Transcript You Can Make a Positive Impact on a Child`s Oral Health! (Piscitelli)

You Can Make a Positive Impact
on a Child’s Oral Health!
Oral Health Care for Very
Young Children and Children
with Special Health Care Needs
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
(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]
Funded 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
In the Mouth
Overall 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
General Health Affects Oral Health
Health Factors
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
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 process
 Window 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, straws
 Testing food temperatures
 “Cleaning” pacifier
 Pre-chewing food
2. Food: Fermentable Carbohydrates
 Simple or complex carbs: sugars, starches
 Bacteria uses the food to produce an acid
 Acid ‘demineralizes’ or eats away at the surface
enamel, starting the disease process
 ‘White spot’ appears, normally at gumline
Snacks
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•
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
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
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
Topical: outside the tooth / enamel
Systemic: through bloodstream
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 apply
 Applied 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
o
Wear/damage of teeth, TMJ disorders
Older children may need a night guard
 Excessive drool
o
o
Skin chaffing/rash, cracked/bleeding lips
Use lotion, creams, lip balm
 Reflux/vomiting
o
o
Erosion of teeth, increased cavities
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
Periodontal (Gum) Disease
Gingival overgrowth
Fungal/Viral
Infection
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
toothpaste
 Toddlers and Preschool (older than 2 years)
 Brush teeth at least twice daily
 Use pea sized (or a kernel of corn sized) amount
of fluoride toothpaste
 Parent supervision and help with brushing until age 7-10
years
 Depends on skill level of the individual child

How To Brush
 Use clean hands
 Use a soft bristled brush
 Brush the front, back, & biting surfaces of each tooth
 Use same pattern each time so you don’t miss teeth
 Angle the brush toward the gums and brush with a
circular motion
 Include 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 tooth
Ask a dentist or hygienist for help
Flossing
Oral Hygiene Modifications
 Toothbrushes and floss may need modification for
CSHCN
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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 birthday
 CSHCN may need to visit dentist every 2-6 months
 Tell dentist what works and doesn’t work at home
 Bring a favorite blanket, toy, music, etc.
 Encourage a consultation between your physician
and dentist
Finding A Dentist
 DentaQuest (formerly DORAL): Smiles for
Children
www.dmas.virginia.gov/dental-home.htm
Some listings will specify special needs: yes/no
 Phone book, word of mouth, parent
organizations
When 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
Health
www.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 Association
www.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???????