You Can Make a Positive Impact on a Childs 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, RDHSpecial Needs Oral Health CoordinatorDivision of Dental Health804-864-7804kami.piscitelli@vdh.virginia.govFunded by Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services

What can you do?

Youre already doing something! Youre 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

TopicsWhy 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?

BackgroundTooth 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 TeethChewing / Digestion

Speech

Facial appearance

Bone structure

Confidence

Baby Teeth Are Important Too!Guide eruption of permanent teethHealthy baby teeth = healthy permanent teeth

Baby Teeth

Oral Health Affects General Health In the Mouth Overall Health

General Health Affects Oral Health Health Factors Oral Health

Two Most Common Dental Diseases

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Two Most Common Dental DiseasesTooth Decaydisease process also called Cariescavities are the result

Periodontal Gum DiseaseGingivitisPeriodontitis

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 treatChildren have trouble cooperating because of age/conditionOften requires oral sedation or general anesthesia

Factors Necessary for Tooth Decay1. Bacteria: Streptococcus mutans 2. Food: fermentable carbohydrates (break down quickly)3. Susceptible tooth 4. Exposure timeThis child is 1 - 2 years old.

1. BacteriaTransmitted from parent to child, not born with itInfectious disease processWindow of infectivity: highest in the first two yearsEarly exposure to S. mutans is one of the major risk factors for future cavitiesPlaque: sticky film

Transmission of BacteriaSharing of forks, spoons, strawsTesting food temperaturesCleaning pacifierPre-chewing food

2. Food: Fermentable CarbohydratesSimple or complex carbs: sugars, starchesBacteria uses the food to produce an acidAcid demineralizes or eats away at the surface enamel, starting the disease processWhite spot appears, normally at gumline

SnacksFoods low in sugar:CheeseFruitsVegetablesCheerios, Rice Chex, Life, Kix, Corn FlakesFoods high in sugar:CandyCookiesSodasFruit drinksSugar Smacks, Sugar PopsApproximately 4 Grams of sugar are in one teaspoon

3. Susceptible ToothSusceptibility 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 effectsIncreases tooths resistance to cavitiesEncourages healing of new small cavitiesPrevents bacteria from making acid

2 categories of fluoride exposureSystemic (swallowed) benefits teeth before and after they come inTopical benefits teeth after they come in

Topical vs. SystemicSystemic: through bloodstreamTopical: outside the tooth / enamel

Systemic (Swallowed) Fluoride SourcesWater with fluoride (fluoridated water)Community water suppliesNaturally occurring in well waterBottled water normally not fluoridatedWater filters

Fluoride prescriptionPrescribed based on results of water testing and other fluoride sources Drops, liquids, tablets (also topical benefits)

Topical Fluoride SourcesFluoridated water

Fluoride toothpastes (ADA seal)

Over the counter fluoride rinses

Prescription supplementsWhen chewed or liquid

Professionally applied fluorideGels, foams, rinsesVarnish

Fluoride VarnishSafe and effective, 40-60% decrease in tooth decayEasy 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 Process1. Plaque (bacteria) left on teeth and around gums

2. Gingivitis

3. Periodontal Disease

GingivitisIrritation and inflammation of the gums

Puffy, red gums that bleed easily

Bleeding is not normalSignal to brush better

Can be completely reversed and controlled with good oral hygiene

Periodontal (Gum) DiseaseCauses 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 DiseaseHeart disease

Stroke

Diabetes

Pre-term low birth weight babies

Lung infections

CSHCN Common Dental ProblemsBruxism: grinding/gritting teeth Wear/damage of teeth, TMJ disordersOlder children may need a night guard

Excessive drool Skin chaffing/rash, cracked/bleeding lipsUse lotion, creams, lip balm

Reflux/vomiting Erosion of teeth, increased cavitiesUse baking soda rinses - tsp soda to 1 cup water

CSHCN Common Dental ProblemsPouching: holding food in the folds of the cheeksIncreased decay, periodontal disease, bad breathFrequent 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 soresSaliva substitutes, sugar-free candy/gum age?

