A Dental Home for PWAs 131027

8/13/2019 A Dental Home for PWAs 131027

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DR. NOEL V. VALLESTEROS

President Elect, Philippine Pediatric Dental Society Inc.

Executive Director, Pediatric Dentistry CenterPhili ine

A DENTAL

HOME FOR

PATIENTSwith

AUTISM


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2

ARTICLE II

PURPOSE & OBJECTIVES

DEFINITION OF PEDIATRIC DENTISTRY:DEFINITION OF PEDIATRIC DENTISTRY:

The specialty of Pediatric Dentistry is the

practice and teaching of and research incomprehensive preventive and therapeuticoral health care of children from birth through

adolescence. It shall include care for specialpatients beyond the age of adolescencewho demonstrate mental, physical and/or

emotional problems.


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THE 1ST BIRTHDAY

An oral health consultation

visit within six months of

eruption of the first tooth isrecommended to educate

parents and provide

anticipatory guidanceforprevention of dental

disease.

THE 1ST

DENTAL VISIT


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Evidenceincreasinglysuggeststha

t

tobesuccessfulatp

reventingdental

disease,dentistsmust

begin

preventiveinterventionswithinthe

firstyearo

flife.

AAPD 2011


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EARLY CHILDHOOD CARIES (ECC)

TWOISTOOLA

TE


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The WHITE SPOT


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DENTIN CARIES


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PULP CARIES


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The SINGLE GREATEST RISK FACTOR for future

caries is DENTAL CARIES EXPERIENCE.American Dental Association (ADA)

Centers for Disease Control (CDC)

American Academy of Pediatric Dentistry (AAPD)


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Children experiencing caries as infants

or toddlers have a much greaterprobability of subsequent caries in both

the temporary and permanent teeth.

Bethesda, MD, 1997

Conference on ECC


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12 year old children: 3.25 DMFT


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Eh baby teeth lang naman yanEh baby teeth lang naman yan

Mapapalitan dinMapapalitan din yan noh.yan noh.


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U Wh It A i Wh It L


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Upper

Tooth

When It Arrives

(Month)

When It Leaves

(Year)

Central Incisor 7.5 7

Lateral Incisor 9 8

Canine 18 11

First Molar 14 9

Second Molar 24 11

Lower

Tooth

When It Arrives(Month)

When It Leaves(Year)

Central Incisor 6 6

Lateral Incisor 7 7

Canine 16 10

First Molar 12 9Second Molar 20 10


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DENTAL CARIES TETRALOGY

CARIES


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FOOD

BACTERIA(PLAQUE)

ACID

DEMINERALIZATION

SUGAR

TOOTH DECAY


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CRITICAL pH5.5- 5.7

DEMINERALIZATION

REMINERALIZATION


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Nursing caries is related with thepractice of the habit at night

(Kroll and Stone 1967)

when the flow of saliva is

diminished.(Scheneyer et al 1956)


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is a dietaryis a dietary--carbohydratecarbohydrate

andand salivasaliva--modifiedmodifiedinfectious bacterial diseaseinfectious bacterial disease

DENTAL CARIESDENTAL CARIES


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Remineralization(Saliva is the sole source of Calcium andPhosphate essential for rebuilding

hydroxyapatite structures.) Protection against demineralization

Buffering acidic challenges(bicarbonate in stimulated saliva)

Flushing the oral cavity


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In Western civilization, infants

generally are weaned from thebreast or bottle by 1 year of age.

(Illingsworth 1975; Rudolph 1977)


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Problems of

PAIN,INFECTION,

MALOCCLUSION,MALNUTRITION


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PAIN


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INFECTION


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Arch length deficiency can produce or increase the

severity of malocclusions with crowding, rotations, ectopiceruption, crossbite, excessive overjet, excessive overbite,

and unfavorable molar relationships.

Brothwell DJ, 1997


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Children are hard to manage.

More dentists are afraid of childrenthan children afraid of dentists.

Oral rehabilitation is difficult.

Pediatric dental treatment is expensive.

NOTREA

TMENT?


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Thus, PREVENTIONis the

immediate solution!!!


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Exposure to the correct amount of fluoride isconsidered by the World Health Organization(WHO) to be the most effective preventive

measure against caries.


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The caries-reducing effectof fluoride is almost

exclusively TOPICAL.


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Fluoride Varnish Applicationfor Nursing Caries Prevention

applied at 9 mos. of age

reapplied every 6 mos. up to3 years of age.


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CARIES-REDUCINGEFFECT of FLUORIDE:

MAINTAINANCE withHOME-USE FLUORIDES


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BRUSHING

with FluorideToothpaste isNON-NEGOTIABLE!

Factors that affect effectiveness


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of fluoride toothpaste:

1. Timing (upon tooth eruption)

2. Available free fluoride concentration

3. Amount used

4. Tooth brushing time

5. Rinsing method

6. Frequency of use

7. Time of application


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1. TIMING

Primary anticaries effect of fluoride

is topical (post eruptive).

Burt BA, Eklund SA, 1999


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Brushing should start as soon as

the first deciduous tooth erupts.

Delivering Better Oral Health:An Evidence-Based Toolkitfor Prevention DH/British Association for theStudy of Community Dentistry, 2007


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Best choice is the toothpaste with

1000 to 1500 ppm free fluoride.FDI and WHO Recommendation

2. AVAILABLE FLUORIDE CONCENTRATION


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Current best practice includesrecommending twice daily use of atoothpaste containing 1000 ppm Ffor children in optimally fluoridated

and fluoride deficientcommunities


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ISSUE ON KIDDIETOOTHPASTES?

500-700 ppm F


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Sodium fluoride 0.22%

0.10% w/w fluoride ion


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Ice cream-, candy- flavored toothpastesshould NOT be used for children.

WHO , 1994

Toothpaste tubes should be keptout of reach of children.

NON-FLUORIDE TOOTHPASTES?!


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Plaque removal by toothbrushing alone

or with unfluoridated toothpaste is noteffective in caries reduction.

Sutcliffe, 1996


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Safety of Fluoride Toothpaste:

Concern over fluorosis from swallowed fluoridetoothpaste in infant (6 mo) and young child (2yr):

The risk for fluorosis is low when fluoridetoothpaste is used properly, even withadult or standard fluoride toothpaste.

3. AMOUNT OF FLUORIDE TOOTHPASTE


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thin smear, half a pea 6 mos- 2yrs


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t s ea , a a pea 6 os y s

years (0.05-1g)

smear- a thin film of paste covering less than of the brush


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Parentsshould do thebrushing

Knee-to-KneePosition

ERR

OR

:

OFFENDI

STA

CK

:


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A Dental Home for PWAs 131027