oral health for school nurses - show-me echo...2020/07/21 · fluoride varnish on early enamel...
TRANSCRIPT
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Oral Health for School Nurses
June 3, 2020
Beth Cameron – Oral Health Consultant Office of Dental
Health
With Special Thanks To
John N. Dane, DDS, FAAHD, DABSCD
Dental Director
Missouri Department of Health and Senior Services and
Missouri Department of Social Services
Objectives
Describe children’s dental health needs in Missouri
Understand the disease called tooth decay (dental caries) and how it can be prevented
Discuss oral health conditions in children and the appropriate response to each within the school setting
Present resources for school nurses
Understand fundamentals of the Preventive Services Program (PSP)
Dental health in Missouri 3rd graders
67% of students have dental decay (cavity) experience (55% US)
27% of students have untreated decay (cavities) (26.1% US)
6.4% had urgent treatment needs
11% of students had dental sealants
2014 Mo Burden Report – PSP data
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Managing Dental Caries (Cavities)
Caries is an infectious oral disease that can be arrested in its
early stages.
Primary prevention
Provided to avert the onset of caries – fluoride and Community Water
Fluoridation
Home Care
Diet Recommendations
Secondary prevention
To avert the progression of early caries to cavitation – sealants,
preventive restorations, Silver Diamine Fluoride (SDF)
Dental caries - most common chronic
disease among children
Consequences of poor oral health:
Overall health, ability to learn, eat, and speak
Children miss 51 million school-hours annually due to dental-related
issues.
Poor self-esteem
Higher Risk Children
Definition - children from low-income families (up to 200%
FPL) are at greater risk for dental caries experience and for
untreated caries than the rest of the population. They are:
less likely to have a dental visit in a year
less likely to have dental sealants
more likely to have untreated caries, greater risk in MO rural
areas.
Community Water Fluoridation helps this group the most
Sealants are most cost-effective when targeted to higher risk
Children’s teeth and an important piece of prevention
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Effects of CWF on Tooth Decay
• Tooth Decay in non - CWF counties
• 27% of students in these counties have untreated tooth
decay (8% higher than fluoridated counties).
• 11% of students in these counties have rampant tooth
decay (4% higher than fluoridated counties).
• Tooth Decay in Counties that have CWF
• 19% of students in these counties have untreated decay
• 7% of students have rampant decay
2016-17 PSP annual report subject to limitations of
sampling and data collection
Basic Oral Health Review- Bacterial
Plaque• Plaque is a sticky film of bacteria that continuously grows
in the mouth.
• An accumulation of plaque can be noticeable when
scraped off the teeth.
TEETH
DECAY
TIME PLAQUE IS ON TEETH
PLAQUE
Bacteria
What Do Cavities Need to Start?
SUGARS &
STARCHES
Repeated eating
or drinking of
sugary & starchy
foods or drinks
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An Acid Attack
• The bacteria in plaque combined with foods destroys
the tooth’s enamel, and after repeated attacks, can
create a hole, or “cavity”
What You May See:
Decay/ Dental Caries
What You May See:
White Spot lesions
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What You May See:
Abscessed tooth – External View
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What You May See:
Abscessed Tooth – Internal View
Eruption and Shedding Sequence
• This is important to note – most children do not lose their last primary tooth until around age 12. If a child has a cavity in a tooth they will need for several more years, it needs to be addressed - you should not “wait for it to fall out”.
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Other Oral Health Issues You May
Encounter: Red sore swollen gums
Cold sores
Toothache
Post Extraction Bleeding
Broken or Displaced tooth
Tooth Avulsion
Possible jaw fracture or dislocation
Orthodontic appliance problems
Objects lodged between teeth
Lacerated lip or tongue
Tooth eruption pain
Dental First Aid Kit
Hanks balanced salt solution (such as a
Save-A-Tooth Kit) cold milk will work as a
substitute
Salt
3% Hydrogen peroxide solution
Benzocaine 20% for tooth pain
Benzocaine 20% for cold sores
Docosanol 10% for cold sores
Basic Supplies:
Cotton swabs, dental floss, tongue depressor,
ice pack, soft wax, 2x2 gauze squares,
stimudents or tooth picks, tea bags,
toothbrushes, and tweezers
Inflamed Red Gums
• Common in adolescence
• Also a sign of poor oral health
• Rinse with warm saltwater if painful
• Plaque needs to be removed
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Quick Oral Health Tips -
* Tilt the brush at a 45° angle against the gum line – this is very helpful for inflamed gums, even in adults!
* Brushing only 2-3 teeth at a time, gently brush the outside, inside and chewing surfaces of all the teeth.
* Use short back-and-forth
or small circular strokes
* Floss between teeth that
touch
Displaced Tooth
• Don’t try to push it back into correct position
• Contact parent to take child to dentist ASAP
Avulsed Tooth
• DO NOT clean the tooth – could destroy
connective fibers
• Try to pick up by the crown
• Keep tooth in appropriate solution
• Many times a dentist can successfully reimplant a
tooth if child is treated immediately
• Obviously does not apply to loose baby teeth
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Orthodontic Appliances
• Use wax to cover protruding wires
Toothache
• Use tooth eruption chart to help determine if ache is from
normal tooth loss/eruption. This pain is usually more
intermittent and less painful than a decayed tooth.
