Many of us have vivid memories of tying a thread to a loose tooth and wiggling it back and forth with our tongue all the time hoping for a profitable visit from the Tooth Fairy.  Facebook is full of school and family photos of kids with cute, gap-toothed smiles. But increasingly, children are losing their baby teeth not due to the budding of their permanent teeth but to the ravages of early decay and cavities.

“Pediatricians refer kids to us all the time who are underweight or malnourished. You look in their mouths and you can see why immediately: it’s because they have these extensive cavities and infection,” says Allison Cavenaugh Eggleston, DDS, a pediatric dentist in North Carolina. “The parents who say to me that baby teeth aren’t important because they’re going to fall out anyway are the same parents who ask how their child will eat when I tell them I may need to extract all of their teeth.”

There are a number of reasons kids and adults don’t make it to the dentist regularly. For some parents, it’s a lack of understanding about the importance of oral health, even at an early age.  Eggleston tries to reach them early by educating pregnant women about the importance of seeing a dentist, not just for themselves but for their babies.

“There is hard evidence to show that reducing the cavity-causing bacteria in a mother’s and father’s mouth will reduce the cavity-causing bacteria in your child’s mouth. Many don’t think of it this way, but oral disease is an infectious disease that can be spread to your baby, even via something as simple as kissing them. That’s why it’s important to go to the dentist regularly, have your cleanings, and understand what you can do to help prevent these cavities.”

Barriers to Dental Care

For many people, just getting to a dentist can be difficult. This may be because the dentist is too far away. Eggleston will soon start her dental practice in an area of rural North Carolina where previously the closest dentist for many residents was 60 miles away. Roughly 47 million Americans live in areas that are recognized by the government as having a shortage of dentists.

Or it may be too difficult to get time off of work to take your child to the dentist.  “If you have someone who can take the kid to the dentist, that’s fine. But many families don’t have that caretaker,” says Jay Friedman, DDS, a dental consultant and author. To get around this, Friedman and many other experts suggest treating kids in schools using licensed dental therapists.

However, one of the greatest barriers to access to dental care is a lack of insurance and cost of care. “The most recent figures are that there are close to 130 million people without dental insurance, which is eye-popping,” said Shelly Gehshan, director of Pew Children’s Dental Campaign.

Even for those with dental insurance, actually seeing a dentist can cause a big hit to one’s pocket book. Cait Goldberg is currently shopping around for an orthodontist for her daughter. “We knew she’d eventually need braces because she’s sucked her thumb her whole life,” she explains. “The first dentist we saw is a Harvard grad and has this incredibly slick office, with iPads in the waiting room and everything. He told us he’d wait until she lost her last few baby teeth before applying braces at $8000 over the two or three years she’d wear them. In the meantime, we could purchase a $1,500 appliance to help her stop sucking her thumb.”  Another dentist had no iPads and zero bedside manner, but would cost $3000 less, she said. Her insurance would cover just $2000, either toward the appliance or the braces.  She’s going to keep looking but the extreme difference in price has made her skeptical. “I’m not even sure if one is better than the other or if it matters.”

Preventing Dental Problems

You can get your child off to a good start by beginning oral hygiene rituals early:

  • Wipe your infant’s gums after eating to get them used to you being in their mouths.
  • Brush your child’s baby teeth with a soft brush and a tiny amount-no larger than a grain of rice-of fluoride toothpaste.
  • Take your child to their first dental visit by age 1.
  • Ask about and consider sealants, which have been shown to reduce cavities.

The American Dental Association recommends that kids and adults:

  • Brush your teeth twice a day using fluoride toothpaste.
  • Use floss or an interdental tool to remove plaque and food particles from between the teeth.
  • Mouthwash can be used to reduce the amount of bacteria in the mouth and may cut down on tooth decay.
  • See a dentist once a year for a professional cleaning.

Asking Questions

One of the best things anyone can do is ask questions about treatment recommendations. Like medical care, dental care costs have been rising partly due to the use of unnecessary tests and procedures. In fact, Dr. Friedman spearheaded a campaign against the removal of wisdom teeth to prevent later problems, saying that up to 70 percent of extractions are unnecessary.

How to Pay for Dental Care

Dental care is essential but many people put it off because of cost. There are a few steps you can take to ease the pain of sticker shock:

  • Check to see if your employer offers dental insurance or flexible spending accounts for health care needs. You can use these to set aside a portion of your paycheck before taxes to help cover dental care.
  • Shop around if possible. Before agreeing to an expensive procedure, see whether another dentist will perform the same procedure for less.
  • Many dental offices will work with patients when it comes to bills. Offer to pay cash in exchange for a discount or ask about setting up a payment plan to stretch payments into smaller installments over time.

The National Institute of Dental and Craniofacial Research suggests seeking out dental and dental hygiene schools for lower cost care.

Original post by the Center for Advancing Health. Updated by the GW Cancer Institute January 2016.