[sak9645]

First off, please understand that dental problems are EXTREMELY common in internationally adopted children.

The main reason is poor birthmother nutrition and medical care. Most children become available for adoption because their birth families are poor. The birthmothers may eat a terrible diet during pregnancy out of sheer necessity, and may have no access to -- or awareness of the need for -- prenatal vitamins/calcium. Poor prenatal nutrition generally translates into poor quality baby teeth, and the problem sometimes persists even in the permanent teeth. My daughter, who is from China, has weak enamel and pitted enamel on her permanent teeth, just as she had on her baby teeth. Despite my attention to her teeth, she got a cavity in a permanent tooth soon after it emerged.

In addition, children who spend some time with their biological parents after birth will continue to experience the effects of poverty. In the early years, when it is very important for children to have adequate calcium and other nutrients, they simply may not get it. Instead of high quality breast milk or formula, for example, they may get powdered milk that is watered down and sugared. This is also a cause of poor tooth and bone development. A lot of kids come home from overseas with rickets, a nutritionally related bone condition, as well as bad teeth.

Birth families may or may not know about the need for toothbrushing and the risks of "nursing bottle mouth". This term refers to the practice of letting a baby have a bottle of formula or milk in his/her crib at night. As the baby sucks on it, the sugars pool in the mouth, without being washed away with drinks of water or tooth brushing. The milk sugars increase the growth of decay-causing bacteria.

Once in an orphanage or foster family, some of the same conditions may apply. Many orphanages around the world are woefully underfunded. The children's diets may be poor, and strategies that get babies fed quickly, such as sugaring bottles to make the babies drink faster, are common. The staff may leave bottles in cribs because there aren't enough employees to hold the children, feed them, and clean their teeth. Babies and toddlers need supervision and assistance, or they will not brush their teeth properly, and without adequate staff, they simply won't get much brushing done. Doctor and dentist visits are few and far between, and usually reserved for serious problems.

Foster families, just as in the U.S., may not go into being foster parents with the best of motives. Money given to the foster parents for care of the children may go for other purposes. But even truly caring foster parents may not be well educated, and may not know how important calcium-rich foods are, how risky it is to prop bottles in cribs at night, or that supervision of toothbrushing is a must. Their stipend may not cover much medical or dental care, and if they don't live in a big city, there may be no dentist around. In many countries, people just pull teeth when they decay.

All in all, it doesn't surprise me that kids come home from overseas with bad teeth. In fact, I'm always surprised that this topic doesn't arise more often in adoption forums.

And one other thing should be noted. It may actually be a blessing in disguise if your older children have had limited dental care overseas. In some countries, particularly in Eastern Europe, it is common practice for children, and especially orphans, to be subjected to some fairly serious dental work without any form of pain control. They may be tied or held down, and may be berated or hit if they scream.

Unfortunately, this sort of treatment is absolutely traumatic for the children, and can leave them with a total fear of dentists. Such a fear can make it difficult for their adoptive parents to get treatment for them, even when they need it badly. It can take months or years for a dentist to win their trust.

As far as fluoridation of water, that is not common in the countries from which Americans adopt. And you aren't going to find many dentists in those countries who use fluoride treatments or sealants. In fact, there is very little preventive dental care, just as there is very little preventive medicine, in many countries. You get treatment when you have a big problem.

The good news is that American dentists can do a great deal to correct dental problems in internationally adopted children, and can do it with good pain control. Many of the dentists also receive special training in how to deal with the concerns and fears of children.

The care that is required won't be cheap, of course. In fact, some children may need to have work done in a hospital setting, under general anesthesia, because the problems are so severe. And the need for orthodontia seems to be almost universal. It wouldn't be a bad idea for a person contemplating international adoption to get dental insurance, if it is available through his/her workplace and he/she doesn't already have it.

Sharon