Getting all kids the dental care they need

Among high risk populations, it has been called a silent epidemic.

Tooth decay is on the rise for children as young as toddlers, setting the stage for a lifetime of oral health problems.

“This is an infectious disease that is completely preventable,” said Dr. Amos Deinard, a pediatrician with the University of Minnesota.

Pediatric dental care has become either unaffordable or hard to find, especially for low income families relying on state insurance programs.

Dental cavities can develop in children who are even under one year of age.

And for kids with limited access to dental care, those risks increase. Left untreated, tooth decay can have drastic impacts on a child’s health, including social and physical development.

It is never too early to start thinking about a baby’s dental health, even before those teeth arrive.

“You start to brush or wipe a child’s mouth at the rupture of the first tooth,” said Deinard.

He has spent the past decade working to get dental care of infants and children to the forefront of wellness care by pediatricians and general practitioners across the state of Minnesota.

Deinard is leading the Oral Health Zone Project through the National Children’s Oral Health Foundation, a public health initiative aimed to increase awareness and follow through of dental care for the youngest of children. His work is focused in Anoka County along with 27 other counties in the state, where at-risk families are challenged to find affordable pediatric dental care.

He sees early intervention as key to preventing tooth decay, an infectious disease that is five times more common than asthma and seven times more common than hay fever, according to the Surgeon General.

The goal is to help participating communities address that dental cavities are a problem affecting children, in particular high-risk children.

High-risk kids include those on Medicaid or MinnesotaCare, or children from working poor, uninsured families who don’t have regular access to a dental clinic.

Among those high-risk children, 20 percent of two-year-olds and 50 to 60 percent of five-year-olds have cavities, according to Deinard, who has been focused on the issue of dental health for over a decade.

“These families have no dental insurance and their pockets aren’t deep enough to cover dental care,” Deinard said.

The system was working well until 1995, said Deinard, when many dentists stopped seeing patients on government funded health care programs because they don’t get paid enough.

“Since then this has become a silent epidemic among high-risk children,” he said.

Now many young children are left without a dental care home and adequate fluoride treatments. The result can be a mouthful of cavities.


What caregivers can do

At the most basic level, there are things parents and caregivers can do to prevent cavities.

Don’t put your baby to bed with a bottle, said Deinard. If you must, it should only contain water instead of formula or milk, which can lead to cavities when in contact with the teeth overnight.

And for parents of children who use a pacifier, don’t put the pacifier in your own mouth thinking you are “cleaning it” for your child after it falls on the floor.

This can spread cavity causing bacteria, said Deinard.

Cavities are caused by bacteria in the mouth that interacts with the sugars from food and drinks.

A child’s teeth should be brushed twice daily with toothpaste containing fluoride. Children should be taken to the dentist every six months for a fluoride treatment. Exposure to sugary foods and drinks should be limited.

Deinard would like to see all early childhood medical providers trained to apply a fluoride varnish to children’s teeth that can fight against cavities. Fluoride strengthens tooth enamel, making it more resistant to damage.

Since primary health care providers see a child 12 times for well visits in the first five years of life, Deinard sees this as an important chance to bridge the gap for kids that aren’t getting dental care.

Since 2004 fluoride varnish has been covered for Medicaid patients but not all pediatricians and particularly family doctors offer the service, said Deinard.

Starting in 2000 he developed a training program that has reached 130 practices where doctors, nurse practitioners, physician assistants, public health nurses and support staff are able to incorporate “caries (cavities) prevention intervention” into routine well-child exams. This includes an oral exam, risk assessment and guidance for caregivers, along with the application of the fluoride varnish.

“The doctors are very important when it comes to prevention in the first two years of life,” said Deinard. “I want to make sure the docs are trained and the parents know they can ask for the fluoride varnish.”

He also feels the major health systems like Fairview, Allina and HealthEast could make a giant contribution if their medical clinics were trained in and doing fluoride varnish applications on high-risk children who have no dental home.

Often, he said, it is the fear of the unknown that prevents family doctors from embracing the procedure.


On the front lines

Connie Blackwell, a nurse practitioner and executive director of North Metro Pediatrics, was one of the first trained by Deinard to apply the fluoride varnish.

It’s a practice North Metro Pediatrics has been doing since 2004, specifically for high-risk children once they are two years old.

“We include the fluoride varnish for any child that doesn’t have access to a dentist or minimal access to dental care,” said Blackwell.

North Metro Pediatrics is a sliding fee clinic run by nurse practitioners, seeing many families that are either without insurance or on state health insurance. Seventy percent of the patients seen are on medical assistance, said Blackwell.

She said it was easy to see the benefits of adopting this practice as part of the Coon Rapids clinic’s well child care.

