Transcript PEDIATRIC ORAL HEALTH CARE

Maternal and Pediatric
Oral Health Care
Presentation to University of Medical Sciences of Bhutan
Faculty of Nursing and Public Health
March 18, 2015
In the US and worldwide, dental caries
(tooth decay) is the most common
chronic disease of childhood.
• Dental caries is almost entirely preventable.
• Highly related to lifestyle factors (high sugar diet and
protective factors like fluoride, oral hygiene).
• Untreated disease results in pain, nutritional
problems, poor appearance, malodor, lost school
days, other disruption of normal activities.
• Socially disadvantaged children are especially
vulnerable.
Oral Health and
Global Burden of Disease
• Dental caries is a major though declining
disease in developed nations and a growing
disease in countries with increasing
consumption of sugar and inadequate
exposure to fluorides.
• Survey of child oral health in nine countries
showed 65% children had decayed, filled or
missing teeth (DFMT), with untreated decay in
47% of children age 1-2 and 97% of children
over age 8
Measures
• Disease prevalence:
– Decayed, missing or filled permanent tooth (DMFT)
– Untreated decayed teeth
• Access to dental care:
– Number of dentists per 1,000 population
• Dental services utilization:
– Claims for care from a dental care professional,
preventive services, treatment
– American Dental Association format for claims
does not include diagnosis codes
Why Oral Health is Important for
Mothers and Young Children
• Often neglected area of public health policy and
health care delivery system
• In childhood, oral health has a significant effect on
normal growth and development, nutrition, learning
and social function.
• Periodontal disease may affect birth outcomes.
• Oral diseases and chronic diseases share common
risk factors
• Traditional separation of medical and dental
practice may limit effective health promotion
Oral Health in Early Childhood
BACTERIA + FOOD + TOOTH = DECAY
Dental Decay is an Infectious
Transmittable Disease
• Cariogenic bacteria:
Streptococcus mutans
• Bacteria is transmitted
from mother or caregiver.
• Mothers with high levels
of bacteria have:
– High levels of decay
– Poor oral hygiene
– High frequency of sugar
intake
Early Childhood Caries (ECC)
• Severe rapidly
developing form of tooth
decay in infants and
young children
• Affects teeth that erupt
first, at about 6 months,
and are least protected
by saliva
• Formerly called Baby
Bottle Tooth Decay or
nursing caries
Impact of Severe Early Childhood Caries
• Extreme pain
• Under-nutrition, low
weight & height
• Spread of infection
• Poor self-esteem
• Speech development
problems
• Lost school days and
difficulty learning
• High risk of dental
decay and crooked
bite in adult teeth
Contributing (Modifiable) Factors
• Feeding habits such as high sugar snacks
or nighttime bottle formula or juice
• Beliefs about child care and teeth:
“Baby teeth are not that important.”
“It is cruel to deny my baby the bottle.”
“The bottle and snacks keep my baby quiet.”
“Decay will happen anyway.”
• Changing feeding practices can health prevent
other conditions like childhood obesity.
Maternal Oral Health
Good Oral Health for Mothers
• Good oral health is important for pregnant
women and for the future health of their
children.
• A child’s oral health begins in uteroandpoor
maternal oral health and malnutrition may
may disrupt enamel formation.
• Most infants and young children acquire
cariogenic bacteria from their mothers during
ordinary caregiving.
Physiologic Changes During Pregnancy
• Pregnancy gingivitis: increased inflammatory
response to dental plaque during pregnancy
causing gingivae swell and bleed more easily.
• Tooth mobility: Ligaments and bone that support
the teeth may loosen during pregnancy
• Erosion of tooth enamel: Due to exposure to
gastric acid from vomiting due to morning sickness
or gastric reflux
• Dental caries: Due to increased acidity in the
mouth, increased sugar intake (cravings), decreased
attention to oral health maintenance
Periodontal Disease During Pregnancy
• Untreated gingivitis can lead to periodontitis,
an inflammatory response in which a film of
bacteria (plaque) adheres to teeth and
releases bacterial toxins that create pockets of
infection in gums and bones.
• Studies have linked periodontal disease and
preterm birth; however, subsequent studies
have not shown any reduction in preterm
birth or low birthweight from treating
periodontal disease during pregnancy.
Maintaining Good Oral Health
In Pregnancy: Advice for Mothers
• Practice good oral hygiene
(brushing twice daily,
flossing daily)
• Eat healthy foods.
• Get oral health care:
Source: Dr. Alex Rose, surgicorps.org
– Oral health care is an
important component of
prenatal care.
– Oral health care is safe
throughout pregnancy.
Program and Policy Options
Strategies for Increasing Access
to Oral Health Care
• Co-locate dental clinics in medical care facilities.
• Locate dental clinics in schools.
• Expand dental provider workforce.
• Train pediatric primary care providers (doctors and
nurses) in providing oral health evaluation and
hygiene instruction for patients under 3 and
topical therapeutic fluoride varnish application for
children at risk for dental caries.
Other Options for Improving
Oral Health in the Community
• Community water
fluoridation
• Steps to reduce
craniofacial injuries from
accidents and sports
injuries
• Reducing smoking
Oral Health Research
Build on
Bhutan National Health Survey
• Oral health indicators:
– Percent who brush teeth at least once a day
– Percent have never received dental care
• Risk factors for oral disease and other diseases:
–
–
–
–
Percent who currently smoke
Percent who use smokeless tobacco
Percent who eat doma/betel quid
Percent who use chewing tobacco
• Add examination survey to track DFMT prevalence
• Add survey questions of child health, nutrition,
infant feeding practices
Recommendations for
Oral Health Research Agenda
• International Association for Dental Research
Global Oral Health Inequalities Task Group on
Dental Caries recommends that research should:
– Integrate health and oral health, using common risk
factors
– Respond to and influence international developments
– Exploit the potential for novel funding partnerships with
industry and foundations
• Translation of research into policy and practice
should be a priority for all.
For further information:
MaryAlice Lee, Ph.D.
Lecturer
Yale School of Public Health
[email protected]
Special thanks to Joanna Douglass DDM, University of
Connecticut, and Connecticut Department of Public Health for
photos of children with early childhood caries.