Katelyn Patthana confidently slid into a chair to have her molars sealed, no big deal for a 7-year-old who had lived through a dental horror story. The suburban Chicago second-grader's tooth decay was so severe two years ago that dentists extracted six teeth, crowned two and filled five.
Katelyn was among a growing number of preschoolers with cavities, creating concern among dentists and parents who hoped that brushing and avoiding candy were enough to silence the drills. But with continual snacking and the use of nonfluoridated bottled water on the rise, experts say parents have to be even more vigilant.
"There's plenty of new cavities coming through," says Dr. Nicola Hill-Cordell, a Chicago area pediatric dentist. "At least once a week, you get a new kid who is less than 2 with a cavity."
Nationwide, nearly 28 percent of children ages 2 to 5 had at least one cavity, based on a federal survey covering the years 1999 to 2004. That represents a 4 percent climb from the previous survey, the first significant statistical increase in 40 years, said Bruce Dye, lead author of a National Center for Health Statistics report on oral health released this year.
The federal government first assessed tooth decay in the 1960s. After widespread efforts to put fluoride in tap water led to declining cavity rates in the 1970s, tooth decay among preschoolers leveled off in the 1980s - until now.
Hectic family lives often leave little time for cooking and preparing fresh vegetables and fruit, Dye said. Trying to avoid sugary drinks, parents often turn to convenient bottled water, but it doesn't necessarily contain the fluoride that dentists once fought for in tap water.
The American Dental Association has long recommended use of fluoridated water and hygiene products such as fluoridated toothpaste.
"Toothpaste is a significant way of delivering it, but water is an additional way and it's cheaper," said Dr. Indru Punwani, executive director of the Illinois Society of Pediatric Dentists. "This is one way to ensure you are getting fluoride to the child - to the poor, young and old. It's one more source."
Experts also attribute the surge in cavities at least partly to the fact that many immigrants have never been exposed to tooth decay prevention measures.
"In many cultures, you do not go to a dentist until you get a toothache and they take it out and that's it," said Punwani.
Born in Laos and raised in the United States, Seng Patthana said no one warned her against putting Katelyn to bed each night with a bottle of calcium-fortified orange juice. The working mother said she thought it was a healthy choice for a growing toddler who didn't like milk.
"It was shocking," said Patthana of the cavities. "I thought at least it had calcium. I wasn't thinking the sugar is sitting there overnight on her teeth."
The most recent NCHS report, released in April, did have some good news on the cavity front. It showed a decline in tooth decay overall among older children compared with the previous survey covering 1988 to 1994.
Decay in the permanent teeth of those 6 to 11 years old decreased from 25 percent to 21 percent; among adolescents, those 12 to 19, it dropped from 68 percent to 59 percent.
But the report also documents several disparities along ethnic, racial and economic lines.
Three times as many poor children had untreated dental disease compared with their more affluent counterparts, according to the report. Thirty-one percent of Mexican-American children ages 6 to 11 had cavities in permanent teeth, compared with 19 percent of non-Hispanic white children.
About two-thirds of Medicaid children did not receive dental care in 2005, according to Centers for Medicare and Medicaid Services data.
The American Academy of Pediatric Dentistry recommends the first dental visit by a child's first birthday or with the appearance of the first tooth.
Requirements that would have preschool or primary pupils show proof of a dental exam are largely a symbolic gesture, experts say.
"I think it's the step in the right direction. ... But given dental decay's progression, it's too late," Punwani said. "By the time the average child starts kindergarten, one out of three already have tooth decay."
With extensive cavities comes the need to find the right treatment and pain relief plan for children, some under 2 years old.
The pain-relief methods vary, depending on dentist and family preference.
Some dentists use more natural methods, treating the child with a local anesthetic and plenty of positive reinforcement.
A more complicated case, such as Katelyn's, generally requires an outpatient hospital visit with general anesthesia.
Seng Patthani and her husband, Khamphone, say they have cut down on sweets and now serve milk or water with meals to daughters Katelyn and Kaylee, 5, who also had several cavities.
"It was an ordeal," Seng Patthani said. "And it's expensive. It's better to prevent it."
Mary Ann Fergus writes for the Chicago Tribune.
A growing number of preschoolers are developing cavities, creating concern among dentists and parents who hoped that brushing and avoiding candy were enough to silence the drills. But with continual snacking and the use of nonfluoridated bottled water on the rise, experts say parents have to be even more vigilant.
Nationwide, nearly 28 percent of children ages 2 to 5 had at least one cavity, based on a federal survey covering 1999 to 2004. That represents a 4 percent climb from the previous survey, the first significant statistical increase in 40 years.