Pediatric Oral Health Risk Assessment Training for Medical Professionals

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Pediatric Oral Health Risk AssessmentTraining
for Medical Professionals
SCDHEC Oral Health Division 2006
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
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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 AssessmentYoung
  Children
• Section VI Anticipatory Guidance for Infants and
  Young 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
3
Pediatric Oral Health Objectives

• At the completion of this section, the
• participant 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.

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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, SCDHEC 2000
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A health problem tooth decay
One of the most common diseases of childhood 5
times as common as asthma 7 times as common as
hay fever (1).
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Early childhood cariestooth 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

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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.

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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

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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.

Lifetime of Freedom from Preventable Oral Disease
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AAP and AAPD Recommendations

• Oral risk assessment
• including a visual oral screening
• Anticipatory Guidance
• Preventive strategies
• Establishment of the dental home by age one

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Tooth Decay how does it happen?
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Parent Sheet The Bottle and Your Infants Dental
Health
Parent Information Booklet, page 9
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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

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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 mothers saliva

Parent Information Booklet Your Infant Can Get
Cavities From You, page 3 The Pacifier and Your
Infants Dental Health, page 10
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Caries-risk assessment

• Childs 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

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Tools for a visual oral screening

• Light
• Tongue depressor
• Long handled cotton swab/toothpick
• 2x2 gauze
• Toothbrush

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Knee to knee position
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Visual oral screening

• Lift the lip
• Check for presence of plaque and food on teeth
• Check gums and soft tissueslook for abscesses

Tip a toothbrush can be used to count the
childs teeth and can also serve as a mouth prop,
preventing the child from biting down on your
finger.
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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

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Looking at the back teeth

• Look for
• Dark spots and stains
• Breaks in the tooth surface

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Show parent how to do a Smile Check

• Gently lift your childs upper lift
• Look at the outside and the inside of the upper
  front teeth

Parent Information Booklet Smile Check, page 6
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Referral for dental care

• The findingsare provided below
• Needs regular dental examination
• Needs dental treatment within one month
• Needs dental treatment immediately

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Needs regular dental examination
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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.
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Immediate dental treatment

• Signs or symptoms that include pain, infection,
  swelling or soft tissue ulceration of more than 2
  weeks duration determined by questioning.

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Needs immediate treatment
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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 14 Your Childs First
Dental Visit, page 15
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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

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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

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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 Booklet How Can I Protect My
Childs Baby Teeth?, page 4
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Oral Hygiene Infant to Toddler

• When teeth appear you can use a small, soft
  toothbrush

Parent Information Booklet Tips for Brushing
Your Infants Teeth, page 8
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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
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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
Infants Dental Health Sippy Cups, page 19
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Encourage Good Food Choices
Parent Information Booklet Healthy Eating Habits
for Good Dental Health, page 16 Juice, page
17 Facts About Milk, page 18 Nutrition and Your
Childs Dental Health, page 30
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Medicines

• Childrens medication often contain sugar
• Some decrease the childs salivary flow
• Be sure to inform parents or caregivers to brush
  the childs teeth after giving him or her their
  medication.

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Fluoridethe 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
• CDCs My Waters 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

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ADA Recommended Supplements
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Fluoride Toothpaste

• Small, pea sized amount beginning at age 2
• Under age 2, water only
• Supervised use under age 8 years

Parent Information Booklet Toothbrushes and
Toothpaste for Toddlers, page 12
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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 Childs Smile Safe When Riding in a
  Car, page 25
• Keeping Your Childs Smile Safe At Home and In
  School, page 26
• Keeping Your Childs Smile Safe When Shopping,
  page 27
• How to Respond to a Dental Emergency, page 28

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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 childs mouth until about age
  11 or 12

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Who should receive fluoride varnish?

• Children are at risk for developing dental
  caries.
• Risk assessment based on the Caries Risk
  Assessment

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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
• Gingivitisgums appear red, swollen, report
  bleeding when brushing
• White spots/demineralization

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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

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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

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White spots
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Knee to knee position
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Fluoride varnish application

• 1. Dry teeth with gauze square

• Apply varnish with brush to all teeth surfaces

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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 childs teeth
  until the next day.
• The first toothbrushing will remove the yellow
  film on the teeth.

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Three months later
Remineralized Enamel
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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

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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 infants birth.

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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.

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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

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Eat healthy foods

• Chose foods low in sugar.
• Eat healthy snacks like fruit, cheese and
  vegetables.
• Get enough calcium for you and your babys
  healthy teeth and bones.
• Calcium is in milk, cheese, dried beans and leafy
  green vegetables.
• Avoid carbonated drinks

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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

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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 childs caries rate.

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Now is the time for mom to learn

• How to keep her child cavity-free!
• Get her mouth healthysee her dentist
• Learn how to do a Smile Check on a baby
• Learn how to clean a babys 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
  youre the babys teeth by age one.
• Talk to her doctor or dentist about fluoride.