Transcript OH presentation Nov2008

Oral Health for MCAH
Populations
Children’s Oral Health Program
Contra Costa Health Services
November 2008
Presentation Outline
• Overview
• Early childhood caries
• Periodontal disease and perinatal health
• Adolescent oral health: Oral piercing and grills
• Prevention of dental decay
• Access to oral health care
• Take-home messages
A Silent Epidemic
• Dental disease is the most common
chronic and infectious disease
affecting children in the U.S.
• Five times more common than
asthma
• 7% of Contra Costa children miss
school because of a dental problem
National Policy
• All children should
see a dentist by
age one or six
months after the
eruption of the
first tooth
– American Academy
of Pediatrics
– American Academy
of Pediatric
Dentistry
What are Early Childhood
Caries (ECC)?
ECC is an infectious and transmissible
disease; however, it is preventable
• Previously known as Baby Bottle Tooth
Decay (BBTD) or Nursing Caries
• Can appear as soon as the first tooth
erupts (around 6 months of age)
ECC is an infectious,
transmissible disease
• Mutans
streptococci,
lactobacilli, and
other acidproducing
bacteria
• Transmission is
both vertical and
horizontal
Colonization
• Can begin
even before
the eruption of
teeth
The Chain of Decay
Cariogenic Bacteria (S. mutans, lactobacilli)
Sucrose, Glucose, Fructose, Starch
Acids dissolve tooth mineral
Fluoride
Caries
No Caries
White Spot Lesions
• The first visible sign of tooth decay
• Reversible with fluoride varnish
White Spot Lesions
Mild/Moderate ECC
Severe ECC
Risk Factors for Caries
• Having a mother
with a high caries
rate or a high
bacterial count of
cavity-causing
germs
• Sleeping with a
bottle or
breastfeeding
throughout the
night
• Demonstrable
caries, plaque,
demineralization,
and/or staining
• Low socioeconomic
status
• Being a later-order
offspring
• Lack of access to
dental care
Children with Disabilities and
Other Special Needs
• Reduced saliva
flow
• Sweetened
medications
• Competing
medical needs
The Effects of ECC
• Loss of primary
teeth
• Pain
• Infection
• Self-esteem
Loss of Primary Teeth
• Primary teeth are important for:
– Nutrition
– Speech development
– Holding spaces for permanent teeth
• Untreated decay in primary teeth can
lead to decay in permanent teeth, or
permanent teeth may not erupt at all
Primary and Permanent
Teeth
Pain
• Children learn to live with the pain
• Missed preschool and school days
• Inability to concentrate; impairs
school readiness
• Can affect sleep and overall health
and well-being
Infection
• Failure to thrive
and delayed
growth patterns
Self-esteem
• Stainless steel crowns
• Unattractive smiles
Importance of Oral Health for
Pregnant Women
• Periodontal disease in a pregnant
woman has been linked to increased
risk for preterm delivery and having
a low birth weight baby
• For mom: pain, infection, poor
nutrition, sleep deprivation, inability
to concentrate, work or take care of
children
Possible Biological Pathway
Between PD and PTB/LBW
Bacteria in PD
Blood
Placenta
Inflammation
Cervical Dilation and Uterine Contractions
Periodontal Disease
• Gingivitis
• Periodontal Disease
Gingivitis
• Early stage of gum
disease – only gums are
infected
• Caused by bacterial
plaque and host risk
factors: smoking,
diabetes, stress,
genetics
• Bacteria in plaque
create toxins that
irritate the gums and
cause redness, swelling,
bleeding
• Reversible with good
oral hygiene
Pregnancy Gingivitis
• Infection that is more superficial and
brought on by hormonal changes
during pregnancy
Periodontitis
• An inflammation and degeneration below
the gum line (bone and tissues surrounding
the teeth)
• Multi-factorial and episodic in nature
• Prevalence in women of childbearing age is
5-40%
• Destruction of the bone is not reversible
• If left untreated can cause tooth loss
Progression of Periodontitis
Severe Periodontitis - Gingival
Recession in Incisors
Treatment of Periodontal
Disease
• Professional deep
scaling and root
planing
• Anti-microbial
mouth rinse
(chlorhexidine)
• Systemic and/or
site-specific
antibiotics
• Gum surgery
Adolescent Oral Health:
Oral Piercing
• Potential consequences of oral piercing include:
– Infection;
– Prolonged or uncontrolled bleeding;
– pain and swelling (in extreme cases, a severely
swollen tongue can close off the airway and
restrict breathing);
– Chipped or cracked teeth;
– Injury to the gums, possibly resulting in bone
loss and root decay;
– Problems with chewing, swallowing, and
pronouncing words properly;
– Blood-borne diseases including various strains
of hepatitis; and
– Endocarditis, an inflammation of the heart
valves or tissues.