Prevention FactsPreventing 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 hygieneBrush/flossModificationsFluoride

Nutrition

Injury prevention

Dental visits

Positioning at HomePositioning depends on each individual family and childHead in your lapStanding with you behind supporting headBean bag or pillowsChild sitting on floor and you sit in chair right behindKnee to knee when two adults availableBe careful of tilting head too far back if there is difficulty swallowing or gagging or neck injury concern

Lift the LipGet to know your childs mouthEarly decay is most commonly found on the lingual (back) surfaces of the front teeth. Abscesses (infections) can hide from you

Disease IdentificationIdentify White Spot Pre-decay and active decay

Disease Identification

Disease Identification

Disease Identification

Disease Identification

Disease Identification

Disease IdentificationFungal/Viral InfectionGingival overgrowthPeriodontal (Gum) Disease

Brushing the TeethInfants (less than 2 years old)Gums should be wiped twice dailyWhen teeth erupt, brushed twice dailyUse a rice grain sized amount of fluoride toothpasteToddlers and Preschool (older than 2 years)Brush teeth at least twice dailyUse pea sized (or a kernel of corn sized) amount of fluoride toothpasteParent supervision and help with brushing until age 7-10 yearsDepends on skill level of the individual child

How To BrushUse clean handsUse a soft bristled brushBrush the front, back, & biting surfaces of each toothUse same pattern each time so you dont miss teethAngle the brush toward the gums and brush with a circular motionInclude gumline and tongue

Brushing TipsIf unable to spit, wipe with damp or dry clean cloth

Change toothbrush every 3 months or when bristles look out of shape

If child doesnt 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 FlossFlossing begins as soon as the sides of two teeth are touchingMost children cannot floss on their own until 8-10 years, some CSHCN may need flossing done for themWork the floss back and forth gently between teethCurve floss around the side of each tooth sliding up and down, just under the gumsFloss both sides of every toothAsk a dentist or hygienist for help

Flossing

Oral Hygiene ModificationsToothbrushes and floss may need modification for CSHCNBattery operated toothbrushesModified toothbrush handlesTennis ball or bicycle gripTaped handlesLengthen by taping to ruler Bend toothbrush handle by heating handle under hot waterSecure toothbrush to the hand with Velcro stripUse bigger or textured gripsThree sided toothbrush headsFloss holdersMouth Props

Fluoride RecommendationsUse fluoride toothpaste for all ages

Talk to the dentist about increasing topical fluorideFluoride mouth rinse brushed on or swished if they can spit out the excessPrescription fluoride gel brushed onProfessional fluoride treatments more often

Feeding / NutritionBegin use of training cup by six months if developmentally able

Use training cups carefully and temporarilyMealtime only if milk, juice, or sweet drinkNot walking around with cupBetween meals offer water only

Talk to physician or pharmacist about sugar free medicines

Well balanced diet

Dental Injury PreventionThings to avoid:Sharp edges on furniture cover if possibleWalking or running with hard or sharp objects in mouth (sippy cup, toothbrush, crayons, etc.) Chewing on electrical cordsChewing 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 doesnt work at homeBring a favorite blanket, toy, music, etc.Encourage a consultation between your physician and dentist

Finding A DentistDentaQuest (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 DentistVA Department of Health, Division of Dental Healthwww.vahealth.org/dental/ Virginia dentist directory click on Find A Dentist

Click here to find a dentistClick 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 dentists name for more information then call the dentists office to describe your needs and ask questions

Resources for More InformationAmerican 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 PointsOral 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???????

**Phenytoin, calcium channel blockers, cyclosporine can enlarge gumsUp to 50% of abused children suffer head and neck injuries, oral-lacerated frenums, scar tissueGenetic and developmental disorders: malocclusion, micrognathia, prognathia, delayed eruption, facial asymmetry