Transcript Smart Mouths Smart Kids Across Ages, Stages & Demographics

Snapshots: Smart Mouths Smart Kids
Across Ages, Stages & Demographics
Patty Braun, MD, MPH
Mary Kay Meintzer, LPC, CACII
Deidre Callanan, RDH, DC, MPH
Meet the presenters!
Goals for This Session
• Identify specific behavioral and physical
characteristics that impact the oral health of
children ages 0 to 5, 6 to 12, and 13+.
• Describe what is “normal/expected” for
children in those age groups, and “red flags”
for their oral health.
• Think with a “whole child” mindset.
• Identify available oral health prevention
interventions.
Children Age 0 to 5
Physical Development & Overall Health
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Growth
Fine motor
Gross motor
Language (cognitive)
Adaptive (social)
Growth, Influential Factors & Problems
• Growth
– Birth weight doubles by 4-5 months, triples by 12
– Birth length increases by 50% by age 1, doubles
by 4 years
• Influential factors
– Nature: birth weight, gestational age
– Nurture: nutrition, illness, medical conditions
• Problems
• Medical conditions
• Non-nutritive grazing
• Nutritional supplements
Gross Motor
-Rolls (4
mo)
-Rides
tricycle
-Sits (6
mo)
-Up stairs
one foot at
a time
-Crawls
(9 mo)
0-1
1-2
2-3
-Skates
-Swims
3-4
-Walks (12 mo)
- Skips
-Runs (15 mo)
- Climbs
-Throws ball (18
mo)
- Catches
toothpaste
with both
hands
4-5
Fine Motor
-Moro
-Grasp
-Raking (6 mo)
-Pincer (9 mo)
0-1
-Cuts with scissors
-Copies vertical
line
1-2
-Uses
spoon
and spills
(15 mo)
-Doesn’t
spill (18
mo)
2-3
3-4
- Copies
a circle
4-5
Language Development
Da
Dada
go
Me brush
my teeth
I brush my
teeth at
school every
day.
Why do I have to
brush my teeth? I
don’t want to.
• Medical and/or environmental conditions
– affect weight gain (e.g FTT)
– result in daily medications (e.g. Fe+)
– delay cognitive development (special needs)
– delay motor development (cerebral palsy)
– impact the introduction to solids (feeding
problems)
– distracting caregiver to focus on other things
– contributing to complacency around oral health
Cognitive Development
0-2 years: Sensorimotor
•
Knowledge of world is limited to child’s sensory
perceptions and motor activities. Object
permanence develops.
2-7 years: Pre-operational Thought
•
Language development is a hallmark of this period.
Children in this stage do not yet understand concrete
logic, cannot mentally manipulate information, and
are unable to take the point of view of other people,
which he termed egocentrism. Other important
concepts for this stage: centration, animism, and
artificialism.
Oral Health Development
Poor oral health:
• Trouble concentrating and learning
• Poor testing results
• Poor school
attendance
Oral Health Development
Early Childhood Caries (ECC)
First Dental Visit
Thumbs, Fingers, and Pacifiers
Early Childhood Caries (ECC)
• Severe decay in the teeth
of infants or young children
• Common bacterial
infection, of
epidemic prevalence
• Highest rates (70%) in
minority and rural
populations
• Infectious and vertically
transmissible
Abscess
• Causes: Trauma (chipped or broken tooth) or
tooth decay
• Complications if untreated:
• Tooth loss
• Blood infection (sepsis)
• Spread of infection to
soft tissue, bone and
other areas of the body
First Dental Visit
• By age 1
– Dental Home: comprehensive, ongoing,
accessible, coordinated and family-centered
• 1 + 1 = ZERO
– ONE dental visit when
there’s ONE tooth can
equal ZERO cavities
Thumbs, Fingers & Pacifiers
• Non-nutritive sucking for pleasure, comfort
and security
• Pacifier-vs-thumb: AAPD supports pacifiers
• Stop the habit:
discourage after
age 3 and decrease
chance for
orthodontic
problems
Children Age 5 to 12
Growth, Influential Factors & Problems
• Growth:
– 4-7 lbs/year
– ~ 3 inches/year
• Influential factors
– Nature: mid-parental height
– Nurture: nutrition, illness, medical conditions
• Problems
• Picky eater
• Problem feeder
Gross Motor
- Skip
- Broad
jump
- Ski bumps
-Ride a
bike
5-6
-Skate well
6-8
-Dribble
a ball
-Dress
self
without
help
9
10
- Catch
a fly
ball
11-12
Fine Motor
- Tie shoe
- Grip
crayon
-Knit/sew
- Cut and
paste
5-6
- Play band
instrument
-Build a model
6-8
-Change
clothes
- Brush
teeth
9
10
- Floss
teeth
11-12
• Medical and/or environmental conditions
– affecting their sleep (e.g. xerostomia)
– with undesirable side affects (e.g antihistamines)
– result in behavior problems (e.g. refusal)
– create concerns about weight gain (e.g. poor growth)
– contribute to complacency around oral health (e.g.
should be old enough to do it him/herself)
Cognitive Development
6-7 years: Pre-operational Thought
7-11 years: Concrete Operations
•
Children gain a better understanding of mental
operations. They begin thinking logically about
concrete events, but have difficulty understanding
abstract or hypothetical concepts. Important
concepts of this stage: conservation, reversibility,
and associative thought.
