pediatric oral health risk assessment
TRANSCRIPT
Pediatric Oral Health Risk AssessmentTraining for Medical Professionals
More Smiling Faces in a SCDHEC led oral health initiative funded by the Robert Wood Johnson Foundation and managed by the Center for Health Care Strategies
SCDHEC
Oral Health Division
2006
Contents Section I: Pediatric Oral Health Overview Section II: Professional Recommendations Section III: Etiology and Prevention of Tooth Decay Section IV: Anticipatory Guidance for Mother Section V: Oral Health Risk Assessment—Young C
hildren Section VI: Anticipatory Guidance for Infants and Y
oung Children Section VII: Fluoride Varnish
More Smiling Faces in a SCDHEC led oral health initiative funded by the Robert Wood Johnson Foundation and managed by the Center for Health Care Strategies
Pediatric Oral Health ObjectivesAt the completion of this section, theparticipant will be able to understand the:
Role of the medical professional in pediatric oral health promotion and the prevention of dental diseases
Recommendations for infant oral health of the American Academy of Pediatric Dentistry and the American Academy of Pediatrics.
Indications for the use of fluoride varnish as a preventive treatment for young children
Recommendations for oral health anticipatory guidance during pregnancy.
Oral Health in America:
A Report of the Surgeon General“…oral health is integral to general health (1)”
Surgeon General David Satcher, MD, PhD and Lisa Waddell, MD, MPH, SCDHEC2000
One of the most common diseases of childhood
5 times as common as asthma 7 times as common as hay fever (1).
A health problem: tooth decay
Early childhood caries—tooth decay Is defined as the
presence of decayed primary teeth
Is also known as baby bottle tooth decay
Advances rapidly due to the thinness of the enamel
What are the costs? Children with early childhood tooth decay are more
likely to get more decay in their permanent teeth. Goes beyond pain and infection…
Affects their speech Affects their ability to eat Affects their ability to learn Affects the way they feel about themselves
Dental treatment can be very costly, especially hospitalization for treatment.
Why begin oral health with the medical provider? First health professional to
provide well child care to the infant and continues this care on a regular basis
Prevention is a critical component of pediatric care.
Today health professionals recognize the importance of oral health as part of total health
American Academy of Pediatric Dentistry Clinical Guideline on
Infant Oral Health Care Recognizes that allied
health professionals and community organizations must be involved as partners to achieve a lifetime of freedom from preventable oral diseases.
Adult Oral Health
Child and AdolescentOral Health
Infant Oral HealthBirth to age 3-the foundation
Lifetime of Freedom from Preventable Oral Disease
AAP and AAPD Recommendations Oral risk assessment
including a visual oral screening Anticipatory Guidance Preventive strategies Establishment of the dental home by age one
Tooth Decay: how does it happen?
Parent Sheet: The Bottle and Your Infant’s Dental Health
Parent Information Booklet, page 9
Tooth decay and infants Oral flora colonize the
mouth soon after birth Current belief that
cariogenic bacteria colonize only after the tooth erupt
Tooth decay can begin as soon as the teeth erupt at 6-10 months of age
Tooth decay is an infectious, transmissible disease Tooth decay bacteria is
transmitted from mom or other primary caregiver to baby through Fingers Sharing eating utensils Cleaning pacifier with
mother’s saliva
Parent Information Booklet:Your Infant Can Get Cavities From You, page 3The Pacifier and Your Infant’s Dental Health, page 10
Caries-risk assessment Child’s History
History of dental decay in mother, child and other family members
Family is of low economic status Child consumes a high sugar/complex carbohydrate
diet Child has special health care needs Child was premature/low birth weight Child routinely is prescribed medications that are
sugar based or that reduce salivary flow
Tools for a visual oral screening Light
Tongue depressor
Long handled cotton
swab/toothpick
2x2 gauze
Toothbrush
Knee to knee position
Visual oral screening Lift the lip
Check for presence of plaque and food on teeth
Check gums and soft tissues—look for abscesses
Tip: a toothbrush can be used to count the child’s teeth and can also serve as a mouth prop, preventing the child from biting down on your finger.
