste. The main culprits? Sugar and poor hygiene.

“I wouldn’t call it negligence, but it’s carelessness,” says dentist D^r Patrick Canonne, whose Montreal clinic operates 900 cases per year.

In Canada, dental problems are the main cause of general anesthesia in children under 5 years old, ahead of ear tubes (ear infections) or removal of tonsils, indicates Health Canada.

“This is not normal in 2024,” reacts Marie-Ève ​​Asselin, head of the dentistry department at Sainte-Justine hospital. We must act upstream.”

In many clinics, patients often have to wait several weeks or months, due to high demand and lack of resources.

“Shaved to the gum”

Early childhood cavities develop when bacteria in the mouth feed on the sugar in food waste. This produces acids that attack the tooth enamel and eat away at it. Cavities can spread quickly in children since the enamel is more fragile.

“When the cavity goes away, it goes so quickly! There are children who have completely destroyed teeth, shaved down to the gum,” underlines Étienne Caron, president of the Association of Pediatric Dentists of Quebec.

A six-year-old girl had to be operated on last January due to an abscess caused by a cavity, in Montreal.

After a certain number of cavities, it becomes practically impossible to treat children without putting them to sleep. Often, the dentist must outright remove the compromised teeth.

“When you have 5 years and 12 teeth to repair, that’s a lot. It’s not that the work is so complicated, but the children are not able to cooperate,” explains the D^D Marleau.

Even if many parents trivialize early childhood cavities because teeth will eventually fall out, the consequences can be significant for children:

• Daily pain
• Emergency visits
• Sleep problems
• Hospitalization to receive an intravenous antibiotic
• Invasive operation under anesthesia
• Absence from school for several days

Other medium-term problems are also associated with early childhood caries: chewing, speech, abnormal permanent teeth, self-esteem, etc. According to the dentists interviewed, the current situation is unacceptable since it is avoidable.

“It’s a lot of money, a lot of time, but the majority of dental problems can be prevented,” underlines the D^D Asselin.

-With the collaboration of Hugo Duchaine

Tooth decay, too trivialized

Even though it is extremely common among children and costs a fortune in health care, dental caries is too trivialized in society, dentists deplore.

“It hurts, a toothache. It’s really a disease, and people tend to see the teeth apart from the body, notes Étienne Caron, president of the Association of Pediatric Dentists of Quebec. All the morbidity that it brings is very problematic. And it’s very expensive.”

“For a long time, dental care was considered separate from human health. It’s a little hard to understand the logic behind this. Quietly, we are becoming more and more interested in it,” observes the D^D Liliane Malczewski, president of the Order of Dentists of Quebec.

“We are very late”

The dental exam is covered for children up to 10 years old by the Régie de l’assurance santé du Québec (RAMQ). However, less than 80% of young Quebecers had consulted a dentist before the age of 5, RAMQ statistics since 2015 show.

“We are very late in our public health policies for early childhood caries,” laments Marie-Ève ​​Asselin, head of the department of dentistry at Sainte-Justine hospital. »

“There is a long way to go to improve our statistics.”

According to several dentists, society’s education regarding the importance of dental hygiene should be greatly improved, in particular by providing better information to parents (prenatal classes, at the doctor’s office, at school, etc.) And even if children do not like brushing their teeth, parents must not give up, insist several specialists.

At the dentist from one year

Contrary to what many general dentists say, babies must be examined as soon as a tooth erupts or at the age of one, specialists insist.

“If your dentist tells you to come at four, it’s because he knows nothing about pediatrics. Find another dentist,” reacts the D^D Annie Marleau, head of the dentistry department at the Montreal Children’s Hospital.

Pediatric dentists surveyed by The newspaper are unanimous: children must be examined as soon as a tooth erupts. However, the reality on the ground is quite different: many general dentists suggest that parents make a first appointment around the age of three or four. At this age, decay has often already taken its toll.

“The objective is that when the child is 2 or 3 years old, we will not be surprised by a rampant cavity, the parents will have received the information”, underlines the D^D Liliane Malczewski, president of the Order of Dentists of Quebec.

According to many, dentists delay the first appointment because they are not comfortable with young children who move and have little cooperation. But this is not a valid reason, many argue.

“Do we tell a parent not to take the baby to the pediatrician because the baby is moving?”, asks the D^D Marleau.

“There is a lack of sensitivity or training,” admits Étienne Caron, president of the Association of Pediatric Dentists of Quebec.

Foods and behaviors to avoid to prevent cavities in children

“Organic juice is no better than neon pink juice. It’s the same amount of sugar,” explains Maryse L’Héreault, hygienist at the Patrick Canonne Dental Center.

▪ All sugary drinks

▪ Chewy bars, candies, chocolates

▪ Dried fruits that stick to your teeth

▪ Bottle of milk given to the baby in his bed

▪ Sipping juice for several hours from a bottle

▪ Eat sweets throughout the day (it’s better to treat yourself only once)

▪ Eating or drinking after brushing your teeth in the evening

What is good dental hygiene in children?

▪ Brush your teeth twice a day (after breakfast and dinner)

▪ The parent must brush the teeth until the child is at least 8 years old

▪ Floss your teeth in the evening

▪ Use fluoridated toothpaste

▪ Consult a dentist as soon as the first tooth appears (or at one year old)

The best snacks to prevent cavities:

▪ Fresh fruit

▪ Fresh vegetables

▪ Cheese

▪ Nuts (if allowed at school)

▪ Accompany the snack with water

Why worry about cavities or even fixing baby teeth that are going to fall out eventually anyway?

The first teeth form the structure of the future teeth.

“A cavity is often between the teeth and it’s soft. So, you lose 1 to 3 millimeters of space which can harm the erupting adult tooth and cause orthodontic problems,” explains dentist Gabriel Tremblay.

Teeth also help with phonetics, when learning to speak. And then painful teeth can prevent a child from concentrating and succeeding in school.

“Adult teeth will also emerge in an environment conducive to cavities, where bacteria have settled,” adds the D^D Caroline Quach, pediatric dentist.

Why not fluoridate the water?

Water fluoridation helps reduce the number of cavities by 20% to 40% in the population, estimates the Ministry of Health and Social Services (MSSS) of Quebec, which is in favor of this inexpensive and effective measure. . However, in Quebec, only 2% of the population has access to fluoridated water. This is much less than Americans (75%) and Ontarians (70%), according to the MSSS.

The decision to fluoridate drinking water rests with municipalities. Currently, only three cities participate in the program: Pointe-Claire, Dorval and Saint-Georges de Beauce.

“It’s one of the least expensive ways to do prevention,” also insists the D^D Liliane Malczewski, president of the Order of Dentists of Quebec.

Despite this, this measure is controversial. Many citizens are opposed to it because they see it as an infringement of freedom of choice or fear negative effects.