Dental care and day care

Last month, a new Massachusetts regulation went into effect requiring caregivers to brush the teeth of kids who spend more than four hours a day in their care.

Now, I'll be honest here: I don't always manage to make my two youngest kids brush their teeth before I send them off to preschool each morning. And by "don't always," I mean "only rarely, if ever." My big kids are 16, 14, and 11 -- more than old enuogh to manage their own mouths, when they're with us -- but my 5- and 3-year-old's teeth are still my responsibility. If I can't get them to the sink before school, how will their teachers do it with so many more kids (and chaos) to condend with?

I wrote about the issue in February for The Boston Globe Sunday Magazine. Here's the piece:

Reality bites
A new regulation calls for dental care at day care.

By Lylah M. Alphonse

I’d like to say that my kids brush their teeth before bed and after every meal. But while the former is true, an after-breakfast brush is rarely on my radar. And after lunch? I don’t even brush my own teeth after lunch.

Last month, a new state regulation went into effect requiring that kids who spend more than four hours in day care or eat a meal there also have their teeth brushed by a caregiver. Parents can opt out, but day-care providers who don’t comply could lose their licenses. (No word on what happens if the kids don’t comply.)

The reasoning is straightforward: Tooth decay is the most common chronic childhood ailment, five times more common than asthma, according to the Massachusetts Department of Early Education and Care, the agency that regulates care providers. Bad teeth can cause a host of health and other problems, including socialization and
self-esteem issues, the agency says.

The American Dental Association recommends that children brush at least twice a day, and experts like Dr. Steve Colchamiro of Harvard Dental School and the Brookside Community Health Center in Jamaica Plain say that the extra sink time wouldn’t hurt. While baby teeth aren’t permanent, they still need to be taken care of, and they last longer than their name implies. “Yeah, the baby teeth do fall out, but the back ones don’t fall out until the child is an average of 12 years old, sometimes even 13,” Colchamiro says. “So, if you get a 3-year-old with a cavity, there’s a pretty
good chance that before that tooth falls out, it would cause pain and infection.
That’s why you want to prevent them.”

My big kids (ages 16, 14, and 11) are old enough to mind their own mouths. But if I can’t manage to make my youngest children, 5 and 3, brush after breakfast, how are their teachers going to manage that for them and all the other kids in their care? They say they don’t mind -- they’re teaching life skills! -- but the details are daunting: Toothbrushes must be labeled, they can’t touch, they can’t be electric, and they must air-dry. Toothpaste can’t be fruity, must be locked up, and can’t be
dispensed directly to the toothbrushes. And that’s just for managing the equipment, not the kids.

But if they have to do it, I have no excuse. I’ll step up to the plate (I mean sink) and do a better job of brushing -- for my kids and myself.

When I interviewed Dr. Colchamiro for the story, I asked him if he'd ever seen a patient who had damage caused by brushing his or her teeth too much. "I've never seen one, and I don't think anybody else has," he told me. Pre-Kindegarteners could probably manage to brush their teeth themselves, but the new rules require caregivers to swab down the toothless gums of infants as well. "That's awful hard to ask of a daycare provider. Some parents struggle with that," Dr. Colchamiro pointed out. "If you get a 1-year-old that doesn't have a whole lot of teeth, that's going to be a challenge."

How often do your kids really brush their teeth each day?