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Healthy Teeth for a Healthy Future

What chronic childhood disease is five times more common than asthma, four times more common than obesity, and causes an estimated 51 million lost school hours every year in the United States?  Affecting over 40% of children ages 2 to 19 years of age, dental caries, or tooth decay, takes the top spot for the most common childhood illness.  Although largely preventable, inadequate or unaffordable access to dental care and services, as well as poor oral hygiene habits, leaves many children with untreated dental caries that can result in both long and short- term consequences including pain, infection, difficulty eating, speech challenges, and decreased school performance.  Oral health care is an integral, yet very often overlooked, part of a child’s overall health and well-being.  In their work to protect students’ whole health, school nurses must be armed with information they can use to promote preventative measures, provide support, and guide access to prompt treatment when concerns arise.

Defining Dental Caries

Dental caries occur when decay-causing bacteria in the mouth produce acids that attack, or break down, the tooth’s surface, or enamel, leading to a small hole in the tooth, called a cavity.  If left untreated, dental caries can cause physical, social, and cognitive complications, as well as serious issues later in life, including periodontal disease, heart disease, stroke, and diabetes.

Risk Factors for Dental Caries

Diet, saliva, and both current and previous experience with caries are all primary risk factors associated with tooth decay.  During the disease process of dental caries, the pathogenic bacteria that demineralize the tooth enamel can proliferate with the intake of dietary sugars.

The risk of caries is greatest if sugars are consumed in large quantities and in forms that remain in the mouth for prolonged periods.  For school-aged children, this means frequent sugary snacks between meals, sticky foods, and recurrent intake of sugared medications.

Saliva acts as a triple threat to promoting oral health by acting as a buffering agent to the destructive acids produced by bacteria, regularly flushing the oral cavity, and providing proteins that have antimicrobial activity.  Abnormalities or impediments in salivary flow, whether due to anatomy or disease, can increase the prevalence of caries.

Finally, the best predictor of dental caries is previous caries experience with robust evidence demonstrating mothers are the primary source of oral bacteria colonization in their children.  The active presence of dental decay in primary caregivers, then, from utensil sharing and other close-contact behaviors, is a critical risk factor for caries in children.


Fluoride is a vital oral health prevention measure that is very effective in preventing dental caries.  The natural mineral not only protects the teeth from the demineralization, or breakdown process, but can also help to rebuild the enamel.  Community water fluoridation has been shown to reduce caries by 25%, while fluoride varnish and toothpastes can also be used to effectively prevent disease.

Oral Health Promotion & Advocacy in School

The American Dental Association has designated February as Dental Health Month and it’s an opportune time for school nurses to educate their communities on the importance of oral health.  In addition to encouraging school food menus that are wholly nutritious, dietary considerations should also include protecting students’ oral health.  Through collaboration with the extended community to potentially offer school-based or school-linked dental care, identification of providers who may accept Medicaid or reduced-fee care for children in need, as well as coordination for students with unique dental needs, school nurses can help prevent dental disease and establish a healthy foundation for kids’ futures.

Shop MacGill’s selection of Oral Hygiene Products HERE and be prepared for all dental-related visits to the school health office by reviewing our Dental First Aid Blog and using our Dental First Aid Shopping List!

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