Adolescent Oral Health:
Oral Piercing
• Because of the risks involved even
after an initial oral piercing wound
has healed, the ADA recommends
that both teens and adults avoid oral
piercing.
Adolescent Oral Health:
Grills
• Made from gold,
silver, or jewelencrusted precious
metals
• Use of permanent
cement not
intended for
internal use
• Do-it-yourself kits
and unlicensed
jewelers
Adolescent Oral Health:
Grills
• Grills can wear away the enamel on the
opposing teeth and inflame the gums; cement
can damage teeth and gum tissues
• Food collects  tooth decay
• ADA recommends that youth avoid wearing
grills, but if they are considering it, youth
should:
– talk to their dentists first
– find out what materials the grills are made of
– limit the time the grills are worn
– remove the grills when eating
– practice good oral hygiene
Prevention of Dental Decay
• Regular dental visits starting at age 1
– Referral by medical providers
• Oral hygiene
• Fluoride
• Dental Sealants
• Healthy feeding practices
• Modifying caregiver’s oral health: Xylitol
Oral Hygiene: Infants
• Before teeth
come in, wipe
gums clean with
gauze or
washcloth,
before or after
last feeding at
night
Oral Hygiene: “Lift the Lip”
• When teeth
are in, “lift the
lip” monthly to
check for
chalky white
spots or brown
spots
Oral Hygiene: Brushing
• Begins when
first tooth erupts
• An adult should
help brush a
child’s teeth
until child is
around 8 years
old
Fluoride Toothpaste
• Encourage daily
use in the morning
and before bed
• A small smear is
the appropriate
amount
• Apply toothpaste
across width, not
length of
toothbrush
Fluoride Varnish
• Brown resin that sets on contact with
moisture in the mouth
• Prevents ECC
• Easy application
• Contains 5% of NaF
Community Water
Fluoridation
• Only about 30% of
Californians have
fluoridated drinking water
(vs. 67% nationwide)
• San Francisco Public
Utilities Commission
areas all fluoridated
• All of Contra Costa is
fluoridated except Bay
Point, Byron, Knightsen,
and Brentwood
Dental Sealants
• Plastic coatings that dentists apply to
the chewing surfaces of the molars
• Make it difficult for plaque to adhere to
the grooves of these teeth, reducing the
risk of developing cavities
• Most effective in children who have
newly developed molars (ages six and
12)
• Last for several years
Dental Sealant Placement
Healthy Feeding Practices
• Eat healthy foods and avoid sticky,
starchy foods between meals
• Don’t let infants and toddlers go to
bed with a bottle or sipper cup or
carry one around during the day,
unless it contains only water
Caregiver’s Oral Health
• Modify
caregiver’s
dental flora
during the
period from birth
until the child is
2 years old
• Use antibacterials like
xylitol
Xylitol
• An antibacterial, non-cariogenic sweetener
• Used in some foods, chewing gum, candies;
available over-the-counter and online
• Caries-causing bacteria cannot feed on
xylitol (it does not produce acid)
• Increases saliva flow
• Studies show that when used by mothers,
there is a 30 to 60% reduction in tooth
decay in their children
Prevention of
Periodontal Disease
• Regular brushing and flossing
• Regular dental exams and
professional cleanings
• Eliminating tobacco use
• Reducing stress
Access to Oral Health Care
• 21% of children (0-17) and 35% of adults (18+) in
CA do not have dental insurance (’05 & ’03 CHIS)
• Many employers do not cover dental insurance
• Lack of dentists and specialists accepting Medi-Cal
• County and community clinics overburdened
• Need more dentists to see young children and
pregnant women
• Lack of dental specialists
• Regular threats by state to cut or eliminate Medi-Cal
dental benefits for pregnant women & children
Take-home Messages
• Oral health is integral part of total health
• Dental disease is very common
• Dental disease is infectious and
transmissible, but it is preventable in many
ways
• Dental visit by age one
• Access to care barriers can be very
significant, especially for low-income
families