Survey finds gaps in kids' dental care.

Think of it as a single snapshot of the smiles on millions of young faces-but be prepared. The picture isn't entirely a pretty one.

As tooth decay continues its slow decline among the nation's children, 80 percent of tooth decay cases among kids aged 5 to 17 now occur in just one-quarter of those children, according to a newly released government survey.

"I'd be hard-pressed to think of any other disease of consequence that affects so many schoolchildren," says Gary Rozier, a dentist and professor at the University of North Carolina School of Public Health in Chapel Hill. The nationwide survey examined 15,000 children under 18 years of age, comparing three ethnic groups. In children over 5 years old, nearly 40 percent of tooth surfaces in non-Hispanic black and Mexican American children were decayed, and 40 percent of those had not been filled.

Among non-Hispanic white children in the same age group, just 14 percent of tooth surfaces were decayed, and over 80 percent of the decayed surfaces were properly filled.

The contrast apparently has little to do with stockpiled sweets or heredity. It is more likely linked to differences in income and insurance. "There definitely is an access problem," says dentist Lawrence J. Furman, a senior epidemiologist at the National Institute of Dental Research (NIDR) in Bethesda, Md.

Furman was one of many investigators involved in phase one of the third National Health and Nutrition Examination Survey, an assessment of the nation's health from 1987 to 1991. Results on dental health appeared in the March Journal of the American Dental Association and other publications, and they are also being presented at a meeting of the International Association for Dental Research this week in San Francisco.

The survey-the first national study of dental health that includes children with baby teeth-found that more than 40 percent of those under 10 years old had cavities in their primary teeth. Many of them don't get the treatment they need, Rozier says. Cutbacks in Medicaid may make matters worse. "Pediatric dentists say they are already overbooked in the emergency room, trying to deal with baby-bottle tooth decay and other problems in low-income children." Baby-bottle decay results when a baby falls asleep with a bottle in his or her mouth, creating a perfect culture medium for destructive bacteria. Despite the bad news, however, the study demonstrates that overall dental health among children has improved slightly in recent years. For instance, 55 percent of kids aged 5 to 17 had decay-free permanent teeth, 5 percent more than reported in an unrelated NIDR survey conducted from 1986 to 1987. Rozier attributed the continued improvement to 40 years of fluoridation in water, toothpaste, dental rinses and other products. In the latest survey, however, only 20 percent of all children-and just 1.4 percent of those with baby teeth-had been treated with dental sealants. These plastic resins are painted onto biting surfaces to seal out bacteria and thus prevent decay. Use of sealants has far to go to reach the 50 percent goal set by the Public Health Service for the year 2000.

The cost, $15 to $35 per tooth, may explain some of the shortfall. The government will make survey data, including information on hygiene and other aspects of dental health, available to researchers seeking to examine such questions.