Lourdes Vazquez, RDH, BS, MS, ECP1Email: Lourdes.Vazquez.Cancel@sedgwick.govWork: 316-660-7398

PREVALENCE* OF UNTREATED DENTAL CARIES†

IN PRIMARY TEETH§ AMONG CHILDREN AGED 2–8 YEARS, BY AGE GROUP AND RACE/HISPANIC ORIGIN —

During 2011–2014, National Health and Nutrition Examination Survey, 2011–2014

13.7% of children aged 2–8 years had untreated dental caries in their primary teeth (baby teeth).

The proportion of children with untreated dental caries in their primary teeth increased with age:

10.9% among children aged 2–5 years and

17.4% among children aged 6–8 years.

A larger proportion of Hispanic (19.4%) and non-Hispanic black children (19.3%) had untreated dental caries in primary teeth compared with non-Hispanic white (9.5%) children.

IMPACT OF ORAL DISEASE ON SCHOOL-AGED CHILDREN AND THEIR SCHOOL

PERFORMANCEEarly tooth loss

Failure to thrive

Impaired speech

Low self-esteem

Poor school performance

Absences from school

Inability to concentrate

Systemic consequences

DYNAMICS

CARIES DISEASE PROCESS TYPES OF CARIES

ANTERIOR BABY TEETH CARIES POSTERIOR BABY TEETH CARIES

DENTAL CARIES & DEVELOPMENT OF AN ABSCESS

ABSCESS

CHRONIC DENTOALVEOLAR ABSCESS (FISTULA, PARULIS)

UNDERSTANDING THE IMPORTANCE OF BABY TOOTH RETENTION

PANORAMIC RADIOGRAPH VIEW RISK ASSESSMENTMom/sibling dental history (biggest influence on risk), active decay in

parent/caregiver automatically places as high risk

Low health literacy of primary caregiver

Low socio-economic levels of parents

Clinically observe OH compliance issues

Poor plaque control, biological presence of S. Mutans, gingival bleeding

Frequent exposure to cariogenic agents

PREVENTIVE MEASURESDENTAL SEALANTS

FLUORIDE

5,000 ppm products are CONTRAINDICATED

Fluoride supplements are required, only when NO other fluoride exposure

Fluoride varnish applied every 6 months is effective in preventing caries in primary and permanent dentition

Two or more annual applications of fluoride varnish effective on high-risk populations

NEW PARADIGM TREATING CHILDHOOD CARIES

Silver Diamide Fluoride (38%)

Caries arrest and prevention, low cost and no drill

Cons: Bad taste, black stains, mouth sore

GINGIVITIS EFFECTS ON OVERALL HEALTH

ACUTE NECROTIZING ULCERATIVE GINGIVITIS

DEPOSITS OF SUPRAGINGIVAL CALCULUS THAT CAN NOT BE REMOVED WITH BRUSHING

FUNGAL INFECTIONS CANDIDIASIS (MONILIASIS) AND THRUSH –

CANDIDA ALBICANS

ANGULAR CHEILITIS IN CHILDREN ERUPTING PERMANENT TEETHERUPTING HEMATOMA

LINEA ALBA IN ADOLESCENT BOYIRRITATION FIBROMA

ON UPPER LIP OF 6-YEAR-OLD BOY

ACUTE HERPETIC INGIVOSTOMATITIS(PRIMARY HERPES SIMPLEX 1)

CHEEK BITE(SELF-INFLICTED)

MUCOCELE / RANULAMIGRATORY GLOSSITIS (GEOGRAPHIC TONGUE)

TONSIL STONES LINGUAL THYROID NODULE

AMALGAM TATTOO MELANIN

COSMETIC ALLERGIC REACTION APHTHOUS ULCER

RECURRENT HERPES SIMPLEX I LABIALIS

TONGUE BAR

ENLARGED PAROTID GLAND DUE TO VOMITING

RUSSELL’S SIGN CLASSIC MAXILLARY EROSION IN PATIENT WITH BULIMIA NERVOSA

CHIPPED ANTERIOR TEETH IN PATIENT WITH BULIMIA NERVOSA

SQUAMOUS PAPILLOMACONDYLOMA ACUMINATA

IN THE TONGUE AND PALATE OF A SEXUALLY ABUSED CHILD

ORAL LESION CAUSED BY HUMAN PAPILLOMA VIRUS

HUMAN PAPILLOMA VIRUS

ASSESSING FOR ABUSE

Dental Professionals – Mandated reporters

Head and Neck injuries occur in more than 50% of child abuse

34% of abuse victims under age 4, highest under age 1

MEDICAL NEGLECT

Acts or omissions by a parent, guardian, or person responsiblefor the care of a child resulting in harm to a child, or presentinga likelihood of harm, and the acts of omissions are not duesolely to the lack of financial means of the child’s parents orother custodian.