Examine the teeth Observe the teeth from
the Outside surfaces Look for “White Spots” Look for obvious signs
of tooth decay such as brown spots or breaks in the tooth surface
Look from the inside of the upper front teeth
Looking at the back teeth Look for
Dark spots and stains Breaks in the tooth
surface
Show parent how to do a Smile Check Gently lift your child’s
upper lift Look at the outside and the
inside of the upper front teeth
Parent Information Booklet:Smile Check, page 6
Referral for dental care The findings…are provided below:
Needs regular dental examination Needs dental treatment within one month Needs dental treatment immediately
Needs regular dental examination
Needs treatment within 1 month
Special Note: an infant or child with any positive caries risk factors should be referred to a dentist within one month even though there are no observable dental problems.
Immediate dental treatment Signs or symptoms that
include pain, infection, swelling or soft tissue ulceration of more than 2 weeks duration determined by questioning.
Needs immediate treatment
Establish a Dental Home Refer
high risk children by 6 months
Refer all children by the age of one
Parent Information Booklet:How do I find a good dentist for my child?, page 14Your Child’s First Dental Visit, page 15
Children with Special Health Care Needs Refer early referral for dental care (before or
by age 1) Collaboration with dentist is especially
important Emphasize with parents the importance of
oral health to CSHCN
Considerations for CSHCN Medications for asthma and allergies often
reduce salivary flow which increases risk for tooth decay
Children who are preterm or low birth weight have a higher rate of enamel defects and are at increased risk for tooth decay
Infants with feeding problems are often placed on special high carbohydrate diets
Oral Hygiene After feeding, an
infant's teeth and gums shall be wiped with a moist cloth to remove any remaining liquid that coats the teeth and gums
Parent Information BookletHow Can I Protect My Child’s Baby Teeth?, page 4
Oral Hygiene: Infant to Toddler… When teeth appear you
can use a small, soft toothbrush
Parent Information Booklet: Tips for Brushing Your Infant’s Teeth, page 8
Oral Hygiene: Supervised Brushing
Parent Information Booklet:
How to Make Toothbrushing Fun! Page 23
How To Choose the Right Toothbrush and Toothpaste for Your Preschooler, page 24
Diet and Oral Health If the baby goes to bed with a bottle,
only use water. Baby should begin using a cup by 6
months Wean from bottle to cup by age 1 Avoid letting baby walk around with a
bottle or sippy cup with milk, juice or sweet liquid
Parent Information Booklet: The Bottle and Your Infant’s Dental HealthSippy Cups, page 19
Encourage Good Food Choices
Parent Information Booklet:Healthy Eating Habits for Good Dental Health, page 16Juice, page 17Facts About Milk, page 18Nutrition and Your Child’s Dental Health, page 30
Medicines Children’s medication often
contain sugar Some decrease the child’s
salivary flow Be sure to inform parents or
caregivers to brush the child’s teeth after giving him or her their medication.
