you can make a positive impact on a childs oral health! division of dental health virginia...
TRANSCRIPT
You Can Make a Positive Impact
on a Child’s Oral Health!
Division of Dental Health Virginia
Department of Health 109 Governor Street Richmond, Virginia
23219 804-864-7775 www.vahealth.org/dental
Oral Health Care for Very Young Children and
Children with Special Health Care Needs
Oral Health Care For Very Young Children and Children With
Special Health Care Needs(CSHCN)
For more information or to schedule an oral health presentation contact:
Kami A. Piscitelli, BSDH, RDH
Special Needs Oral Health Coordinator
Division of Dental Health
804-864-7804
[email protected] by Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services
What can you do?
You’re already doing something! You’re here!
You can make an impact by:
Increasing your awareness of the oral health needs of children
Promoting oral health to families of young children and CSHCN
Encouraging age one dental visits
Topics
Why oral health is important?
What are the two most common dental diseases?
The results of untreated dental disease
Common dental problems of CSHCN
Prevention of dental disease
Visiting the Dentist
At what age should children start seeing the dentist?
Background
•Tooth decay is the most common chronic childhood disease.
•Tooth decay is 5 times more common than asthma; 7 times more common than hayfever.
•Approximately 28% of children ages 2-5 years old have tooth decay.
•CSHCN are almost twice as likely to have unmet oral health needs than children without SHCN.
Why is this important?
They are only teeth!
The Function of Teeth
Chewing / Digestion
Speech
Facial appearance
Bone structure
Confidence
Baby Teeth Are Important Too!
Guide eruption of permanent teeth
Healthy baby teeth = healthy permanent teeth
Baby Teeth
Oral Health Affects General Health
oral disease and infection systemic infection; can threaten life; unsuccessful organ transplant; surgery delay
periodontal disease diabetes, bacterial pneumonia, low-birth weight, heart disease, stroke
tooth decay malnutrition, failure to thrive, pain, loss of concentration, emotional/psychological stress
malocclusion difficulty speaking/chewing, infections due to difficult oral hygiene
In the Mouth Overall Health
General Health Affects Oral Health
gastric reflux / vomiting erosion of teeth, sensitivity
medications reduced saliva, enlarged gums, decay
special diets (soft, high carb)
decay, periodontal disease
oral habits trauma, injury
chronic infections reduces ability to fight oral infections
antibiotic therapy oral fungal infections
physical abuse often seen as oral trauma
Health Factors Oral Health
Two Most Common Dental Diseases
?
?
Two Most Common Dental Diseases
Tooth Decay disease process also called Caries cavities are the result
Periodontal “Gum” Disease Gingivitis Periodontitis
Early Childhood Caries (ECC)
Definition: The presence of one or more decayed, missing or filled tooth surfaces in a child younger than six
Begins soon after teeth erupt and can progress to a cavity in only 6-12 months
Very quick, destructive form of decay
Costly to treat Children have trouble cooperating because of
age/condition Often requires oral sedation or general anesthesia
Factors Necessary for Tooth Decay
1. Bacteria: Streptococcus mutans 2. Food: fermentable carbohydrates (break
down quickly)3. Susceptible tooth 4. Exposure time
This child is 1 ½ - 2 years old.
