new mexico - head to toe

New Mexico

Welcome

New Mexico Office of Oral Health

Rudy Blea, BA

Carol Hanson, RDH, BSDH, MPH

The Tooth of the Matter:

Assessing a Student’s Oral

Health

Definitions

• National Health and Nutrition Examination

Survey (NHANES)—cross sectional

survey designed to monitor health and

nutrition status of the civilian non

institutionalized U.S. population

• Untreated dental caries—Tooth decay

(cavities) that have not received

appropriate treatment

More Definitions

• Dental caries—Having a tooth

appropriately treated for tooth decay or

having untreated tooth decay present

• Dental sealant—Plastic-like coating that is

applied to the chewing surfaces of back

teeth; the applied sealant resin bonds into

the grooves of teeth to form a protective

physical barrier

Dental Caries and Sealant Prevalence in Children

and Adolescents in the U.S., 2011-2012

• Approximately 23% of children aged 2-5

had dental caries in primary teeth

• Untreated tooth decay in primary teeth

among children aged 2-8 was twice as

high for Hispanic and non-Hispanic black

children compared with non-Hispanic

white children

NCHS Data Brief, No.191, Mar 2015

Other Key Findings

• Among those aged 6-11, 27% of Hispanic children had any dental caries in permanent teeth compared with nearly 18% of non-Hispanic white and Asian children

• About three in five adolescents aged 12-19 had experienced dental caries in permanent teeth, and 15% had untreated tooth decay

• Dental sealants were more prevalent for non-Hispanic white children (44%) compared with non-Hispanic black and Asian children (31% each) aged 6-11

NCHS Data Brief, No.191, Mar 2015

OOH Staff At Work

Barriers to Oral Health

– LACK OF PROVIDERS

– NO DENTAL INSURANCE

– LOW INCOME

– MEDICAID ELIGABILITY

– TRANSPORTATION

– LACK OF SCHOOL PROGRAMS

THE PERIODONTIUM

Cross-section of a normal tooth

and supporting structures.

DECIDUOUS DENTITION

• Nomenclature for primary teeth.

PERMANENT DENTITION

• Nomenclature for permanent teeth.

AGES AT ERUPTION (AND EXFOLIATION)

• Age range at eruption of primary and permanent teeth and at exfoliation of primary teeth is shown.

VENN DIAGRAM OF DENTAL CARIES

• Caries occurs at the intersection of a susceptible host (one with teeth), presence of microorganisms (e.g., Streptococcus mutans; Lactobacillus), and dietary substances (fermentable carbohydrates). The intensity of bacterial and dietary factors and their interplay will determine caries activity levels.

DENTAL CARIES: ETIOLOGY

The process of dental caries requires:

• Susceptible tooth

• Presence of bacteria

• Fermentable carbohydrates

• Bacteria metabolize fermentable carbohydrates (sugars and cooked starches) and produce acid, resulting in localized lowering of the pH.

• Species of Streptococcus (initiate caries) and Lactobacillus (promote continuation of caries development) are most often implicated in the caries process. The bacteria are transmitted usually from the primary caregiver (mother), but others (e.g., other parent, day care staff) have also been implicated.

THE CARIES PROCESS

• The caries process requires a tooth, fermentable sugar and cariogenic bacteria. To reach cavitation, demineralization must exceed remineralization. Demineralization may be reversible (e.g., with fluoride applications or sound oral hygiene).

DEMINERALIZATION V. CAVITATION

• Since caries is a process and cavitation the end result of that process, four situations are possible.

COMMON PATTERNS OF DECAY:

• Four patterns of decay commonly exist.

CARIES AND INFECTION

• Left untreated, a carious area typically will continue to enlarge. Once the caries process has exposed the pulp, which is the neurovascular bundle at the center of each tooth, a soft tissue infection can result. An untreated dental abscess (single arrow) can lead to the rapid development of cellulitis. Cavernous sinus thrombosis and Ludwig’s angina (both uncommon) pose life-threatening complications which can also result from an untreated dental abscess. Fortunately, most dental abscesses remain localized.

• Note: Carious central and lateral maxillary incisors (double arrows). Though the central and lateral

• mandibular incisors touch (triple arrow), they are protected from decay by the tongue/lip and

• the saliva from the sublingual salivary glands.

