Bright Smiles for Babies

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					You Can Make a Positive Impact
   on a Child‟s Oral Health!

      Oral Health Care for Very
     Young Children and Children
    with Special Health Care Needs

           Division of Dental Health
         Virginia Department of Health
              109 Governor Street
           Richmond, Virginia 23219
             Oral Health Care For
     Very Young Children and Children With
           Special Health Care Needs

For more information or to schedule an oral health presentation contact:
               Kami A. Piscitelli, BSDH, RDH
            Special Needs Oral Health Coordinator
                   Division of Dental Health
  Funded by Maternal and Child Health Bureau, Health Resources and Services Administration,
    U.S. Department of Health and Human Services
               What can you do?

You‟re already doing something! You‟re here!
You can make an impact by:
 Increasing your awareness of the oral health needs
 of children
 Promoting oral health to families of young children
 and CSHCN
 Encouraging age one dental visits

 Why oral health is important?

 What are the two most common dental diseases?

 The results of untreated dental disease

 Common dental problems of CSHCN

 Prevention of dental disease

 Visiting the Dentist
At what age should children start
      seeing the dentist?

• Tooth decay is the most common chronic childhood
• Tooth decay is 5 times more common
 than asthma; 7 times more common
 than hayfever.
• Approximately 28% of children ages 2-5 years old
 have tooth decay.
• CSHCN are almost twice as likely to have unmet oral
 health needs than children without SHCN.
Why is this important?

They are only teeth!
           The Function of Teeth

 Chewing / Digestion

 Speech

 Facial appearance

 Bone structure

 Confidence
Baby Teeth Are Important Too!

             Guide eruption of permanent teeth

             Healthy baby teeth = healthy
             permanent teeth
Baby Teeth
   Oral Health Affects General Health
          In the Mouth            Overall Health

oral disease and infection   systemic infection; can
                             threaten life; unsuccessful
                             organ transplant; surgery delay
periodontal disease          diabetes, bacterial pneumonia,
                             low-birth weight, heart disease,
tooth decay                  malnutrition, failure to thrive,
                             pain, loss of concentration,
                             emotional/psychological stress
malocclusion                 difficulty speaking/chewing,
                             infections due to difficult oral
   General Health Affects Oral Health
         Health Factors                 Oral Health
gastric reflux / vomiting         erosion of teeth, sensitivity

medications                       reduced saliva, enlarged gums,
special diets (soft, high carb)   decay, periodontal disease

oral habits                       trauma, injury

chronic infections                reduces ability to fight oral
antibiotic therapy                oral fungal infections

physical abuse                    often seen as oral trauma
Two Most Common Dental Diseases


  Two Most Common Dental Diseases

 Tooth Decay
   disease process

    also called Caries
   cavities are the result

 Periodontal “Gum” Disease
   Gingivitis

   Periodontitis
       Early Childhood Caries (ECC)

 Definition: The presence of one or more decayed, missing
  or filled tooth surfaces in a child younger than six

 Begins soon after teeth erupt and can progress to a cavity in
  only 6-12 months

 Very quick, destructive form of decay

 Costly to treat
   Children have trouble cooperating because of
   Often requires oral sedation or general anesthesia
  Factors Necessary for Tooth Decay

1. Bacteria: Streptococcus mutans
2. Food: fermentable carbohydrates (break down
3. Susceptible tooth
4. Exposure time

                          This child is 1 ½ - 2 years old.
                    1. Bacteria

 Transmitted from parent to child, not born with it
 Infectious disease process
 Window of infectivity: highest in the first two years
    Early exposure to S. mutans is one of the major risk
     factors for future cavities
 Plaque: sticky film
         Transmission of Bacteria

 Sharing of forks, spoons, straws
 Testing food temperatures
 “Cleaning” pacifier
 Pre-chewing food
2. Food: Fermentable Carbohydrates

 Simple or complex carbs: sugars, starches
 Bacteria uses the food to produce an acid
 Acid „demineralizes‟ or eats away at the surface
  enamel, starting the disease process
 „White spot‟ appears, normally at gumline

•   Foods low in sugar:
     Cheese
     Fruits
     Vegetables
     Cheerios, Rice Chex, Life, Kix, Corn Flakes
•   Foods high in sugar:
     Candy
     Cookies
     Sodas
     Fruit drinks
     Sugar Smacks, Sugar Pops
•   Approximately 4 Grams of sugar are in one teaspoon
                3. Susceptible Tooth