MEDICAL NEGLECT

This term may include the following, but shall not be limited to:

Failure to use resources available to treat a diagnosed medicalcondition if such treatment will make a child substantiallymore comfortable, reduce pain and suffering, or correct orsubstantially diminish a crippling condition from worsening.

A parent legitimately practicing religious beliefs who does notprovide specified medical treatment for a child because ofreligious beliefs shall not for that reason be considered anegligent parent. (KSA 38-2202)

INDICATORS OF NEGLECT

While physical abuse is usually episodic, physical neglect tends to be chronic.

COMMON PHYSICAL INDICATORSConstant hunger

Lack of proper supervision, abandonment or desertion

Lack of adequate clothing and good hygiene

Clothing consistently not appropriate for weather conditions

Lack of medical or dental care

Lack of adequate nutrition and shelter

Failure to achieve expected growth patterns

Physical and speech delays

Failure to thrive physically or emotionally

Child states feeling pain in the mouth, jaw or ear

Diagnosed signs of dental decay and the child states feeling pain and difficulty eating

REPORTING CHILD ABUSE AND NEGLECT

As mandated reporters with reason to suspect a child may be in need of care may report may report the matter :

a. Form of report – may be made orally and shall be followed by a written report if requested. Provide child’s name and address and child’s parents, location of the child, child’s gender, race and age. The reasons of suspect the child may be in need of care.

b. When reporting a suspicion that a child may be in need of care, the reporter shall disclose protected health information freely and cooperate fully with the secretary and law enforcement throughout the investigation and any subsequent legal process.

c. To whom made: The Kansas Protection Report Center (24/7)

TO REPORT SUSPECTED CHILD ABUSE OR NEGLECT

Telephone: 1-800-922-5330

Fax: Sent to KSPRC (Kansas Protection Report Center) 1-866-317-4279

E-mail: KSPRC@dcf.ks.gov

Mail: Kansas Protection Report Center

Docking State Office Building

915 SW Harrison, 5th floor

Topeka, KS 66612

Access mandated report at: http://www.dcf.ks.gov/Pages/HotlineNumbers.aspx

SEDGWICK COUNTY SCHOOLS WITH HIGH CARIES RATE

32.7031.88

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29.45 29.1028.64

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Top 6 Schools with High Dental Caries in Sedgwick County, 2015-2018

Colvin Elementary Spaght L'Ouverture

Valley Center/West Cessna Elementary Gammon Elementary

TOP GRADES WITH DENTAL CARIES IN SEDGWICK COUNTY, 2015-2018

TOP SCHOOLS WITH URGENT DENTAL CARE IN SEDGWICK COUNTY 2015-2018

12.79

11.25 11.11 10.789.97

9.25 9.20 8.78 8.33

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Spaght Valley Center/Abilene ElementaryColvin Elementary L'OuvertureClark Elementary School Cessna ElementaryBlack Elementary Valley Center/West ElementaryValley Center/Wheatland Elementary

TOP GRADES WITH DENTAL CARE NEEDS IN SEDGWICK COUNTY, 2015-2018

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TOP SCHOOLS WITH URGENT DENTAL CARE IN SEDGWICK COUNTY, 2017-2018

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TOP GRADES WITH URGENT DENTAL CARE IN SEDGWICK COUNTY, 2017-2018

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MULTIPLE URGENT DENTAL NEEDS BY STUDENT AND FAMILY IN SEDGWICK COUNTY, 2014-2018

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Children with RecurringUrgent Dental Needs

Siblings with UrgentDental Needs

ESTABLISHING A DENTAL HOMEParent interview

Examination of child

Assign risk level

Individualized treatment based on risk

Individualized home care recommendations

Anticipatory guidance

Re-evaluation

Collaborate/refer