Fluoride—the Tooth Protector Water that may contains fluoride:
Community water systems Well water with naturally occurring fluoride
Fluoride in the water helps slow down the loss of the tooth surface---by replacing the lost minerals with fluoride, a process called remineralization
Check local water systems for fluoridation information at: CDC’s My Water’s Fluoride website:
http://www.scdhec.net/hs/mch/dental/WaterFlou.html Optimal fluoride concentration of water systems should
be in the .7 to 1.2 parts per million
ADA Recommended Supplements
Fluoride Toothpaste Small, pea sized
amount beginning at age 2
Under age 2, water only
Supervised use under age 8 years
Parent Information BookletToothbrushes and Toothpaste for Toddlers, page 12
Injury Prevention
Parent Information Booklet: Is Your Home Safe?, page 20 Safety: Toys and Dental Health, page 21 Home for the Holidays, page 22 Keeping Your Child’s Smile Safe When
Riding in a Car, page 25 Keeping Your Child’s Smile Safe At
Home and In School, page 26 Keeping Your Child’s Smile Safe When
Shopping, page 27 How to Respond to a Dental
Emergency, page 28
Why do we recommend fluoride varnish for very young children? To prevent dental caries and in some cases
reverse early dental caries Children with early childhood decay are more
likely to get more decay Baby teeth are in a child’s mouth until about
age 11 or 12
Who should receive fluoride varnish? Children are at risk for
developing dental caries. Risk assessment based on the
Caries Risk Assessment
Risk factors for dental caries are: History
History of dental decay in mother, child and other family members Family is of low economic status Child consumes a high sugar/complex carbohydrate diet Child has special health care needs Child was premature/low birth weight Child routinely is prescribed medications that are sugar based or that
reduce salivary flow
Clinical evaluation Visible plaque, white spots and/or decay Gingivitis—gums appear red, swollen, report bleeding when brushing White spots/demineralization
How does fluoride varnish work? The lacquer-based product adheres to the
dental enamel forming a depot from which fluoride is slowly released
A dry tooth surface allows the uptake of the fluoride into the tooth surface
Saliva actually sets the varnish
Advantages of fluoride varnish easy to apply teeth do not need professional prophylaxis children can eat and drink following
applications potential ingestion of fluoride is low due to
the sticky form of the varnish and the small amount used
prevents tooth decay and reverses early decay
White spots
Knee to knee position
Fluoride varnish application1. Dry teeth with gauze square 2. Apply varnish with brush
to all teeth surfaces
Post application instructions for parents Varnish will set on contact with saliva and look
like a yellowish film Child can eat or drink right after application but
should try to eat soft foods Instruct parent not to brush their child’s teeth until
the next day. The first toothbrushing will remove the yellow
film on the teeth.
Three months later
Remineralized Enamel
You can make a difference!! Integrate oral health assessment into well child visits Provide patient education regarding oral health Document findings and follow up Train office staff in oral assessment Identify dentists in your area who accept new
patients and Medicaid patients. Take a dentist to lunch to establish a referral
relationship Investigate fluoride content in area water supply
Anticipatory Guidance for Mother At the completion of
this section, the participant will be able to describe anticipatory guidance for the mother both before the baby is born and following the infant’s birth.
Water Ask your doctor or
your dentist if your water has fluoride in it.
Fluoride is a safe, easy way to protect your teeth from tooth decay.
If you buy bottled water, check the label for fluoride.
Anticipatory guidance for mother Or other intimate
caregiver before and during colonization process Brush and floss daily to
disturb cariogenic bacteria and reduce bacterial plaque levels
Use toothpaste with fluoride
Eat healthy foods Chose foods low in sugar. Eat healthy snacks like
fruit, cheese and vegetables.
Get enough calcium for you and your baby’s healthy teeth and bones.
Calcium is in milk, cheese, dried beans and leafy green vegetables.
Avoid carbonated drinks
Dental care for mother Refer to dentist to:
To maintain or to restore to health the oral tissues which includes not only healthy teeth but also gums and the supporting tissues or the oral cavity.
If dental caries are present, removal of decay and restoration of teeth
Mother chewing xylitol gum Recent evidence suggests
that chewing xylitol gum kills cariogenic bacteria
Chew 1 piece of gum for 5 minutes 3-5 times a day
decreases the child’s caries rate.
Now is the time for mom to learnHow to keep her child cavity-free! Get her mouth healthy—see her dentist Learn how to do a Smile Check on a baby Learn how to clean a baby’s teeth Learn how to prevent baby bottle tooth decay by not
putting the baby in bed with a bottle at night or naptime.
Be prepared to ask her doctor or dentist to check you’re the baby’s teeth by age one.
Talk to her doctor or dentist about fluoride.