 Susceptibility of the tooth is directly related to fluoride

 What is Fluoride?
     a natural mineral
     found in ground water (wells) and surface water
      (lakes, ponds)
     fluoride is added to most community water
      supplies in Virginia for dental benefits
     tooth enamel „absorbs‟ fluoride before and after
     enamel is then more resistant to decay process

 Fluoride has several preventive effects
      Increases tooth‟s resistance to cavities
      Encourages healing of new small cavities
      Prevents bacteria from making acid

 2 categories of fluoride exposure
      Systemic (swallowed) – benefits teeth before
       and after they come in
      Topical – benefits teeth after they come in
           Topical vs. Systemic

                                Topical: outside the tooth / enamel

Systemic: through bloodstream
   Systemic (Swallowed) Fluoride Sources

 Water with fluoride (fluoridated water)
   Community water supplies

   Naturally occurring in well water

   Bottled water normally not fluoridated

   Water filters

 Fluoride prescription
   Prescribed based on results of water testing and other
    fluoride sources
   Drops, liquids, tablets (also topical benefits)
          Topical Fluoride Sources

 Fluoridated water

 Fluoride toothpastes (ADA seal)

 Over the counter fluoride rinses

 Prescription supplements
   When chewed or liquid

 Professionally applied fluoride
   Gels, foams, rinses

   Varnish
                  Fluoride Varnish

 Safe and effective, 40-60% decrease in tooth decay
 Easy to apply
 Applied by nurses, doctors, dentists, and dental
           4. Time (Acid Attacks)

 The more time teeth are exposed to the acids
 produced by the combination of bacteria and food,
 the more likely tooth decay will occur! (20-40 min
 acid attacks)
    Results of Untreated Tooth Decay

 Unnecessary pain and discomfort

 Unfavorable treatment experiences

 Systemic (whole body) infections

 Premature loss of primary teeth

 Increased risk for permanent tooth decay

 Loss of school/work time

 Increased treatment expense
  Periodontal (Gum) Disease Process

1. Plaque (bacteria) left on teeth and around gums

2. Gingivitis

3. Periodontal Disease

 Irritation and inflammation of the gums

 Puffy, red gums that bleed easily

 Bleeding is not normal
   Signal to brush better

 Can be completely reversed and controlled with good
 oral hygiene
         Periodontal (Gum) Disease

 Causes irreversible bone loss in the bone
 surrounding the teeth
 Leads to tooth loss

 Often completely painless, only a dentist or hygienist
 can detect the beginning stages
 Early stage treatment can stop or control the disease

 Later stages of the disease are much more difficult to
Periodontal Disease
  Conditions Linked to Gum Disease

 Heart disease

 Stroke

 Diabetes

 Pre-term low birth weight babies

 Lung infections
      CSHCN Common Dental Problems

 Bruxism: grinding/gritting teeth
  o   Wear/damage of teeth, TMJ disorders
  o   Older children may need a night guard

 Excessive drool
  o   Skin chaffing/rash, cracked/bleeding lips
  o   Use lotion, creams, lip balm

 Reflux/vomiting
  o   Erosion of teeth, increased cavities
  o   Use baking soda rinses
       ¼ - ½ tsp soda to 1 cup water
      CSHCN Common Dental Problems

 Pouching: holding food in the folds of the cheeks
   Increased decay, periodontal disease, bad breath
   Frequent oral hygiene care

 Picking or poking at gums/teeth (source?)
   Trauma to teeth and gums
   Oral exam and behavior modification

 Xerostomia (Dry Mouth)
   Increased decay and mouth sores
   Saliva substitutes, sugar-free candy/gum – age?
               Prevention Facts

 Preventing decay in primary teeth reduces risk in
 permanent teeth

 Preventing decay until age 4 reduces risk of decay
 through age 18
 How can you prevent dental diseases?
 Positioning

 Lift the lip/ identify disease

 Oral hygiene
  Brush/floss
  Modifications
  Fluoride

 Nutrition

 Injury prevention

 Dental visits
                Positioning at Home

 Positioning depends on each individual family and child
   Head in your lap
   Standing with you behind supporting

   Bean bag or pillows

   Child sitting on floor and you sit in chair right
   Knee to knee when two adults available

 Be careful of tilting head too far back if there is difficulty
  swallowing or gagging or neck injury concern
                   Lift the Lip

 Get to know your child‟s mouth

• Early decay is most commonly found on the lingual
 (back) surfaces of the front teeth.
• Abscesses (infections) can hide from you
             Disease Identification

