“Help! I need a doctor!” Mona’s mother was frantic. “She’s in pain. Someone please help!” Mona, a four-year-old girl who loves chocolate milk, was wailing in fear in my dental chair.

Finally, after I delivered the anesthetic, Mona’s tooth was numb. I was seeing Mona for her second emergency tooth extraction. This is not how I wanted the situation to play out, but Mona was a fearful four-year-old with cavities. Typically, a child with this much dental fear is treated with sedation to make the extraction procedure more comfortable and less anxiety-inducing. However, my next available dental sedation appointment was 10 months away because so many other patients also needed treatment for similar dental disease. Furthermore, Mona was overweight, which made sedation relatively contraindicated due to increased risks of adverse outcomes. The only help that I could offer was an emergency extraction. I reassured Mona’s mother, “Mona’s tooth is getting numb. It’s not pleasant but I assure you she is not feeling pain.” Six minutes later, after tears, more anxious cries and a skillful tug, the tooth was out.

Chocolate milk was new to Mona a few months ago. She entered transitional kindergarten last fall and fell in love with it. Soon, mom was buying chocolate milk for home, too. Since starting school, Mona would no longer accept plain milk and the extra calories contributed to Mona’s weight gain, increasing her risks for adverse health consequences like diabetes and hypertension. Sadly, Mona was not alone. Children get a taste for cavity-causing sugar-sweetened beverages, like juice and chocolate milk, that are introduced and made available at schools and daycare.

As a pediatric dentist, seeing patients like Mona is an everyday occurrence in my practice. The United States Department of Health and Human Services recognizes that tooth decay is the most prevalent craniofacial or dental condition affecting 18% of children nationwide. (1) In California, the Kindergarten Oral Health Assessment form is a requirement for enrollment in public school. In San Diego County, where I live and work, of the 41,000 forms returned for the 2022-2023 school year, fewer than 34% of children had completed an oral health assessment and 24% of children had untreated dental decay. (2) It’s no wonder that I see patients struggling in school because of tooth pain. I see children who have a hard time cutting down on their consumption of sugar-sweetened beverages. And I see children who are so overweight that the only place they can safely receive dental care is in a hospital operating room where they can undergo general anesthesia.

We can prevent children like Mona from experiencing devastating health consequences by treating more than just the symptoms and digging deeper to find the root of the problem. We must build school environments that support healthy behaviors and lifestyles. As a Champion Provider Fellow, I am working with my colleague to develop policy changes to limit the availability of sugar-sweetened beverages in our local schools as well as encouraging my patients to reduce their consumption. I hope you’ll join me in taking the extra step of counseling patients on reducing their consumption of sugar-sweetened beverages. And if you’re feeling emboldened, find out more about the wider health issues tied to sugar-sweetened beverages by connecting with your local public health department to learn how your expertise can help bridge a gap in education or advocacy needs in your community.

1. National Institutes of Health. Oral Health in America: Advances and Challenges; Section 2A: Oral Health Across the Lifespan: Children. National Institute of Dental and Craniofacial Research, National Institutes of Health; December 2021. Available at: “https://www.nidcr.nih.gov/sites/default/files/2021-12/Oral-Health-in-America-Advances-and-Challenges.pdf#page=159”. Accessed May 10, 2024.

2. County of San Diego Health and Human Services Agency, Public Health Services, Maternal, Child, and Family Health Services, Oral Health Program, 2022-2023 Aggregated School-Reported Kindergarten Oral Health Assessment (KOHA) Data.

Dr. Wai-Yin Chan is a pediatric dentist at a Federally Qualified Health Center practicing in San Diego County and serves as clinical faculty for NYU-Langone Advanced Education in Pediatric Dentistry. Dr. Chan's interests include the integration of medicine and dentistry, promoting HPV immunization awareness, providing and advocating for the care of patients with special health needs and supporting resident education in the specialty of pediatric dentistry.