Nearly every time Michael Stubblefield peers into the mouth of a young patient, he sees signs of tooth decay.

The dentist, who is the director of the Toledo-Lucas County Health Department dental program, estimates between 65 percent and 70 percent of patients he sees have some form of tooth decay, a number he’s seen gradually rise in his 14 years in practice. Most of the health department’s patients are children on Medicaid, uninsured, or underinsured.

Tooth decay is a multifaceted problem, Dr. Stubblefield said, one that combines diet, oral health habits, and access to dental care. Sugary and acidic drinks are a major concern nationwide, he said, but a trend away from tap water may be part of the problem here in Toledo.

“I do believe that our getting away from drinking tap water is part of the issue,” he said. “I’m not blaming bottled water, but I definitely think it is factoring in; usually there isn’t fluoride in bottled water.”

Given the scramble toward bottled water after the 2014 water crisis that fouled the tap water for Toledo-area customers and lingering concerns about water quality, Dr. Stubblefield said he stresses Toledo’s water safety and the benefits that come from fluoridated water.

“Like most municipalities, the water here in the city is fluoridated; that does serve to help protect, primarily in children the formation of teeth, especially when their mothers are carrying them in utero. That’s when we see the most benefit from the fluoride because it is incorporated into the teeth when they are still forming.”

It also is beneficial in young children during the formation of their permanent teeth, he said.

“I make sure with every patient visit to talk to make sure they are drinking water as opposed to juices and pop, I also try to emphasize that the [tap] water is safe,” he said. “There is a lot of misinformation on the Internet about fluoride. I’ve heard all sorts of different things. I try my best to dispel some of these myths. ... I really push tap water.”

With younger patients, Dr. Stubblefield said he talks to parents about concerns such as not putting babies to bed with a bottle, which allows sugars to sit on the teeth for hours. For older students, it’s about teaching healthy choices over soda, Gatorade, or energy drinks.

“We’re still seeing lots of decay,” said Robin Kramer, a dental hygienist at the health department. “As soon as they can make those decisions for themselves, that’s when they’re reaching for water.”

Tooth decay remains the most common chronic disease in children and left untreated can result in long-term problems, Dr. Stubblefield said. He sees about 25 to 30 cases a year of what he considers “severe decay.”

“Along with pain and missed school days, it can get to the point where you have systemic infections due to tooth decay,” he said.

The health department has several programs to treat patients — at its downtown clinic that served 4,000 patients last year, the mobile dental program that visits about a dozen Toledo Public Schools annually, and a mobile sealant program that screened 5,700 students last year.

Above all, Dr. Stubblefield said he promotes healthy habits — drinking water over sugary drinks, brushing and flossing twice daily, and getting regular checkups.

The health department’s dental clinic is accepting new patients. To schedule an appointment, call 419-213-4266.

Contact Lauren Lindstrom at llindstrom@theblade.com, 419-724-6154, or on Twitter @lelindstrom.

First Published September 18, 2016, 4:00 a.m.