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Early Childhood Oral Health for MCH Professionals
Julia Richman, DDS, MSD, MPH
Who are we?
A. Medical care providers (ie MD, RN)
B. Dental care providers
C. Social services providers
D. Other public health professionals
Healthy People 2010
Oral Health Goal: Prevent and control oral and craniofacial diseases, conditions, and injuries and improve access to related services.
21-1 Dental caries experience
21-2 Untreated dental decay
21-3 No permanent tooth loss
21-4 Complete tooth loss
21-5 Periodontal diseases
21-6 Early detection of oral and pharyngeal cancers
21-7 Annual examinations for oral and pharyngeal cancers
21-8 Dental sealants
Healthy People 2010
21-9 Community water fluoridation
21-10 Use of oral health care system
21-11 Use of oral health care system by residents in long-term care facilities
21-12 Dental services for low-income children
21-13 School-based health centers with oral health component
21-14 Health centers with oral health service components
21-15 Referral for cleft lip or palate
21-16 Oral and craniofacial State-based surveillance system
21-17 Tribal, State, and local dental programs
Dental Caries
• Dental caries is the most common chronic childhood disease – 5x more prevalent than asthma
• Entirely preventable and treatable• 80% of caries in permanent teeth affect 25% of
the children – NHANES III – Poor children disproportionately affected
• Early childhood caries: caries affecting teeth in a child under 72 months of age
Dental Caries
http://mi.gceurope.com/en/identify2.jpg
Early Childhood CariesSequellae of dental caries• Pain
• Poor sleep due to pain
• Problems with school readiness and learning
• Poor nutrition due to pain eating
• Need for sedation or general anesthesia
– Problems with access to this care
• Negative dental experiences
• Emergency room care
• Hospitalization for severe dental infections
Early Childhood Caries
www.aafp.org/afp/20041201/2113_f1.jpg
Courtesy of Dr. Bryan Williams
Some Photos from My Practice
Sugar, dextrose, corn syrup, malic acid, citric acid,
buffered lactic acid, artificial flavor and color
Sugar, dextrose, corn syrup, malic acid, citric acid,
buffered lactic acid, artificial flavor and color
For Want of a Dentist
By Mary Otto, Washington Post Staff Writer Wednesday, February 28, 2007
Twelve-year-old Deamonte Driver died of a toothache Sunday.
A routine, $80 tooth extraction might have saved him.
If his mother had been insured.
If his family had not lost its Medicaid.
If Medicaid dentists weren't so hard to find.
If his mother hadn't been focused on getting a dentist for his brother, who had six
rotted teeth.
By the time Deamonte's own aching tooth got any attention, the bacteria from the
abscess had spread to his brain, doctors said. After two operations and more
than six weeks of hospital care, the Prince George's County boy died.
Disparities in Untreated Caries
CDC. NHANES I and NHANES III 2002 Annual Report
Disparities in Untreated Caries
CDC. NHANES I and NHANES III 2002 Annual Report
Caries in Washington State
According to the WA Smile Survey 2005,
• Significant increases since 2000 in:– Caries experience (55.6% 59.0%)– Rampant caries (15.2% 22.6%) – Caries in permanent teeth (15.3% 22.1%)
• Caries disproportionately affects Native American children – 3-5 year olds in Head Start– 25% of HS children had untreated caries – 48% of Tribal HS children had untreated caries
Please use the text chat to share your experience.Please use the text chat to share your experience.
Questions
Have you had a recent frustrating experience with trying to help a family obtain dental care for a young child?
What barrier(s) to access did you encounter?
Barriers to Care
• Knowing when to seek dental care
• Finding a dentist who will take Medicaid
• Finding a dentist who will see a young child
• Transportation
• Geographical isolation
• Workforce shortage
• Need to take time off from work
• Language
• Finances
• Other barriers (dental fear, culture, health beliefs)
Medicaid
• An estimated 47 million children eligible but not enrolled (1996)
• Only 1 in 3 children enrolled in Medicaid visited the dentist in the past year
• Coverage does not guarantee access to oral health care.
GAO 2000
What Dentists Can Do
• Practice in rural or underserved areas• Accept Medicaid• See young children, or refer to pediatric
dentists• Provide anticipatory guidance to pregnant
moms• Be active in dental organizations• Be an active member in the community
What MCH Non-Dental Professionals Can Do
• Be aware of oral health issues affecting clients and refer to dentists
• Do not dismiss dental concerns as trivial• Be aware of the recommendation for the age
one dental visit• Work with dentists to improve access and
reduce barriers to care• Be an active member of the MCH community
and lobby for oral health
Oral Health: How to Keep Your Child’s
Teeth HealthyFebruary 11th, 2009
Julia Anne Richman, DDSJessica De Bord DDS
Penelope Leggott DDS MS
Department of Pediatric DentistryUniversity of Washington
Goals of this Presentation
Parents and families will learn
• About tooth eruption and dental development
• How to help keep children’s baby and permanent teeth healthy, and prevent cavities
• Why oral health is important for pregnant moms
• What things you need to go and see a dentist for
Primary (Baby) Tooth Development and Eruption
• Tooth development begins at 4-6 weeks after conception
• The first primary tooth comes in at approx 6 months
• The permanent teeth develop in close proximity to the primary teeth
Six year molar Eye tooth/cuspid
Differences between baby and permanent teeth
• Baby teeth are whiter and smaller than permanent teeth
• Baby teeth have thinner enamel (outer covering) and cavities can grow faster when the enamel is damaged
• The first permanent teeth to come in are the lower front incisors (age 6)
Baby teeth
Permanent teeth
How do I prevent my child from getting cavities?
