dental facts for the frontline
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Dental Facts for the FrontlineDental Facts for the Frontline
Danielle G. Dooley, MD, MPhil, FAAPPediatrician
Unity Health Care
Is Your Child Care, Practice or Is Your Child Care, Practice or Organization Dental-Friendly?Organization Dental-Friendly?
Education Preparation Prevention
Are You Advocating for Oral Are You Advocating for Oral Health?Health?
Ways child care providers can advocate:– Learn about oral health issues – Teach dental hygiene to the children you serve
Ways advocacy organizations can advocate:– Educate policy makers at local, state and federal
level – Organize a dental advocacy campaign
Ways doctors can advocate:– Learn updates on oral health care – Learn to do an oral health risk assessment – Talk to patients about oral health – Work with advocacy organizations to educate
policymakers and the public
Topics for TodayTopics for Today
Why early intervention matters Tooth development and decay Baby bottle tooth decay Teeth grinding Thumbsucking Dental emergencies
Good Oral Hygiene Habits Good Oral Hygiene Habits Start EARLY!Start EARLY!
90% of all cavities are preventable with good oral hygiene and dental care
The younger a child is when they develop dental caries, the more likely they are to have future dental disease
Poland, Charles. Promoting Oral Health in Young Children. http://www.aapd.org.
Teeth are in JeopardyTeeth are in Jeopardy
There is a silent epidemic of dental disease in our country
This epidemic affects poor and minority children the most- these children are 5X as likely to have untreated tooth decay than other kids
Krol, David M. Educating Pediatricians on Children’s Oral Health: Past, Present, and Future. Pediatrics 2004;113:e487-492
Why Are Teeth in Jeopardy?Why Are Teeth in Jeopardy?
Dental caries, or cavities, is the most common chronic disease among children in the United States (5X more common than asthma!)
50% of kids have at least one cavity by the time they start elementary school
Teenagers have an average of 8 cavities by the time they are 17 yrs old
Poland, Charles. Promoting Oral Health in Young Children. http://www.aapd.org
Where do Kids Learn to Keep Where do Kids Learn to Keep Their Teeth Healthy?Their Teeth Healthy?
Dentists Pediatrician Family School/Child Care
Dental Access is a ProblemDental Access is a Problem
Many kids have never been to the dentist- 1 out of 10 kids between the ages of 5 and 10 have NEVER seen a dentist
There are not enough pediatric dentists in the United States to meet the health needs of children
Kids from low income families are 5X as likely to have untreated tooth decay due to poor access to dental services
Poland, Charles. Promoting Oral Health in Young Children. http://www.aapd.org
Pediatricians Don’t Have the Pediatricians Don’t Have the Training or the TimeTraining or the Time
American Academy of Pediatrics declared in May 2003 that all pediatricians should be able to perform oral health risk assessments starting at 6 months of age
60% of pediatricians have not received any oral health training
75% of pediatricians consider their knowledge of oral health inadequate
Krol, David M. Educating Pediatricians on Children’s Oral Health: Past, Present, and Future. Pediatrics 2004;113:e487-492
There Just Isn’t Time!There Just Isn’t Time!
In a standard 15 minute well child visit, pediatricians must:– Talk with the parents– Examine the child– Address other topics such as violence and
injury prevention, nutrition, breastfeeding, school issues, developmental issues
What is a Tooth?What is a Tooth?
Crown- above the gum
Root- below the gum; makes up 2/3 of the total length of the tooth!
EnamelEnamel
Enamel- white covering that protects tooth from wear and tear of chewing
DentinDentin
Dentin- supports the enamel; carries the nerve fibers that sense hot/cold/pain
PulpPulp
Pulp- center of the tooth; soft tissue containing blood, nerves. Carries nutrition to the tooth.
Types of TeethTypes of Teeth
Incisors- teeth in the very front; sharpest; made to cut food and shovel it into mouth
Types of TeethTypes of Teeth
Canine- corners of mouth; meant for grasping and tearing food
Types of TeethTypes of Teeth
Molars- last teeth towards the back of the mouth; big flat surfaces for chewing and grinding food into smaller pieces
Tooth DevelopmentTooth Development
At birth, children have 20 primary teeth Teeth start erupting at about 6 months
of age Children shed their baby teeth starting
at about 6 years of age By age 21, they have all 32 of their
permanent teeth
Tooth DevelopmentTooth Development
Why Are Baby Teeth Why Are Baby Teeth Important?Important?
Baby teeth are important for:– Learning to eat– Learning to speak– Saving a space for the permanent teeth (if
baby teeth are lost or decay early, then there is less space for the permanent teeth and this causes crowding)
What is Tooth Decay?What is Tooth Decay?