1. Bacteria
Transmitted from parent to child, not born with it
Infectious disease processWindow of infectivity: highest in the first two
years Early exposure to S. mutans is one of the major
risk factors for future cavities
Plaque: sticky film
Transmission of Bacteria
Sharing of forks, spoons, strawsTesting food temperatures“Cleaning” pacifierPre-chewing food
2. Food: Fermentable Carbohydrates
Simple or complex carbs: sugars, starchesBacteria uses the food to produce an acidAcid ‘demineralizes’ or eats away at the
surface enamel, starting the disease process‘White spot’ appears, normally at gumline
Snacks
• Foods low in sugar: Cheese Fruits Vegetables Cheerios, Rice Chex, Life, Kix, Corn Flakes
• Foods high in sugar: Candy Cookies Sodas Fruit drinks Sugar Smacks, Sugar Pops
• Approximately 4 Grams of sugar are in one teaspoon
3. Susceptible Tooth
Susceptibility of the tooth is directly related to fluoride exposure
What is Fluoride? a natural mineral found in ground water (wells) and surface
water (lakes, ponds) fluoride is added to most community water
supplies in Virginia for dental benefits tooth enamel ‘absorbs’ fluoride before and
after eruption enamel is then more resistant to decay
process
Fluoride
Fluoride has several preventive effects Increases tooth’s resistance to cavities Encourages healing of new small cavities Prevents bacteria from making acid
2 categories of fluoride exposure Systemic (swallowed) – benefits teeth before
and after they come in Topical – benefits teeth after they come in
Topical vs. Systemic
Systemic: through bloodstream
Topical: outside the tooth / enamel
Systemic (Swallowed) Fluoride Sources
Water with fluoride (fluoridated water) Community water supplies Naturally occurring in well water Bottled water normally not fluoridated Water filters
Fluoride prescription Prescribed based on results of water testing and
other fluoride sources Drops, liquids, tablets (also topical benefits)
Topical Fluoride Sources
Fluoridated water
Fluoride toothpastes (ADA seal)
Over the counter fluoride rinses
Prescription supplements When chewed or liquid
Professionally applied fluoride Gels, foams, rinses Varnish
Fluoride Varnish
Safe and effective, 40-60% decrease in tooth decay
Easy to applyApplied by nurses, doctors, dentists, and
dental hygienists
4. Time (Acid Attacks)
The more time teeth are exposed to the acids produced by the combination of bacteria and food, the more likely tooth decay will occur! (20-40 min acid attacks)
Results of Untreated Tooth Decay
Unnecessary pain and discomfort
Unfavorable treatment experiences
Systemic (whole body) infections
Premature loss of primary teeth
Increased risk for permanent tooth decay
Loss of school/work time
Increased treatment expense
Periodontal (Gum) Disease Process
1. Plaque (bacteria) left on teeth and around gums
2. Gingivitis
3. Periodontal Disease
Gingivitis
Irritation and inflammation of the gums
Puffy, red gums that bleed easily
Bleeding is not normal Signal to brush better
Can be completely reversed and controlled with good oral hygiene
Periodontal (Gum) Disease
Causes irreversible bone loss in the bone surrounding the teeth
Leads to tooth loss
Often completely painless, only a dentist or hygienist can detect the beginning stages
Early stage treatment can stop or control the disease
Later stages of the disease are much more difficult to treat
Periodontal Disease
Conditions Linked to Gum Disease
Heart disease
Stroke
Diabetes
Pre-term low birth weight babies
Lung infections
CSHCN Common Dental Problems
Bruxism: grinding/gritting teeth o Wear/damage of teeth, TMJ disorderso Older children may need a night guard
Excessive drool o Skin chaffing/rash, cracked/bleeding lipso Use lotion, creams, lip balm
Reflux/vomiting o Erosion of teeth, increased cavitieso Use baking soda rinses
¼ - ½ tsp soda to 1 cup water
CSHCN Common Dental Problems
Pouching: holding food in the folds of the cheeks Increased decay, periodontal disease, bad
breath Frequent oral hygiene care
Picking or poking at gums/teeth (source?) Trauma to teeth and gums Oral exam and behavior modification
Xerostomia (Dry Mouth) Increased decay and mouth sores Saliva substitutes, sugar-free candy/gum – age?
Prevention Facts
Preventing decay in primary teeth reduces risk in permanent teeth
Preventing decay until age 4 reduces risk of decay through age 18
How can you prevent dental diseases?
Positioning
Lift the lip/ identify disease
Oral hygiene Brush/floss Modifications Fluoride
Nutrition
Injury prevention
Dental visits
Positioning at Home
Positioning depends on each individual family and child Head in your lap Standing with you behind supporting head Bean bag or pillows Child sitting on floor and you sit in chair right
behind Knee to knee when two adults available
Be careful of tilting head too far back if there is difficulty swallowing or gagging or neck injury concern
Lift the Lip
Get to know your child’s mouth
•Early decay is most commonly found on the lingual (back) surfaces of the front teeth.