Identify “White Spot”
 Pre-decay and active
Disease Identification
Disease Identification
Disease Identification
Disease Identification
Disease Identification
                  Disease Identification
Periodontal (Gum) Disease

                                     Gingival overgrowth

                Brushing the Teeth

 Infants (less than 2 years old)
   Gums should be wiped twice daily
   When teeth erupt, brushed twice daily
   Use a rice grain sized amount of fluoride
 Toddlers and Preschool (older than 2 years)
   Brush teeth at least twice daily
   Use pea sized (or a kernel of corn sized) amount
    of fluoride toothpaste
 Parent supervision and help with brushing until age 7-10
   Depends on skill level of the individual child
                  How To Brush

 Use clean hands
 Use a soft bristled brush
 Brush the front, back, & biting surfaces of each tooth
 Use same pattern each time so you don‟t miss teeth
 Angle the brush toward the gums and brush with a
  circular motion
 Include gumline and tongue
                  Brushing Tips

 If unable to spit, wipe with damp or dry clean cloth

 Change toothbrush every 3 months or when bristles
 look out of shape
 If child doesn‟t tolerate toothpaste, try dipping brush
 in an over-the-counter fluoride mouth rinse (like
 ACT) then brush
 Let the child be as independent as possible, use the
 toothbrush themselves, then you brush as well
                    How To Floss

 Flossing begins as soon as the sides of two teeth are
   Most children cannot floss on their own until 8-10
    years, some CSHCN may need flossing done for
   Work the floss back and forth gently between teeth
   Curve floss around the side of each tooth sliding up
    and down, just under the gums
   Floss both sides of every tooth
   Ask a dentist or hygienist for help
          Oral Hygiene Modifications

 Toothbrushes and floss may need modification for
    Battery operated toothbrushes
    Modified toothbrush handles
      Tennis ball or bicycle grip
      Taped handles
      Lengthen by taping to ruler
      Bend toothbrush handle by heating handle under hot water
      Secure toothbrush to the hand with Velcro strip
      Use bigger or textured grips
      Three sided toothbrush heads
    Floss holders
    Mouth Props
        Fluoride Recommendations

 Use fluoride toothpaste for all ages

 Talk to the dentist about increasing topical fluoride
   Fluoride mouth rinse – brushed on or swished if they
    can spit out the excess
   Prescription fluoride gel brushed on

   Professional fluoride treatments more often
              Feeding / Nutrition

 Begin use of training cup by six months if
 developmentally able
 Use training cups carefully and temporarily
  Mealtime only if milk, juice, or sweet drink
  Not walking around with cup

  Between meals – offer water only

 Talk to physician or pharmacist about sugar free
 Well balanced diet
          Dental Injury Prevention

 Things to avoid:
   Sharp edges on furniture – cover if possible
   Walking or running with hard or sharp objects in
    mouth (sippy cup, toothbrush, crayons, etc.)
   Chewing on electrical cords

   Chewing on ice, hard candy, any hard objects

   Riding in the car without a car seat

 Mouth guards and helmets as needed
      Dental Visits: “Home by One!”

 Dental appointment by the first birthday
 CSHCN may need to visit dentist every 2-6 months
 Tell dentist what works and doesn‟t work at home
 Bring a favorite blanket, toy, music, etc.
 Encourage a consultation between your physician
 and dentist
             Finding A Dentist

 DentaQuest (formerly DORAL): Smiles for
 Some listings will specify special needs: yes/no

 Phone book, word of mouth, parent
 When you call, ask if the dentist will see
  children with the particular condition the
  child has
            Finding A Dentist

 VA Department of Health, Division of Dental
 Virginia dentist directory – click on “Find A
Click here to
    find a

                Click here to find
                 more oral health
                 information on
Click Advanced
 Search for the
 most options
Click here when you
 have made your
Click on the dentist‟s name for more
 information then call the dentist‟s office to
 describe your needs and ask questions
     Resources for More Information

 American Academy of Pediatric Dentistry
 American Academy of Pediatrics – type in „oral health‟
 American Dental Association
 The Center for CSHCN, Washington State – type in „oral health‟
               Additional Resource

    Financial assistance for dental care for children with
     disabilities under age 18 with Cerebral Palsy, Muscular
     Dystrophy (and related neuromuscular disorders), mental
     retardation, and organ transplant recipients.
                     Key Points

 Oral health is directly related to overall health

 Preventing decay in primary teeth reduces risk in
 permanent teeth
 The more time teeth are exposed to acids the more
 likely tooth decay will occur!
 Dental home by age one

 Fluoride is important for all ages

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