Preventatively speaking: avoiding “bad teeth”

Photo by Diana Polekhina on Unsplash

by Beth Donovan | Special to the Courier

Have you ever wondered why some people seem to have “bad teeth” and have lots of dental work done?

We all know people who seem to have a lot of cavities filled and even crowns and root canals while others have very few. There are many factors that contribute to our oral health, but getting the right amount of fluoride early in life can be a key contributor to healthy teeth in the future.

Dental caries (also known as tooth decay or dental cavities) is the most common chronic disease in children in the United States and is more common in children living in poverty. Parents and caregivers of young children should discuss the most appropriate treatment options as soon as the child’s first tooth erupts since caries can develop at any time. Caries is known to cause pain, tooth loss, and dietary changes. Studies have shown that kids without dental caries do better in school and have a better quality of life.

Children should receive both topical and oral fluoride. The current recommendation is to take supplemental fluoride starting at age 6 months for children whose water supply is deficient (<0.6 parts fluoride per million parts water, or ppm F) in fluoride. Additionally, primary care clinicians should apply topical fluoride varnish to teeth during a well child visit just after the first teeth erupt. The expert opinion regarding the frequency of topical fluoride application varies slightly from one professional organization to the next, but the consensus seems to be somewhere around every six months as a preventive service throughout childhood. Topical fluoride can be applied at the office of a physician or dentist.

In much of California, including in Claremont, the water supply has added fluoride as part of the Center for Disease Control’s Community Water Fluoridation Program. You can access a full report of the water quality in the City of Claremont through Golden State Water Company’s website at Ingesting too much fluoride can be harmful, so it should only be taken if prescribed.

Since the enactment of the Patient Protection and Affordable Care Act, preventive services recommended by the United States Preventive Services Task Force, including oral and topical fluoride for children, must be covered by most commercial plans with no cost to the patient. It’s a good idea to meet with your primary care provider at least annually to make sure you are up to date on preventive screenings, services, and immunizations. It is always a good idea to check with your health or dental insurance company to make sure that the service is covered as preventive and that it is done with an approved healthcare professional.

The US Preventive Services Task Force is a panel of preventive medicine experts who volunteer to review literature and clinical guidelines; develop recommendations for preventive screenings, medications, and counseling; and assign a grade to their recommendations. In 2021, the task force reviewed its previous recommendations from 2014 and reaffirmed the previous statement. They assigned this screening to a grade B, meaning that there is moderate net benefit. All grade A and grade B recommendations must be covered by most commercial health insurance plans with no cost to the patient. Children on Medi-Cal can receive services for free either from their primary care physician or from their Denti-Cal Provider.

You can download an app or go to the task force’s website at to learn which preventive screenings, medications or counseling services are recommended for you.

Claremont resident Beth Donovan, PA-C, practiced as a physician assistant for 20 years and served as chair of legislative affairs for the California Academy of Physician Assistants from 2004 to 2012. She is on the advisory board for Keck Graduate Institute’s Physician Assistant Program.


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