• Use dental floss to remove any lodged food
• Check for abscess
Referring for Care
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Preventive Services Program
• Free of cost to any Missouri child - infant through age 18,
no qualification necessary
• Community-based, volunteer program with four
components:
• Oral Screening
• Oral Health Education
• Prevention (fluoride varnish)
• Referral
• 2018-2019 School Year:
• 91,384 students in 750 schools and organizations
What Is A Screening?
• Not a thorough clinical exam, no x-rays are taken
• Does not involve making a clinical diagnosis that results in a treatment plan
• Does identify obvious oral lesions
• Is conducted by volunteer licensed dentists and dental hygienists
• Conducted ONCE a year
Oral Health Education Resources
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Why Use Fluoride Varnish?
• Fluoride Varnish has been proven effective in preventing tooth decay in both primary and permanent teeth.
• Fluoride varnish can reverse early decay and can arrest active decay lesions.
• Fluoride varnish promotes the remineralization of tooth enamel making it resistant to tooth decay.
• Fluoride varnish is readily adaptable requiring no special equipment and can be applied in a variety of settings (school classroom, library or gymnasium).
• Fluoride varnish sets on contact with moisture (saliva), reducing the risk of ingestion & therefore recommended for all ages.
• Fluoride varnish is a cost effective preventive measure against tooth decay.
Who Can Apply Varnish?
• Anyone over 18
• We ask that they take a short training video and
agree to be confidential - this is found on our
PSP website
What Supplies are Provided by DHSS?
These are ordered through a DHSS Oral Health Consultant
Supplies from DHSS include:• Screening Forms
• Disposable Mouth Mirrors
• Fluoride Varnish
• Toothbrushes and Toothpaste
• Dental Floss
• Educational Materials
• Other Promotional Items
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What Supplies Does the Event Coordinator Need to Obtain?
• Masks
• Gloves
• Light Source
• Eye Wear
• Tooth picks
• Gauze
• Hand Sanitizer
• You will be asked to provide masks, gloves and hand sanitizer for your community volunteers, though you may ask your dental screeners to bring their own masks and gloves. Be sure to advise your screeners to bring a lighting source such as a small flashlight.
Our Website – Find Your Consultant:
Locate Your Oral Health Consultant
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Nurses Pamphlet:
Nurses Pamphlet:
Resources
“School-based or school-linked mobile or portable dental
Services”, Association of State and Territorial Dental
Directors (ASTDD.org)
“Fluoride varnish issue brief”, Association of State and
Territorial Dental Directors (ASTDD.org)
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Resources Evidence-based Clinical Recommendation: Professionally Applied
Topical Fluoride. Report of the Council on Scientific Affairs. American Dental Association. May, 2006
Synopses of State and Territorial Dental Public Health Programs Programs. Center for Disease Control and Prevention. Feb. 6 2004. Available at: apps.nccd.cdc.gov/synposes/aboutv/asp. Accessed on : 03/12/07.
Fluoride Varnish Protocol. Iowa Department of Public Health. 4/2002. Available at: http://www.idphstate.ia.us/hpcdp/commomn/pdf/oral_health/fluoride_protocol.pdf. Accessed on: 03/07/07.
Gold-Autio,Jaana,Courts, Frank (2001). Assessing the effect of fluoride varnish on early enamel carious lesions in the primary dentition. J Am Dent Assn.132(9):1247-53.
Seppa,Lisa (2004). Fluoride varnishes in caries prevention. Medical Principles & Practice.13(6):307-11.
Vivaldi-Rodrigues, G. et al (2006). The effectiveness of a fluoride varnish in preventing the development of white spot lesions. World J of Ortho. 7(2):138-44.
Resources U.S. Department of Health and Human Services. 2000. Oral Health in America:
A Report of the Surgeon General. Rockville, MD: National Institute of Dental and Craniofacial Research. Available from: www.nidcr.nih.gov/AboutNIDCR/SurgeonGeneral/default.htm
U.S. Department of Health and Human Services. National Call to Action to Promote Oral Health. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Dental and Craniofacial Research. NIH Publication No. 03-5303, Spring 2003.
Wientraub,J.A. et al (2006). Fluoride varnish efficacy in preventing early childhood caries. J Dent Res. 85(2):172-176.
Wilkins, Esther Clinical Practice of the Dental Hygienist. Philadelphia: Lea & Febiger. 1976.
Photos: Microsoft product box shots reprinted with permission from Microsoft Corporation. All photos obtained from office.microsoft.com/clipart unless otherwise noted.
Oral Bacteria May Predict Pregnancy Outcomes. March 2005. Chicago. Available at: http://www.perio.org/. Accessed on: 05/15/06.
Kerpen, J, Fleischer, A. An Obstetrician and Periodontist Translate Periodontal-Systemic Research to Preserve the Health of Pregnant Women at Risk for Adverse Pregnancy Outcomes. Grand Rounds. November 2006; 1: 28-38
Contact Information
Beth Cameron, RDH
Oral Health Consultant
Office of Dental Health
Missouri Department of Health and Senior Services
912 Wildwood Dr.
Jefferson City, MO 65109
573-529-3889