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New Pittsburgh Courier Features Pitt Dental Medicine Faculty in New Pitt Health Column

The following are excerpted from the September 13-19 2023 issue of the New Pittsburgh Courier.

Teaching children good oral health habits helps them grow into healthier adults

More than 40 percent of U.S. kindergarteners have tooth decay when they start school. In fact, tooth decay in kids is five times more common than asthma and seven times more common than environmental allergies. But there's good news. Tooth decay is preventable and treatable-and parents, grandparents, and caregivers play a big role. By helping children develop good oral health habits starting at birth, parents are laying the foundation for a lifetime of better overall health. That includes less chance of them developing inflammatory diseases like heart attacks and strokes, rheumatoid arthritis, Type 2 diabetes, and certain types of cancer.

Dr. Mary L. Marazita, Director, Center for Oral Research in Appalachia and Distinguished Professor of Oral Biology and Human Genetics at the University of Pittsburgh, studies oral health in Appalachia, which includes western Pennsylvania and all of West Virginia, among other states. Appalachia has more oral health problems per person than anywhere else in the U.S.

"Cavities, gum disease, and missing teeth arc some of the health problems Appalachians face in greater numbers than the general population," explains Dr. Marazita. The high numbers have a lot to do with where Appalachians are born, live, work and grow old. Appalachia is a mountainous, rugged, isolated rural area with limited economic opportunities and structural inequities. This disparity leads to a lack of access to education, good paying jobs, affordable transportation, health insurance and healthcare providers, as well as food and housing insecurities for the people who live there.

"These circumstances can cause dental problems at an early age that result in pain and infections that can affect a child's ability to eat, play, and learn, and contribute to low self-esteem about how they look and speak," Dr. Marazita says.

While the circumstances need to be addressed on a system level-including universal access to dental insurance-Dr. Marazita's research shows there are effective things parents can do to help their children develop healthy oral habits. 

Giving your child good guidance 

Based on her research, Dr. Marazita (and the American Dental Association) recommends these practices to give children the lifetime gift of good oral health. 

Start at birth. To get your child used to oral cleaning, start when they're a baby. After every feeding, gently wipe their gums with a dean, damp soft cloth. 

Finish bottles before bed. "Never put your baby to bod with a bottle. It might soothe them to sleep, but it can also cause Baby Bottle Tooth Decay," says Dr. Marazita. Choose to give your child healthy drinks without added sugar or artificial sweeteners, such as breastmilk or formula. When your child begins drinking out of a training cup, the best drink between meals is water, preferably treated with fluoride. 

Brush baby's teeth. When baby teeth first appear, brush them twice a day with a soft baby toothbrush and a tiny bit of fluoride toothpaste. "Baby teeth are important and should be protected in the same way as adult teeth,'' says Dr. Marazita. 

Supervise brushing until about age 6. Continue brushing your child's teeth until they're old enough to spit out, not swallow, toothpaste—around first grade. 

Visit a dentist regularly. After a child's first tooth appears-or by age one—take them to a dentist for their first checkup. If you don't have access to or can't afford a dentist, talk about oral health with your pediatrician or family doctor," says Dr. Marazita. "Many pediatricians are offering preventative oral care in places where there's a shortage of dentists." 

Model good habits. When children are young, they're mimics. Take advantage of this by brushing your teeth with them and choosing to eat healthier food and drinks. You'll serve as a role model and boost your own oral health. "The best teacher is you,'' says Dr. Marazita.

Taking oral healthcare to the streets

Oral health and overall health are interconnected. According to the American Dental Association, poor oral health, including gum disease and infections, can lead to system-wide inflammation. Inflammation begins when the body is trying to fight against something that's irritating it, such as a germ that causes a cold or a splinter that causes skin to become red, swollen, and painful. Inflammation has been linked to a greater risk of health issues like diabetes, heart disease, respiratory infections, and negative pregnancy outcomes, including low birth weight. What's more, certain conditions like diabetes can weaken the body's ability to fight oral infections and make oral health problems worse. That's why good oral hygiene and regular dental care are so important. They promote a healthy mouth-the door to the body's digestive system-and also support the body's overall well-being. Social determinants of health (SDoH) can make it hard for underserved populations, especially people who are unhoused/unsheltered, to maintain good oral health. 

SDoH arc non-medical factors that impact about 80 percent of people's health outcomes. They include education, income, social and community conditions, neighborhood, and healthcare quality and availability. For vulnerable people, these factors are unequal due to forces beyond their control.
To make oral healthcare more equal, University of Pittsburgh Professor Adriana Modesto, D1ID, MS, PhD, and Pitt's first Assistant Dean of Diversity, Inclusion and Social Justice, has created a college course titled Community Outreach Experiences for Vulnerable Populations. In it, Dr. Modesto's 30+ dental students provide free oral healthcare and social support to underserved Pittsburghers thru the university's Street Medicine outreach.

"To do that, we divide students into three groups:' Dr. Modesto explains. "Because unhoused/unsheltered people have a higher risk for oral cancer, the first group provides cancer screenings on the street and in shelters." The risk factors include alcohol and tobacco use, sun exposure, chronic dental disease, and HPV infection. Like other cancers, early detection of oral cancer is key to survival. The second group of students act as ambassadors to underserved populations, such as LGBTQIA individuals, veterans, people with physical and mental challenges, children and youth, pregnant people, and those who are unhoused/unsheltered. "These students offer care and resources, such as health screenings, follow-up treatment, appointment scheduling and transportation to and from clinics, and help with paperwork for those who are insured," Dr. Modesto continues. A third group of students make regular clinical street rounds. 

"With Street Medicine, we all work together—healthcare providers and community organizations-to meet people where they live, be in relationship with them, and get them what they need to feel supported and live healthier lives," Dr. Modesto adds. That can mean getting someone's broken tooth fixed as well as providing shoes and a warm coat that fits and distributing fresh food, hygiene products, and NARCAN. While Dr. Modesto's course has grown in scope and student count since she began offering it in 2021, the one constant is its relevance. "The Street Medicine team now has a dental offering, which it didn't have before," she explains. "They're grateful for our contributions and supportive of our efforts. 

"The patients we serve appreciate the healthcare we provide that's improving their lives," Dr. Modesto continues. "While there's no research to confirm this, I think the patients also feel respected and have begun to trust us as allies." That trust is especially important for Pittsburgh's LGBTQIA individuals who are at a higher risk for violence, rejection, homelessness, and suicide than their peers.

The dental students are also changed by the experience. "Part of the course requirement is to write about their assignments," says Dr. Modesto. "My students' notes include their surprise at the large number of vulnerable people who live in Pittsburgh. They also acknowledge their own privilege compared to their patients'. By doing this work on their own, many also conclude that underserved populations deserve quality healthcare, too. It's eye-opening for everyone."