TODDLER TIMETODDLER TIMEEstablishing an Infant Oral Health Care ProgramEstablishing an Infant Oral Health Care Program

Robert D. Elliott, D.M.D., M.S.Robert D. Elliott, D.M.D., M.S.Julie R. Molina, D.D.S, M.S.Julie R. Molina, D.D.S, M.S.

www.CaryPediatricDentistry.comwww.CaryPediatricDentistry.comAAPD Annual SessionAAPD Annual Session

Chicago, IL Chicago, IL

Schedule is blocked before lunch 7 chairs - exclusively for toddlers

Informal group setting Allows for interactive discussions with

parents

Patient Desensitization Patients explore their surroundings with

other children of the same age Play therapy prior to knee to knee exam

OVERVIEWOVERVIEW

Education and Current Information Oral Development Diet and Nutrition Oral Habits and Trauma Prevention Fluoride Adequacy

Introduction to preventive care Exam Oral Hygiene Instruction Fluoride Application

OVERVIEWOVERVIEW

Infant oral health care starts with Infant oral health care starts with USUSEstablishing a Dental HomeEstablishing a Dental Home

Parents appreciate children of the Parents appreciate children of the same age being seen togethersame age being seen together

Extensive amount of information and Extensive amount of information and kids don’t like being held that longkids don’t like being held that long

OVERVIEWOVERVIEW

Anyone can give talk Anyone can give talk doctor, assistants, hygienists, health doctor, assistants, hygienists, health

educatoreducator

Patient ages range from 12-36 Patient ages range from 12-36 monthsmonths

We welcome any caregivers We welcome any caregivers parents, grandparents, nannies, etc.parents, grandparents, nannies, etc.

OVERVIEWOVERVIEW

CONCEPTIONCONCEPTION Our office conceptOur office concept

"Developing healthy smiles for infants and "Developing healthy smiles for infants and toddlers through positive interactions in a toddlers through positive interactions in a safe environment“safe environment“

Follows University of North Carolina’s Follows University of North Carolina’s Baby Baby Oral Health ProgramOral Health Program (BOHP) (BOHP) and AAPD’s and AAPD’s Dental Home Dental Home recommendationrecommendation

Implemented program 10 years agoImplemented program 10 years ago scheduled weeklyscheduled weekly

LAYOUT & SETUPLAYOUT & SETUP

LAYOUT & SETUPLAYOUT & SETUP

EDUCATIONEDUCATION

TTOODDDDLLEERR TTII MMEE

1. Dental Home at 12 months – not age 3! a. Patient of record f or trauma b. Education c. 18-24 mo for siblings fi rst visit

2. Risk Factors – Early Childhood Caries - ECC (new term) a. Special health care needs b. Grazers – drinks and snacks c. Liquid medicine – Zyrtec d. Breastfeeding – brush teeth AFTER! e. Milk/ juice/ sweetened liquid to bed in bottle/ sippie cup f . Reflux (GERD) – stomach acid contacting teeth g. Mom’s cavity potential – xylitol chewing gum (4 pieces/ day by

mom) h. Brush teeth AFTER breakfast and before you go to bed

3. Diet and drinks a. A tooth, some sugar and bacteria (plaque) b. Natural sugar vs. processed c. Snacking or grazing greatly increases risk! d. Sticky f ruits, gummies, f ruit roll-ups, skittles e. Carbs, crackers, breads

i. Cheerios a better choice – oat grain! f . Milk and citric acid juices g. Watered down juice – this is only helpful f or hyperactivity –

teeth still at risk! h. Flavored waters/ alternatives

i. Fruit2O, Aquafina - Splenda ii. Crystal Light – Nutrasweet

4. Toothbrushing and flossing a. Technique – 45 degree angle and brush the way the teeth grow b. Knee to knee position c. Control by parent not child d. Wet toothbrush early on (no wiping) e. Spin brushes vs. traditional f . Closed contacts – wild flossers/ floss handles

5. Toothpaste a. Use Fluoride toothpaste twice-daily. i. ‘Rice-size/ smear’ f or children <2 yrs. ii. ‘Pea-size’ for children 2-5 yrs once they can spit consistently. iii. Parents should assist with brushing. b. Spit training suggestions – ping pong ball technique

6. Fluoride History a. Topical (paste, gels, rinses) vs. Systemic (water). b. City water – need to ask f urther questions:

i. Filtration Systems – reverse osmosis and distillation – reduced fluoride levels.

