Why Bother? They're Just Baby Teeth!

By Dr. Harry W. Bickel, Jr.

"Why bother? They're just baby teeth!" I cannot tell you how many times I have heard that statement over the past 30 years. I do not usually hear it from the parent of a child, because I have limited contact with parents. Most likely, I hear it secondhand, from a health coordinator or family service worker. They, however, have heard it repeatedly from parents. "Why bother? They're just baby teeth. The child is gonna lose them anyway."

My usual response to this question involves a detailed explanation of the development of the teeth, accompanied by a series of poorly drawn sketches (I am a dentist, not an artist). My idea here is to provide people with all the ammunition they will ever need to counter these statements. This is a dentist's approach: use knowledge to prove your point. While I feel that teaching the consequences of untreated disease is important, that is not what I plan to do here. Instead, I will start at a much more basic level and will begin with a story.

Many years ago, when I was a Head Start dental consultant for the U.S. Public Health Service, I worked with a program in the mountains of Eastern Kentucky. Part of my work involved visiting the centers and examining the children for evidence of dental treatment. I will never forget my visit to one very rural center. As I walked into the classroom and began talking with the staff, one of the staff members pointed to a little boy who was sitting at a table playing quietly. The staff member said that this child had been their number one behavior problem from the very first day of school. In fact, they had completed six mental health referrals on the child, all to no avail. Nothing worked until they fixed the child's severely decayed teeth. From that point on, the child behaved like all the other children.

That small incident made an indelible impression upon me. It caused me to realize how much pain some of these children experienced. Even though I have had children come to me, crying from the pain of a toothache, I never understood until then how much it affects their entire life, particularly if it is allowed to drag on. I can not imagine children that small having to face that much pain every day of their life.

I could continue describing all the problems that might occur if we fail to deal with a child's dental problems. The child can not eat properly. The child has trouble speaking. The child has infections that are draining into the mouth. The child's permanent teeth may come in crooked or jumbled-up, because we have lost the baby teeth too early. All of these are valid reasons why we should deal with dental problems. They are overshadowed, however, by one very important reason: the child may be in pain or, at the very least, susceptible to pain.

Dentists may not know everything, but we do know one thing: decayed teeth do not get better. What looks like a small hole today could become an extraction three months from now. If teeth simply decayed and disappeared, the consequences of non-treatment might be far less. Unfortunately, however, this is not the case. As decay worsens, the likelihood of developing an abscess increases dramatically. An abscess is a serious infection that can spread throughout the jaw and cause extreme pain.

If a child came to us with open sores, or visible injuries, we would do something about it immediately. Because it is in the mouth, however, we often allow much more serious conditions to persist. Maybe it is because they are "baby teeth" and they are going to be lost anyway. Maybe it is because they are in the mouth, and we do not have to look at them as often. Whatever the reason, ignoring the problem is not the right thing to do. Pain is pain, regardless of where it occurs in the body. If we in Head Start are truly child health advocates, we need to make sure this pain is dealt with properly and quickly.

Harry W. Bickel, Jr. D.M.D. is a Health Specialist, Region IV Quality Improvement Center, Western Kentucky University, T: 270-745-4041; E: hbickel@home.com.