Every year, the week after Halloween, Mary Pagana's phone rings off the hook. Another child with a tooth ache is crying in a school nurse's office, and the child needs urgent help.
Pagana is the dental health educator for the Palm Beach County (Fla.) Health Department, and it's her job to try to find a dentist willing to give emergency care to children who often have not seen a dentist before.
It's not an easy task, especially the week after Halloween, when there may be a dozen or more dental emergencies she must manage.
"Next week I will be bombarded with calls from school nurses who have kids with toothaches," Pagana said.
It takes three ingredients to make a cavity: A vulnerable tooth, bacteria, and sugar.
If there's a cavity anywhere near a tooth nerve, that Halloween candy can push it right over the edge, and the consequence is excruciating pain for those children, Pagana said.
Longer term, the consequences of untreated dental disease can be much worse. Missed school and work are just the beginning. Mouth infections can lead to heart disease, pregnancy loss, and diabetes complications, said Dr. Claude Earl Fox, executive director of the Lake Worth, Fla.-based Florida Public Health Institute.
He urged adults to consider giving out sugarless gum, xylitol lollipops, string cheese, or non-candy items like stickers and Silly Bandz instead of candy this Halloween.
But more than that, he urged state and local public officials to move beyond the unfocused, penny-wise, pound-foolish approach that Florida has long taken with dental health issues.
The non-profit Pew Center on the States recently gave Florida an "F" for its short-sighted policies on dental care.
Instead of allowing dental hygienists to apply tooth-saving dental sealant to children's teeth, for example, Florida mandates a dentist's exam in advance.
That's an impossible hurdle for many families.
The Florida Public Health Institute has grants from the Quantum Foundation, the Allegany Franciscan Foundation and DentaQuest to focus public attention on the problem. Last year, it co-hosted a Healthy Happy Halloween event at the South Florida Science Museum to promote healthier Halloween alternatives. Their advice?
Brush and floss regularly, eat a healthy diet low on sugar and high on fresh fruits and vegetables, rinse with water or chew sugar-free gum if it's not possible to brush between meals, and never put a baby to bed with anything other than water in his or her bottle.
Protecting baby teeth with fluoride varnish and sealant can reduce tooth decay by as much as 60 percent. Application of a sealant costs only about one-third the cost of filling a cavity.