What are cavities?
What are Cavities?• Cavities are caused by germs, or bacteria,
on the teeth
• Most of us carry these cavity-causing bacteria in our mouths
• The bacteria can be spread from a mother or caregiver to a baby
• When we don’t brush our teeth, bacteria build up on the teeth to become plaque, sticky white stuff that can cause cavities easily
Cavities
• The bacteria feed on the sugars in foods and make acids
• When children get lots of sugar exposures in a day (snacks and juice), the bacteria can make acids all day. The acids dissolve tooth surfaces, causing defects which become cavities over time
Dissolving tooth surface
Enamel defect
Cavity
Early Tooth DecayWhite Spots (pre-cavities)
You can stop pre-cavities from getting worse!
Cavities• Why are cavities bad for children?
– Pain
– Difficulty sleeping
– Difficulty concentrating at school
– Difficulty eating and speaking
– The need for fillings or crowns at a young age
– Teeth may need to be pulled (extracted)
• This can lead to future crowding of the teeth
– Teeth roots can get infected, called an abscess
– Sickness or death as a result of the infection
Why Fix Cavities in Baby Teeth?
• Cavities in baby teeth will not go away or get smaller- Cavities can spread to other teeth in the
mouth
- They need to be fixed to get rid of the disease
damaged enamel on developing permanent tooth
abscess
How do I prevent my child from getting cavities?
What are cavities?
Prevention
• Cavities are an infection that can be prevented with: – Good brushing – A diet low in sugary and starchy foods
• Healthy teeth don’t have cavitiesHealthy mouth
Healthy body
Prevention Tips for Parents
• Serve water, not pop or juice
• Give fruits and vegetables, not fruit snacks, chips, crackers, or sweets as snacks
• Brush twice a day and floss every day
• Take your child to the dentist every 6 months starting by age 1
• 3 meals and 2 tooth friendly snacks each day
• Wean from the bottle by age 12-14 months
Snacking
Snacks which are not healthy for children’s teeth:•Fruit juice•Soda pop•Gatorade•Crackers •Chips•Sweet snacks
•Gummy bears and fruit snacks
Starchy Snacks
Snacks like chips, pretzels, and crackers have starch or carbohydrates•Carbohydrates are a form of sugar•Carbohydrates turn into sugar in the mouth•Starchy snacks cause cavities just like sweet snacks•Children should not eat starchy snacks frequently•Teeth should be rinsed or brushed after children eat starchy snacks
Snacking
Healthy snacks for teeth and bodies are:• Vegetables like carrots, celery, cucumbers
• Fresh fruit
• Lean meat
• Cheese
• Nuts
• Water
Tooth Brushing Tips
• Start brushing your child’s teeth when they come in
• Brush twice a day using a small soft toothbrush
• A smear of fluoride toothpaste should be used
• Babies and young children may not like tooth brushing, but it is very important for health
When should I take my child to the dentist?
What kinds of things do I need to go to the dentist for?
A Visit to the Dentist
• Babies should visit the dentist no later than their 1st birthday
• At that visit, the dentist will check the teeth, brush them, and put fluoride on them
• The dentist will talk to you about how to take care of baby teeth
A Visit to the Dentist
• Some people think that young children are too young to go to the dentist
• Babies and toddlers will usually cry when their teeth are checked
• Even if a baby or toddler cries, the visit to the dentist is very important for their health
• A pediatric dentist, or child dentist, has special training to take care of young children
How does the dentist fix cavities in a young child?
•Small cavities can be fixed easily and quickly in the office
•If a child has a lot of cavities or has big cavities, they may need medicine to make them sleep when the cavities are fixed
•This medicine is called general anesthesia
When should I take my child to the dentist?
What kinds of things do I need to go to the dentist
for?
See a dentist as soon as possible for:• Pain, swelling, fever• Chipped or loose tooth (injury)• Gums are very red and bleed easily
See a dentist in the next few days:• Gums bleed when teeth are brushed• Something looks like a cavity (no pain)• Teeth aren’t coming in straight• Loose tooth
abscess
Did You Know?
• Taking care of your mouth while you are pregnant is very important for you AND your baby.
• Children born early (< 33 weeks), are 12 times more likely to have cavities at ages 3-5 years
• Cavity-causing bacteria can be spread from a mother to her baby
• 28% of children age 2-5 years have cavities
Take Home Messages!
• Children’s oral health is part of their overall health
• Cavities are preventable• Limit “sugar” exposures• Take your child to get
his/her teeth checked by age one
www.cliffordbeers.org/ www.hazelwood.k12.mo.us
Thank You!