By Katie Kerwin McCrimmon
An unlikely culprit is spurring costly and debilitating tooth decay among Latino families: fear of tap water.
“In Denver, our water is great, but families don’t know that,” said Dr. Patricia Braun, a pediatrician with Denver Health, who has focused extensively on the harms of tooth decay. “In other countries, especially Mexico, families don’t drink the water and it’s not safe. Some of those perceptions are carried over to the U.S.
“Some still fear that the water’s not safe. And it’s a bit of a status issue. If you have a guest, it’s perceived as unsophisticated to serve them tap water,” said Braun, who practices at Denver Health’s Eastside Family Health Center and is also a professor at the University of Colorado School of Medicine.
“We want families to drink tap water in Denver. We need to educate them,” Braun said.
A widespread reluctance among Hispanics to drink Colorado water could contribute to a triple whammy that allows cavities to form and multiply.
First, if Hispanics avoid tap water, they are missing out on fluoride in the water. (Approximately 75 percent of Colorado water is fluoridated.) Second, some parents who avoid water are giving their babies, toddlers and older children juice or other sugar-sweetened beverages throughout the day instead of water. Sipped on regularly, sugary drinks can cause cavities, obesity and diabetes. And third, beverage companies are targeting Hispanic families who may be more receptive to ads for sugar-sweetened beverages if they avoid water.
Experts at the Yale Rudd Center for Food Policy and Obesity found in a 2014 study that beverage giants including Coca-Cola Co., PepsiCo, Dr. Pepper Snapple Group and four others spent $83 million to advertise sugary drinks and energy shots on Spanish-language TV in 2013, an increase of 44 percent compared to 2010.
Hispanic preschoolers and children saw between 23 and 32 percent more Spanish-language TV ads for sugary drinks and energy shots in 2013 than in 2010, the study found.
African-American kids, who are also at greater risk for tooth decay and obesity, are also seeing more ads. The Rudd study found that black children and teens see twice as many ads for sugary beverages and energy drinks compared with white children and teens.
Wyatt Hornsby, director of the Cavities Get Around Campaign for the Delta Dental of Colorado Foundation, said the beverage industry appears to be borrowing from the tobacco industry playbook by marketing to kids and harming their health.
“If history is repeating itself, these children who are being targeted by the sugary drink industry are being singled out for higher rates of tooth decay, diabetes and obesity,” Hornsby said.
Cavities may not sound like an earth-shattering health problem. But, in fact, tooth decay is the No. 1 chronic disease among children in Colorado.
The statistics are startling and the problem is most pronounced among Latinos and children from low-income families. If experts can hone in on unexpected causes, like fear of water, they may be able to slow the tooth decay epidemic.
According to state health statistics for 2011 — the most recent year available — 32 percent of Caucasian kids already had at least one cavity by kindergarten, while 38 percent of black kids did. Among Hispanics that number was 55 percent.
By third grade, the numbers had spiked significantly.
At that age, 48 percent of white kids had a cavity, compared to 56 percent of African Americans and 70 percent of Hispanics.
In attempting to combat cavities, Hornsby’s group first focused on getting kids to brush more often. But then they realized they were reaching parents and children too late. They started honing in on baby teeth and the little-understood fact that cavities in baby teeth spread to adult teeth. Tooth decay in babies can start as early as six months.
If problems escalate, kids can have a mouth full of cavities before they ever enter school. Those with severe problems can end up in an operating room with costs that swell to $10,000 or more to have the teeth pulled.
To try to reverse the problem, researchers working with Hornsby began interviewing families around Colorado and started hearing comments that surprised them.
“There was something going on here with sugary drinks and water,” Hornsby said.
As researcher Karl Weiss started talking to more and more immigrants from Mexico, he kept hearing about the tap water.
“Their mindset was: if it’s coming out of the tap, it’s going to make you sick. You want to avoid it,” Weiss said.
So Hornsby said the campaign began emphasizing the benefits of tap water.
“If we can move them to water, the fluoridated water will strengthen the enamel,” he said.
The trick is steering parents away from drinks they’ve long enjoyed and underscoring the fact that too much juice can be unhealthy — especially when many families say they are receiving it from government programs like the federal Women, Infants and Children program.
A Delta Foundation survey of 600 homes last year found that 87 percent of parents reported giving their children juice several times a week, 72 percent thought juice was healthy and 55 percent said juice was the most common beverage that their children drank.
“A lot of parents think juice is good for their children, but it’s pretty much sugar water,” said Weiss. “If they’re drinking it from a sippy cup, the sugar is just landing on the teeth all day. It’s the biggest cause of early childhood caries (cavities).”
Dr. Braun of Denver Health, says once the disease process has started in babies and toddlers, it’s very difficult to reverse.
“Eighty percent of the problem is in 20 percent of the kids. It’s low-income families and exposure to sugary drinks,” she said.
Poverty worsens dental problems because there’s little money to afford a dentist. Shortages of providers only compound the problems.
“It’s hard for families to get to a dentist, period. We want to provide the service early and often,” Braun said.
More health clinics are integrating dental health providers so patients can get basic dental care at the same time they’re getting medical check-ups.
Sometimes not seeing a dentist is cultural too. Parents never went to the dentist and aren’t great at brushing themselves.
“If there are other stresses in your life and the child isn’t used to having their teeth brushed, sometimes it’s easier not to fight your kid on it. It just takes a minute or two to help them establish these routines,” Braun said.
Few people also understand that cavities are essentially an infection that can spread from adult to child.
“There are cavity germs that live in our mouth that we don’t want to pass along to kids,” Braun said. “Once a baby has acquired the germ, that increases the chance of a lifetime of cavities.”
To cut cavities, doctors suggest:
- Getting babies to the dentist by age 1 or as soon as the first tooth appears.
- Brushing baby teeth early and often.
- Being cautious about sharing germs from adults who have cavities with babies and older children. For instance, sharing drinks or licking a pacifier can spread cavities.
- If allowing juice, give one serving of 100 percent real fruit juice in an open glass. Have the child drink it all at once (preferably with meals), then brush and move on.
- Avoid sippy cups of juice that babies and toddlers drink from all day.
- Avoid “bottle propping,” giving babies juice, milk or formula that sits on their teeth as they fall asleep.
- Drink tap water throughout the day.
- If avoiding tap water, turn to bottled water rather than sugar-sweetened beverages.
Tooth decay that starts at a young age has long-term implications.
“When kids have cavities in their teeth and that turns into tooth pain, they miss more days of school and fall behind. GPAs are lower. There’s an ongoing cumulative effect that starts as a simple cavity,” Weiss said. “If you don’t take care of it early, it can impact a child’s entire life.”