ii. Bottled water brought in (variable fluoride but usually low). iii. Other places? school, grandmas, f oods/ beverages made with water including infant f ormula. iv. Nursery water with fluoride – need 6oz/ day.

c. Well Water (private or community well). i. Water test kit – health dept test. ii. Supplementation fluoride schedule and prescription.

d. Teas and Grape J uices – higher in natural fluoride. 7. Thumbs, Fingers, Pacifiers

a. Anticipatory Guidance. b. Pacifiers – trimback technique, plant in yard, pacifier f airy. c. Thumb – substitute pacifier f or thumb, thumb paint/ nail bitters

paint, reminders – band aids, gloves, socks, reward charts, thumbguard.

8. Trauma a. Frenum (skin under lip) tear. b. Concussion injury – tooth is “bumped”. c. Subluxation – loose tooth, not displaced. d. Luxation displaced (pushed back) – most common injury. e. Avulson (tooth knocked out) – locate, but don’t replace in mouth. f . I ntrusion (pushed into gum) – use towel on bathtub.

9. Fluoride and Radiographs required – our policy a. I n- offi ce topical fluoride treatment every 6 months. b. Radiographs as recommend by American Academy of Pediatric Dentistry . c. High risk kids may need to be seen every 4 months (3 times a year) or extra fluoride treatments every 3 months.

For more inf ormation, log onto: http:/ / www.cdhp.org/ Projects/ PPMCHResources.asp or www.aapd.org

Diplomate, American Board of Pediatric Dentistry

Cary Pediatric Dentistry 540 New Waverly Place, Suite #300, Cary, NC 27518 (919) 852-1322

EDUCATIONEDUCATION

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SSUUGGAARR BBAACCTTEERRII AA ((ffrroomm ppllaaqquuee))

HHEEAALLTTHHYY TTOOOOTTHH DDEECCAAYY!!!!!!

EDUCATIONEDUCATIONNew Patient Toddler New Patient Toddler

FolderFolder* Toddler Brochure* Toddler Brochure* Toddler Time Handout* Toddler Time Handout* Appointment Policies* Appointment Policies* Financial Policies* Financial Policies* Healthy Snacks* Healthy Snacks* Dental Emergencies* Dental Emergencies* Meet our TEAM* Meet our TEAM* Eruption diagram* Eruption diagram

EDUCATIONEDUCATIONClick HereClick Here

INTERACTIVE INTERACTIVE DISCUSSION WITH DISCUSSION WITH

PARENTSPARENTS

INTERACTIVE INTERACTIVE DISCUSSION WITH DISCUSSION WITH

PARENTSPARENTS

INTERACTIVE INTERACTIVE DISCUSSION WITH DISCUSSION WITH

PARENTSPARENTS

INTERACTIVE INTERACTIVE DISCUSSION WITH DISCUSSION WITH

PARENTSPARENTS

DENTAL ASSISTANTS DENTAL ASSISTANTS ROLE & ROLE &

RESPONSIBILITIESRESPONSIBILITIES

Knee to Knee PositionKnee to Knee Position Oral Hygiene InstructionOral Hygiene Instruction TB ProphyTB Prophy FlossingFlossing

DENTAL ASSISTANTS DENTAL ASSISTANTS ROLE & ROLE &

RESPONSIBILITIESRESPONSIBILITIES

DOCTORS ROLE & DOCTORS ROLE & RESPONSIBILITIESRESPONSIBILITIES

Review Medical HistoryReview Medical History Review Fluoride AdequacyReview Fluoride Adequacy Oral ExaminationOral Examination Oral Development DiscussionOral Development Discussion Develop Individual Preventive PlanDevelop Individual Preventive Plan Vanish ApplicationVanish Application

DOCTORS ROLE & DOCTORS ROLE & RESPONSIBILITIESRESPONSIBILITIES

DOCTORS ROLE & DOCTORS ROLE & RESPONSIBILITIESRESPONSIBILITIES

PATIENT DENTAL PATIENT DENTAL HOME CARE KITHOME CARE KIT

What’s in the bag?What’s in the bag?– Infant ToothbrushInfant Toothbrush– Prepackaged Hand Flosser and Dental FlossPrepackaged Hand Flosser and Dental Floss– Fluoride Varnish Information SheetFluoride Varnish Information Sheet– Plastic Dental MirrorPlastic Dental Mirror– Toy and StickerToy and Sticker

Special handle toothbrushes for parentsSpecial handle toothbrushes for parents