NEW YORK (Reuters Health) – Three- and four-year-olds in certain disadvantaged neighborhoods in New York City have higher rates of untreated cavities than youngsters their same age in other parts of the US, researchers report.

“When we examine the children who have dental caries–or cavities–there is a sharp disparity when a comparison is made to the US population. Very few preschool children receive care,” study author Dr. David A. Albert of Columbia University told Reuters Health.

The researchers, led by Dr. Joseph M. McManus of Columbia University in New York, surveyed 1,605 dental charts of children from the Manhattan neighborhoods of Washington Heights, and Central and East Harlem. Records were accumulated during 18 months from 1995-1997. Each child was treated by the same dentist, who surveyed the child’s oral health from inside a mobile dental van.

The investigators found that children in these communities had more decayed teeth and fewer fillings than the US average. An average of only 1 in 10 diseased teeth had been filled, McManus and colleagues report in the journal Pediatric Dentistry.

While the children had at least one cavity or filling on average, 66% had no tooth decay, with slightly more boys showing decay than girls. If the children did have cavities, they tended to have several, according to the report.

“The burden of disease for preschool children in northern Manhattan is evident when we examine the number of decayed teeth present, for children who have more than one cavity typically have almost three cavities present,” Albert said in an interview with Reuters Health.

According to a series of government studies, US children are less likely to have untreated tooth decay today compared with youngsters in 1971, a trend that includes all ages, races, and ethnic groups. However, the exception to that decrease is children born to families living below the federal poverty line–drawn in 1999 at an income of $16,700 or below for a family of four. In these children, there has not been any noticeable improvement in tooth decay treatment for 30 years.

In 1990, half of the households in Washington Heights and Central and West Harlem had incomes of $21,800 and $16,000 or below, respectively. Around one-half of the population is Latino, and the other half is mostly African American.

“In (low-income, urban) communities, both poverty, with its impact on ability to afford care, and limited access to dental services are likely to lead to high levels of untreated dental disease among very young children,” McManus and his team write.

Overall, 91% of all cases of decay were untreated, compared with a national average of 76% in this age group, the report indicates.

There are many reasons why such children might have more tooth decay than others, Albert noted. For instance, they could eat more cavity-causing foods, or use baby bottles with sweetened liquids for longer periods during infancy. In addition, lack of education about dental health, expense, and cultural views could influence how often families visit the dentist. And, unfortunately, this region of Manhattan is experiencing a shortage of dental health professionals.

The rate of early tooth decay tends to increase as children age, the authors point out, and a high level of tooth decay in young mouths can lead to a “lifetime of dental disease.”

“Preventive dentistry and access to care for disadvantaged urban preschool children is critical to thwart a preventable disease process,” McManus and colleagues write.

SOURCE: Pediatric Dentistry 2002;24:229-233.