Pediatric Oral Health Risk AssessmentTraining for Medical Professionals

More Smiling Faces in a SCDHEC led oral health initiative funded by the Robert Wood Johnson Foundation and managed by the Center for Health Care Strategies

SCDHEC

Oral Health Division

2006

Contents Section I: Pediatric Oral Health Overview Section II: Professional Recommendations Section III: Etiology and Prevention of Tooth Decay Section IV: Anticipatory Guidance for Mother Section V: Oral Health Risk Assessment—Young C

hildren Section VI: Anticipatory Guidance for Infants and Y

oung Children Section VII: Fluoride Varnish

More Smiling Faces in a SCDHEC led oral health initiative funded by the Robert Wood Johnson Foundation and managed by the Center for Health Care Strategies

Pediatric Oral Health ObjectivesAt the completion of this section, theparticipant will be able to understand the:

Role of the medical professional in pediatric oral health promotion and the prevention of dental diseases

Recommendations for infant oral health of the American Academy of Pediatric Dentistry and the American Academy of Pediatrics.

Indications for the use of fluoride varnish as a preventive treatment for young children

Recommendations for oral health anticipatory guidance during pregnancy.

Oral Health in America:

A Report of the Surgeon General“…oral health is integral to general health (1)”

Surgeon General David Satcher, MD, PhD and Lisa Waddell, MD, MPH, SCDHEC2000

One of the most common diseases of childhood

5 times as common as asthma 7 times as common as hay fever (1).

A health problem: tooth decay

Early childhood caries—tooth decay Is defined as the

presence of decayed primary teeth

Is also known as baby bottle tooth decay

Advances rapidly due to the thinness of the enamel

What are the costs? Children with early childhood tooth decay are more

likely to get more decay in their permanent teeth. Goes beyond pain and infection…

Affects their speech Affects their ability to eat Affects their ability to learn Affects the way they feel about themselves

Dental treatment can be very costly, especially hospitalization for treatment.

Why begin oral health with the medical provider? First health professional to

provide well child care to the infant and continues this care on a regular basis

Prevention is a critical component of pediatric care.

Today health professionals recognize the importance of oral health as part of total health

American Academy of Pediatric Dentistry Clinical Guideline on

Infant Oral Health Care Recognizes that allied

health professionals and community organizations must be involved as partners to achieve a lifetime of freedom from preventable oral diseases.

Adult Oral Health

Child and AdolescentOral Health

Infant Oral HealthBirth to age 3-the foundation

Lifetime of Freedom from Preventable Oral Disease

AAP and AAPD Recommendations Oral risk assessment

including a visual oral screening Anticipatory Guidance Preventive strategies Establishment of the dental home by age one

Tooth Decay: how does it happen?

Parent Sheet: The Bottle and Your Infant’s Dental Health

Parent Information Booklet, page 9

Tooth decay and infants Oral flora colonize the

mouth soon after birth Current belief that

cariogenic bacteria colonize only after the tooth erupt

Tooth decay can begin as soon as the teeth erupt at 6-10 months of age

Tooth decay is an infectious, transmissible disease Tooth decay bacteria is

transmitted from mom or other primary caregiver to baby through Fingers Sharing eating utensils Cleaning pacifier with

mother’s saliva

Parent Information Booklet:Your Infant Can Get Cavities From You, page 3The Pacifier and Your Infant’s Dental Health, page 10

Caries-risk assessment Child’s History

History of dental decay in mother, child and other family members

Family is of low economic status Child consumes a high sugar/complex carbohydrate

diet Child has special health care needs Child was premature/low birth weight Child routinely is prescribed medications that are

sugar based or that reduce salivary flow

Tools for a visual oral screening Light

Tongue depressor

Long handled cotton

swab/toothpick

2x2 gauze

Toothbrush

Knee to knee position

Visual oral screening Lift the lip

Check for presence of plaque and food on teeth

Check gums and soft tissues—look for abscesses

Tip: a toothbrush can be used to count the child’s teeth and can also serve as a mouth prop, preventing the child from biting down on your finger.

