Gabriel Sanchez is screaming at the top of his tiny lungs.
But he's not hurt. At 13 months old, he's just objecting to the stranger's hands in his mouth. He's having his nine baby teeth brushed, on his first visit to the dentist.
Even though dental hygienist Valerie Haustein is trying to make Gabriel laugh by wearing a Groucho-Marx-like mask and using a Tigger toothbrush, the toddler is not falling for it.
The nation is in the midst of a resurgence in childhood tooth decay. So the top U.S. dental associations now recommend a first visit when a child has just one tooth. That can be as young as six months.
"I always tell moms that if their kids are fighting and fussing with you when you're brushing their teeth, this is a fight you have to win," said Haustein, who was recently treating Gabriel at the dental clinic in Children's Hospital of Colorado. She finds some white spots on some of the toddler's teeth, and warns his mom they could be an early sign of decay. "We're seeing a lot more cavities in children, even Gabriel's age."
Gabriel's mother, Lisa Casaus, tells Haustein she is careful not to load her son up with too much sugar, and she scores extra points with the hygienist because she gives him tap water. It's better than bottled water because it contains cavity-fighting fluoride.
Gabriel's visit is part of a statewide University of Colorado-coordinated initiative called "Cavity Free at Three," which works with parents and health care providers to eliminate all tooth decay in Colorado children under age three.
Dental disease is the number one chronic health problem for American children - more common than hay fever and asthma, according to the Centers for Disease Control.
Colorado mirrors the nation. The state's latest health report card, compiled by The Colorado Health Foundation, indicates that parents in Colorado are often slacking when it comes to caring for their children's teeth. Some 23 percent of Colorado kids didn't go to the dentist for a preventative visit last year, ranking the state 38th in the nation.
Among uninsured families, only a third of 2 to 4-year-olds went to the dentist, the report card found.
By age 17, nearly 80 percent of Colorado kids have had at least one cavity. Nearly 10 percent have lost a tooth because it rotted out.
"This is not surprising," says pediatric dentist Mark Koch. He has seen an alarming increase in the amount of cavities in young children. His worst case ever: a 4-year-old who lost all 20 of his teeth to decay. "They were so far gone, we couldn't repair them."
Koch adds that oral surgery is a serious proposition for preschoolers, as they almost always have to go under anesthesia. Children's Hospital reports nearly 3,000 pediatric dental surgical cases last year, at a cost of $8,000 to $10,000 per child.
Poverty is a major reason for the increase in cavities among children. Studies show that poor kids have 12 times more restricted-activity days - such as missing school - than higher income children, due to dental problems.
But many American families take the easy way out when it comes to feeding their children.
"Fast foods, which can have more sugars, have become a part of our diets, over fresh fruits and vegetables," Haustein said.
Koch says too many parents also want to be their kids' best friends, but they need to be stricter. Parents "aren't making them brush their teeth and they don't recognize what decay looks like until it's too late."
When a serious toothache does happen, parents are relying more and more on the emergency room.
That's a mistake, says Koch.
"Most ER's aren't equipped to respond to dental needs other than 'Are they in pain? Do they have an infection?'" Koch said. After charging a hefty emergency fee, "What they'll probably do is provide medication and tell you to see a dentist."
Dentist Ulrich Klein, also of Children's, notes that many parents also don't think baby teeth are important. "They figure they'll fall out eventually, so why bother? They are setting their kids up for a lifetime of cavities."
Klein advises that if a baby can't stand toothbrushes, parents can wipe their teeth with a cloth.
Further, Klein tells parents not to share spoons with a baby, or put an infant's pacifier in their own mouths before handing it over to their child. This can introduce bacteria that cause decay.
Back in the exam room, by the time Haustein puts the finishing touches on a brand new tooth with vitamin fluoride, Gabriel Sanchez is hopping mad. "Wowie zowie! Let's hurry up!" she says to him, and she folds him back into his mom's lap for a big hug. All is well for little Gabriel, whose mom promises she'll bring him regularly.
But next time, things will be different. Next check-up, he'll actually have a mouthful of teeth.
To read more health coverage from Colorado Public News, visit www.ColoradoPublicNews.org.