“Your dental health affects your whole body – it’s such an important piece,” said Blackwell. “It’s a simple procedure that doesn’t take very long. The kids don’t seem to mind it at all.”

The varnish – a thin caramel-like substance – is painted on the child’s teeth, followed by a quick wipe. The only restriction is nothing sticky to eat for the remainder of the day.

At well child visits the nurse practitioners talk to parents about the importance of brushing. Blackwell said they also make referrals if they see dental problems.

“The families we see come back and they are really grateful for something that really is a simple little procedure,” she said.

But the fluoride varnish is not a substitute for finding dental care for toddlers and preschoolers.


A community concern

Deinard says tooth decay is the most common chronic disease of childhood.

While death is rare, it has happened. In 2007 a 12-year-old boy in Maryland and a six-year-old boy in Mississippi died from brain abscess and generalized infection.

Both deaths were traced back to an abscessed tooth.

But dental problems do commonly cause other quality of life issues for children and their families ranging from affecting self-esteem to significant health problems.

Pain, difficulty eating and a delay in growth and development can stem from tooth decay.

Deinard’s next charge as part of the Oral Health Zone is establishing specific zones throughout the state, identifying nine regions where the community’s stakeholders, ranging from health care providers to community service groups, become more aware of the issue.

“I want these groups to know they are part of a community that has a problem,” said Deinard on how others can help. “These are their kids and they are the ones who can put pressure on the doctors and the clinics to go and start doing this.”

Dental clinics in the area that are low cost, sliding fee or accepting new medical assistance patients. Call for payment and insurance details.



Spring Lake Park, 651-635-0556



Coon Rapids, 763-784-7570



Fridley, 763-786-4260



Coon Rapids, 763-767-4888






Coon Rapids, 763-422-2000


Minneapolis and over 250 portable locations throughout the metropolitan area, 612-746-1530


Dental clinic for children with special needs:


Coon Rapids, 763-767-1524


Coon Rapids, 763-784-7570

If you need help finding a doctor or dentist, contact Anoka County Human Services Department at 763-422-6932.

Mandy Moran Froemming is at [email protected]


  • Eddie

    I know that in pennsylvania dentist insurance is extremely limited for children. I’ve been shopping for months now to almost no avail.

  • Fluoride varnish has a hugely toxic 26,600 parts per million fluoride and has never been safety tested by the FDA. The FDA never approved fluoride varnish to prevent tooth decay.

    Fluoridated toothpaste carries a warning that, if it is swallowed, call poison control.

    Just like all drugs, fluoride gets absorbed into the body via diffusion through the mouth membranes.

    Fluoride toothpaste (1,000 ppm) is not recommended for children under two years old. Fluoridated water (1 ppm) must not be routinely mixed into infant formula. Putting fluoride varnish on baby’s first tooth should be criminal.

    It’s abhorant that the dental lobby with its pockets filled with corporate cash have gotten laws passed that allow fluoride varnish to be applied to babies teeth without consideration for their total fluoride intake which contributes to fluoride overdose symptoms such as dental fluorosis (discolored teeth)

    • It Matters

      It’s wrong that people feel the need to provide the public with ill guided advice. Statements claiming that fluoride toothpaste, water, and varnish are unsafe are simply someones person opinion based on no legitimate evidence. This information is filled with one inaccuracy after another. While I understand people are entitled to their own opinion, they are not entitled to thier own facts. I take offense to fear mongering tactics. Fluoride is both safe and effective. It’s been used for more than a half a century and has hundreds of valid scientific studies to support its use.

  • Although fluoride varnish has been widely used, it isn’t approved by Food and Drug Administration (FDA) as an anti-caries agent. I agree with nyscof that parents should take precautions before letting their kids undergo this procedure even if this is free. There can be acute complications with this HIGH concentrations of sodium fluoride although applied in minute amounts since this varnish is flushed away and swallowed. Here is an article for that: I have just read a book entitled “Cure Tooth Decay” by Ramiel Nagel and he has points regarding preventing tooth decay– through reinforced nutrition. As a point, fluoride doesn’t answer to every dental need. Strengthened nutrition and proper regular oral hygiene can.

  • Linda Lindeke

    I applaud your article about Dr Deinard whose work I have admired for 35+ years. There is an error in the story that is unfortunate. I have looked on a number of websites about dietary restrictions after the varnish. Here is what I found consistently, including one of the manufacturers’ website:
    “Children may drink water immediately after procedure. Advise patient to choose foods that are soft and not to brush until the next morning to allow longest fluoride exposure.”

    Linda L. Lindeke PhD RN CNP FAAN
    Associate Professor School of Nursing & Dept of Pediatrics, Director of Graduate Studies, Nursing