•Abscesses (infections) can hide from you
Disease Identification
Identify “White Spot” Pre-decay and active decay
Disease Identification
Disease Identification
Disease Identification
Disease Identification
Disease Identification
Disease Identification
Fungal/Viral Infection
Gingival overgrowth
Periodontal (Gum) Disease
Brushing the Teeth
Infants (less than 2 years old) Gums should be wiped twice daily When teeth erupt, brushed twice daily Use a rice grain sized amount of fluoride
toothpasteToddlers and Preschool (older than 2 years)
Brush teeth at least twice daily Use pea sized (or a kernel of corn sized)
amount of fluoride toothpasteParent supervision and help with brushing until age
7-10 years Depends on skill level of the individual child
How To Brush
Use clean handsUse a soft bristled brushBrush the front, back, & biting surfaces of
each toothUse same pattern each time so you don’t miss
teethAngle the brush toward the gums and brush
with a circular motionInclude gumline and tongue
Brushing Tips
If unable to spit, wipe with damp or dry clean cloth
Change toothbrush every 3 months or when bristles look out of shape
If child doesn’t tolerate toothpaste, try dipping brush in an over-the-counter fluoride mouth rinse (like ACT) then brush
Let the child be as independent as possible, use the toothbrush themselves, then you brush as well
How To Floss
Flossing begins as soon as the sides of two teeth are touching
Most children cannot floss on their own until 8-10 years, some CSHCN may need flossing done for them
Work the floss back and forth gently between teeth
Curve floss around the side of each tooth sliding up and down, just under the gums
Floss both sides of every toothAsk a dentist or hygienist for help
Flossing
Oral Hygiene Modifications
Toothbrushes and floss may need modification for CSHCN Battery operated toothbrushes Modified toothbrush handles
Tennis ball or bicycle grip Taped handles Lengthen by taping to ruler Bend toothbrush handle by heating handle under hot water Secure toothbrush to the hand with Velcro strip Use bigger or textured grips Three sided toothbrush heads
Floss holders Mouth Props
Fluoride Recommendations
Use fluoride toothpaste for all ages
Talk to the dentist about increasing topical fluoride Fluoride mouth rinse – brushed on or swished if
they can spit out the excess Prescription fluoride gel brushed on Professional fluoride treatments more often
Feeding / Nutrition
Begin use of training cup by six months if developmentally able
Use training cups carefully and temporarily Mealtime only if milk, juice, or sweet drink Not walking around with cup Between meals – offer water only
Talk to physician or pharmacist about sugar free medicines
Well balanced diet
Dental Injury Prevention
Things to avoid: Sharp edges on furniture – cover if possible Walking or running with hard or sharp
objects in mouth (sippy cup, toothbrush, crayons, etc.)
Chewing on electrical cords Chewing on ice, hard candy, any hard objects Riding in the car without a car seat
Mouth guards and helmets as needed
Dental Visits: “Home by One!”
Dental appointment by the first birthdayCSHCN may need to visit dentist every 2-6
monthsTell dentist what works and doesn’t work at
homeBring a favorite blanket, toy, music, etc.Encourage a consultation between your
physician and dentist
Finding A Dentist
DentaQuest (formerly DORAL): Smiles for Childrenwww.dmas.virginia.gov/dental-home.htmSome listings will specify special needs:
yes/no
Phone book, word of mouth, parent organizationsWhen you call, ask if the dentist will see
children with the particular condition the child has
Finding A Dentist
VA Department of Health, Division of Dental Healthwww.vahealth.org/dental/ Virginia dentist directory – click on
“Find A Dentist”
Click here to find a
dentist
Click here to find more oral health information on CSHCN
Click Advanced Search for the most options
Click here when you have made your selections
Click on the dentist’s name for more information then call the dentist’s office to describe your needs and ask questions
Resources for More Information
American Academy of Pediatric Dentistry www.aapd.org
American Academy of Pediatrics www.healthychildren.org – type in ‘oral health’
American Dental Associationwww.ada.org
The Center for CSHCN, Washington State www.cshcn.org – type in ‘oral health’
Additional Resource
http://hfgrotto.org/ Financial assistance for dental care for children
with disabilities under age 18 with Cerebral Palsy, Muscular Dystrophy (and related neuromuscular disorders), mental retardation, and organ transplant recipients.
Key Points
Oral health is directly related to overall health
Preventing decay in primary teeth reduces risk in permanent teeth
The more time teeth are exposed to acids the more likely tooth decay will occur!
Dental home by age one
Fluoride is important for all ages
Questions???????