TOOTHBRUSHING TECHNIQUE

• The correct positioning of the brush is shown. A small amount of fluoride toothpaste (a thin film (less than pea-sized) should be used by children two years of age and older. For the child who is less than two years of age, the dentist/medical provider should decide whether fluoride toothpaste should be used.

Pit and Fissure Caries

• Caries is present in both the “biting surface” of a permanent first molar (single arrows) and in the buccal pit (a non-biting surface) (double arrow). Dental caries can readily begin on the biting surfaces of posterior teeth, in a pit or fissure (which is typically narrower than a single toothbrush bristle, making it impossible to clean with a toothbrush) or in minute defects in the enamel which, at the base of these structures, is frequently thin. Plaque collects in these areas and is not easily removed by normal oral hygiene measures (brushing). Fissures such as these can be protected with sealant. Generally, primary teeth have better coalesced, less angular and less deep fissures and are therefore often less susceptible to the caries process.

DENTAL SEALANTS

• The placement of sealants is a minimally invasive, preventive procedure and an integral part of a caries prevention plan. The biting surfaces of permanent teeth, with their deep, narrow pits and fissures, are susceptible to the carious process and less well protected by topical fluorides or by controlling frequent consumption of fermentable carbohydrates.

• In the presence of high caries rate or risk, primary teeth may also be considered candidates for sealant application. Resin sealant material seals the pits and fissures, forming a physical barrier that prevents acid demineralization of enamel. Sealants should be applied within six months to one year of eruption of the tooth. Once applied, sealants should be regularly evaluated by a dentist; they may need to be reapplied.

DENTAL SEALANTS

• Note sealant application on occlusal (biting) surfaces of primary and permanent molars (arrows).

DENTAL SEALANTS

• Dental sealants are available in an opaque, tinted, or clear form. Tinted and opaque sealants are easier to detect at subsequent dental examinations. Eighty-five to 95% of sealants are in place after one year, 65-80% after 5 years, and 40-55% after 10 years.

• Sealants are easily repaired or replaced if necessary. (Tooth before sealant applied, single arrow; after application, double arrow).

School Based Programs—What Can be Done?

– Increase Dental Screenings by School Nurse or

Physician

– Implement Dental Sealant Program

– Implement Eight Component Model

– Increased permission slips from parents

– Dental Case Management = Dental Providers

– Data Collection

– Increased Funding for Program

ORAL HEALTH STATUS OF NEW MEXICO 3RD

GRADE

• TOOK KIT

– ASTDD Pain and Suffering Brochure

– ASTDD School and Adolescent Sealant Policy

– CDC Coordinated School Health Program

– CDC Oral Health

– OOH Oral Health Brochure

– OOH Dental Sealant Brochure

– Tooth Brush

Whole School, Whole Community,

Whole Child (WSCC)

Whole School, Whole Community, Whole

Child (WSCC)

• A collaborative approach to learning and health

• Quick Links

• Download Resources

• Expanding the CSH Approach

• Establishing healthy behaviors during childhood is easier and more effective

than trying to change unhealthy behaviors during adulthood. Schools play a

critical role in promoting the health and safety of young people and helping

them establish lifelong healthy behavior patterns. Research shows a link

between the health outcomes of young people and their academic success.

To have the most positive impact on the health outcomes of young people,

government agencies, community organizations, schools, and other

community members must work together through a collaborative and

comprehensive approach.

Whole School, Whole Community, Whole Child

(WSCC)

• The Whole School, Whole Community, Whole Child

(WSCC) model expands on the eight elements of

CDC’s coordinated school health (CSH) approach

and is combined with the whole child framework.

CDC and ASCD developed this expanded model—in

collaboration with key leaders from the fields of

health, public health, education, and school health—

to strengthen a unified and collaborative approach

designed to improve learning and health in our

nation’s schools.

Whole School, Whole Community, Whole

Child (WSCC)

The Whole School, Whole Community, Whole

Child (WSCC) model expands on the eight

elements of CDC’s coordinated school health

(CSH) approach and is combined with the

whole child framework. CDC and ASCD

developed this expanded model—in

collaboration with key leaders from the fields

of health, public health, education, and school

health—to strengthen a unified and

collaborative approach designed to improve

learning and health in our nation’s schools.

Contact Information

• Rudy Blea 505-827-0837

• Carol Hanson 505-222-8685

• rudy.blea@state.nm.us

• carol.hanson@state.nm.us

ORAL HEALTH IS INTEGRAL TO GENERAL HEALTH

Thank you!