Examine the teeth Observe the teeth from

the Outside surfaces Look for “White Spots” Look for obvious signs

of tooth decay such as brown spots or breaks in the tooth surface

Look from the inside of the upper front teeth

Looking at the back teeth Look for

Dark spots and stains Breaks in the tooth

surface

Show parent how to do a Smile Check Gently lift your child’s

upper lift Look at the outside and the

inside of the upper front teeth

Parent Information Booklet:Smile Check, page 6

Referral for dental care The findings…are provided below:

Needs regular dental examination Needs dental treatment within one month Needs dental treatment immediately

Needs regular dental examination

Needs treatment within 1 month

Special Note: an infant or child with any positive caries risk factors should be referred to a dentist within one month even though there are no observable dental problems.

Immediate dental treatment Signs or symptoms that

include pain, infection, swelling or soft tissue ulceration of more than 2 weeks duration determined by questioning.

Needs immediate treatment

Establish a Dental Home Refer

high risk children by 6 months

Refer all children by the age of one

Parent Information Booklet:How do I find a good dentist for my child?, page 14Your Child’s First Dental Visit, page 15

Children with Special Health Care Needs Refer early referral for dental care (before or

by age 1) Collaboration with dentist is especially

important Emphasize with parents the importance of

oral health to CSHCN

Considerations for CSHCN Medications for asthma and allergies often

reduce salivary flow which increases risk for tooth decay

Children who are preterm or low birth weight have a higher rate of enamel defects and are at increased risk for tooth decay

Infants with feeding problems are often placed on special high carbohydrate diets

Oral Hygiene After feeding, an

infant's teeth and gums shall be wiped with a moist cloth to remove any remaining liquid that coats the teeth and gums

Parent Information BookletHow Can I Protect My Child’s Baby Teeth?, page 4

Oral Hygiene: Infant to Toddler… When teeth appear you

can use a small, soft toothbrush

Parent Information Booklet: Tips for Brushing Your Infant’s Teeth, page 8

Oral Hygiene: Supervised Brushing

Parent Information Booklet:

How to Make Toothbrushing Fun! Page 23

How To Choose the Right Toothbrush and Toothpaste for Your Preschooler, page 24

Diet and Oral Health If the baby goes to bed with a bottle,

only use water. Baby should begin using a cup by 6

months Wean from bottle to cup by age 1 Avoid letting baby walk around with a

bottle or sippy cup with milk, juice or sweet liquid

Parent Information Booklet: The Bottle and Your Infant’s Dental HealthSippy Cups, page 19

Encourage Good Food Choices

Parent Information Booklet:Healthy Eating Habits for Good Dental Health, page 16Juice, page 17Facts About Milk, page 18Nutrition and Your Child’s Dental Health, page 30

Medicines Children’s medication often

contain sugar Some decrease the child’s

salivary flow Be sure to inform parents or

caregivers to brush the child’s teeth after giving him or her their medication.

Fluoride—the Tooth Protector Water that may contains fluoride:

Community water systems Well water with naturally occurring fluoride

Fluoride in the water helps slow down the loss of the tooth surface---by replacing the lost minerals with fluoride, a process called remineralization

Check local water systems for fluoridation information at: CDC’s My Water’s Fluoride website:

http://www.scdhec.net/hs/mch/dental/WaterFlou.html Optimal fluoride concentration of water systems should

be in the .7 to 1.2 parts per million

ADA Recommended Supplements

Fluoride Toothpaste Small, pea sized

amount beginning at age 2

Under age 2, water only

Supervised use under age 8 years

Parent Information BookletToothbrushes and Toothpaste for Toddlers, page 12

Injury Prevention

Parent Information Booklet: Is Your Home Safe?, page 20 Safety: Toys and Dental Health, page 21 Home for the Holidays, page 22 Keeping Your Child’s Smile Safe When