11+ years: Formal Operations
•
People develop the ability to think about abstract
concepts. Skills such as deductive reasoning and
systematic planning emerge during this stage.
Oral Health Development
Mouth guards
Orthodontics
Mouth Guards
• 50-80% of dental injuries involve front teeth
of the upper jaw
• Most common injures: secondary to falls,
traffic accidents, violence and sports
• Protect teeth and reduce the force of blows
that can cause concussions, neck injuries and
jaw fractures
• Three types: preformed, mouth-formed and
custom-fabricated
Dental injuries are also prevalent in
non-contact activities and exercises:
gymnastics and skating
Orthodontics
• Age 6-7: permanent teeth and orthodontic
problems
• Orthodontic treatment uses appliances,
tooth removal, or surgery
• Functional appliances use muscle action from
speaking, eating, and swallowing
• Fixed orthodontic appliances are sets of wires
and brackets cemented to the teeth
Wires, brackets and bands
may become dental caries
hubs with poor oral hygiene
Pre-adolescents/adolesents
Age 13+
Growth, Influential Factors & Problems
• Growth
– Puberty
• Girls: 9-14 years
• Boys: 10-15 years
• Getting earlier
• Influential factors
– Nature: family size
– Nurture: self-image, self-serve, nutrition, illness
• Problems
• Obesity
• Eating disorders
Gross & Fine Motor
13
14
15
16
17
• Medical and/or environmental conditions
– impact receipt of health care (e.g. stop going to
healthcare provider)
– result in dental trauma (e.g. don’t use mouth guards)
– result in invincibility (e.g. won’t happen to me)
– produce anxiety (e.g. learning about diseases)
– contribute to complacency around oral health (e.g.
who cares?)
Cognitive Development
• 11+ years: Formal Operations
• Consider Ethical Development here
Oral Health Development
Gingivitis/Periodontal Disease
Tobacco, Cannabis, etc.
Oral Piercing
Gingivitis
• Mildest form of periodontal disease
• Inflammation of the gingiva surrounding tooth
• Immunosuppression and hormonal changes lead
to an altered response to bacterial plaque
• If untreated, can lead to periodontitis
Contributions by Morgan Lauer,University of Colorado, School of Medicine, MS-IV
Periodontal Disease
• Chronic exposure to bacterial plaque =
chronic inflammation
• Destruction of the periodontal ligament,
loss of supportive bone and tooth loss
2x as likely to suffer from heart disease.
May make it more difficult for diabetics to
control their blood sugar.
Tobacco
• 1 in 4 high school students report using some
type of tobacco
• If current tobacco use patterns continue in
the US:
– 6.4 million persons now under 18 years will die
prematurely from a tobacco-related illness
Cannabis
• 3 main forms of cannabis: marijuana, hash,
and hash oil
• Delta-9-tetrahydrocannbenol (THC)
• Cannabis smoke is carcinogenic
• Increased risk of xerostomia (dry mouth)
• Complications with adrenaline-containing
local anesthetics
E-Cigarettes/Vaporizers
• ENDS have the look and feel of tobacco:
– E-cigarettes and Vaping
• Cartridge filled with liquid nicotine: flavored
and varying strengths
• Upon inhalation, heat vaporizes the liquid,
bringing a mist to the user
• Medical Hx– ask about tobacco and
marijuana use
E-Cigarettes/Vaporizers
• Marijuana can be sold and consumed in
vaporizers
• Vape pens – Can be sold pre-loaded with
highly concentrated marijuana
A major public health concern
Hookahs
• Waterpipe used to smoke tobacco and marijuana
• Myths:
– Harmless- tobacco smoke goes through water
– Less addictive/nicotine in a water pipe is less
addictive than smoking cigarettes
Oral Piercing
• Intraoral piercing as a body art has been
gaining popularity
• Complications:
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Infection
Prolonged bleeding
Swelling and possible nerve damage
Blood borne disease transmission
Inflammation of the heart valves or
tissues is a risk of oral piercing.
Oral piercing can provide opportunity for
bacteria to enter the bloodstream and
travel to the heart.
Children With Special Needs
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Inability or difficulty to brush and floss
Poor diet
Difficulty clearing food from the mouth
Medications can lead to increased risk of
dental disease
• Tooth eruption: Delayed, accelerated, or inconsistent
• Malocclusion: Poor fit between the upper and lower
teeth, and crowding of teeth
• Developmental defects: Pits, lines, or discoloration
• Tooth anomalies: Variations in the number, size,
and shape
Prevention & Intervention
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First Dental Visit by Age One
Cavity Free at Three
Community Water Fluoridation
Fluoride Varnish
Sealants
Questions?