Riding in a Car, page 25 Keeping Your Child’s Smile Safe At

Home and In School, page 26 Keeping Your Child’s Smile Safe When

Shopping, page 27 How to Respond to a Dental

Emergency, page 28

Why do we recommend fluoride varnish for very young children? To prevent dental caries and in some cases

reverse early dental caries Children with early childhood decay are more

likely to get more decay Baby teeth are in a child’s mouth until about

age 11 or 12

Who should receive fluoride varnish? Children are at risk for

developing dental caries. Risk assessment based on the

Caries Risk Assessment

Risk factors for dental caries are: History

History of dental decay in mother, child and other family members Family is of low economic status Child consumes a high sugar/complex carbohydrate diet Child has special health care needs Child was premature/low birth weight Child routinely is prescribed medications that are sugar based or that

reduce salivary flow

Clinical evaluation Visible plaque, white spots and/or decay Gingivitis—gums appear red, swollen, report bleeding when brushing White spots/demineralization

How does fluoride varnish work? The lacquer-based product adheres to the

dental enamel forming a depot from which fluoride is slowly released

A dry tooth surface allows the uptake of the fluoride into the tooth surface

Saliva actually sets the varnish

Advantages of fluoride varnish easy to apply teeth do not need professional prophylaxis children can eat and drink following

applications potential ingestion of fluoride is low due to

the sticky form of the varnish and the small amount used

prevents tooth decay and reverses early decay

White spots

Knee to knee position

Fluoride varnish application1. Dry teeth with gauze square 2. Apply varnish with brush

to all teeth surfaces

Post application instructions for parents Varnish will set on contact with saliva and look

like a yellowish film Child can eat or drink right after application but

should try to eat soft foods Instruct parent not to brush their child’s teeth until

the next day. The first toothbrushing will remove the yellow

film on the teeth.

Three months later

Remineralized Enamel

You can make a difference!! Integrate oral health assessment into well child visits Provide patient education regarding oral health Document findings and follow up Train office staff in oral assessment Identify dentists in your area who accept new

patients and Medicaid patients. Take a dentist to lunch to establish a referral

relationship Investigate fluoride content in area water supply

Anticipatory Guidance for Mother At the completion of

this section, the participant will be able to describe anticipatory guidance for the mother both before the baby is born and following the infant’s birth.

Water Ask your doctor or

your dentist if your water has fluoride in it.

Fluoride is a safe, easy way to protect your teeth from tooth decay.

If you buy bottled water, check the label for fluoride.

Anticipatory guidance for mother Or other intimate

caregiver before and during colonization process Brush and floss daily to

disturb cariogenic bacteria and reduce bacterial plaque levels

Use toothpaste with fluoride

Eat healthy foods Chose foods low in sugar. Eat healthy snacks like

fruit, cheese and vegetables.

Get enough calcium for you and your baby’s healthy teeth and bones.

Calcium is in milk, cheese, dried beans and leafy green vegetables.

Avoid carbonated drinks

Dental care for mother Refer to dentist to:

To maintain or to restore to health the oral tissues which includes not only healthy teeth but also gums and the supporting tissues or the oral cavity.

If dental caries are present, removal of decay and restoration of teeth

Mother chewing xylitol gum Recent evidence suggests

that chewing xylitol gum kills cariogenic bacteria

Chew 1 piece of gum for 5 minutes 3-5 times a day

decreases the child’s caries rate.

Now is the time for mom to learnHow to keep her child cavity-free! Get her mouth healthy—see her dentist Learn how to do a Smile Check on a baby Learn how to clean a baby’s teeth Learn how to prevent baby bottle tooth decay by not

putting the baby in bed with a bottle at night or naptime.

Be prepared to ask her doctor or dentist to check you’re the baby’s teeth by age one.

Talk to her doctor or dentist about fluoride.