Tooth destruction caused by interaction between teeth, food, and bacteria
Streptococcus Mutans is the main bacteria involved in tooth decay
Bacteria in the saliva sticks to teeth in a thick film called plaque
Tooth DecayTooth Decay
When kids eat starchy foods, the bacteria break down the starch to produce acids that attack the tooth enamel
Repeated acid attacks cause the tooth to decay in the form of a cavity, or pit in the tooth
Is the Bacteria that Causes Is the Bacteria that Causes Tooth Decay Contagious?Tooth Decay Contagious?
YES Adults have a high concentration of S. mutans
in their mouths which can be spread in saliva Sharing forks, spoons; allowing children to put
fingers into adult’s mouth; testing the temperature of a bottle with the mouth
Caregivers need to practice good oral hygiene too!
Who is at Increased Risk for Who is at Increased Risk for Tooth Decay?Tooth Decay?
Children in communities without fluoridated water or where kids drink mostly bottled water
Children from low income families Children from racial and ethnic minority
groups Children with limited or no dental insurance Children with special health care needs-
Down’s syndrome, cleft palate
Is There a Familial Component Is There a Familial Component to Tooth Decay?to Tooth Decay?
YES! In 71% of mother-infant pairs, identical
genotypes of S. mutans have been found Children of mothers with high caries rates are
at a higher risk of decay Proper dental hygiene in mothers has been
shown to decrease the rate of caries in kids
Section on Pediatric Dentistry. Oral Health Risk Assessment Timing and Establishment of the Dental Home. Pediatrics 2003;111:1113-1116
How to Prevent Tooth Decay?How to Prevent Tooth Decay?
Proper brushing Proper snacking Fluoride Regular dental visits
Cleaning Infant TeethCleaning Infant Teeth
Begin cleaning an infant’s teeth as soon as the first tooth erupts
Use a soft cloth to wipe the tooth down or a very soft toothbrush with plain water
No toothpaste!
Cleaning Toddler TeethCleaning Toddler Teeth
Ages 2 and up Brush with a pea sized
amount of toothpaste using a soft toothbrush
Have the child spit out the toothpaste after brushing but do not rinse with water
When Can Kids Brush by When Can Kids Brush by Themselves?Themselves?
It is important for young children to participate in tooth brushing by helping to hold the toothbrush
They have the fine motor skills to clean their teeth well by age 7 or 8 years
Snacks that are Good for Snacks that are Good for SmilesSmiles
Avoid sticky, sugary snacks- cookies, cake, candy, sodas
Fruits, vegetables, whole grain snacks are best
Snack at regular times- don’t allow all-day snacking!
Offer the child plenty of water (not juice!), especially with snacks
Fruits, grains, dairy products provide excellent snacks for healthy smiles!
What is Fluoride?What is Fluoride?
Mineral that increases tooth strength Main source of fluoride is public water
systems; it is also found in toothpaste Exposure to fluoride can reduce tooth
decay by 50-70% Most important method of preventing
tooth decay
Why Don’t Our Kids Get Why Don’t Our Kids Get Enough Fluoride?Enough Fluoride?
Most bottled water contains no fluoride Due to lead service lines in the District
of Columbia, many families are opting to use bottled water for their kids
Is There Such a Thing as Too Is There Such a Thing as Too Much Fluoride?Much Fluoride?
YES Don’t give fluoride toothpaste to kids
under 2 years- if they swallow too much toothpaste the fluoride can cause spots on their teeth
Avoid fluoride mouth rinses in kids under 6 years- they will get more than enough fluoride from their toothpaste
When Should Kids go to the When Should Kids go to the Dentist?Dentist?
Recommendation from the ADA and AAP is that kids have their first visit to the dentist by age 1 year
Reality is that many families do not have access to dental services and there is a shortage of pediatric dentists
Baby Bottle Tooth DecayBaby Bottle Tooth Decay
Occurs when kids are put to bed with a bottle or allowed to have bottle in their mouth for long periods of time
Parents and caregivers often give a bottle to encourage sleep or quiet the child and feel it is cruel to deny food to the infant
Affects 5-10% of children
Baby Bottle Tooth DecayBaby Bottle Tooth Decay
Milk or juice pools in the child’s mouth around the teeth and remains there for long periods, allowing dental cavities to form
There is not a lot of saliva produced in the mouth during sleep, so there is nothing to wash away the milk or juice
The bacteria in the mouth interact with the sugars in the liquid to produce acid and cause tooth decay
What does Baby Bottle Tooth What does Baby Bottle Tooth Decay Look Like?Decay Look Like?
Upper front teeth and incisors are affected most
Loss of glossy appearance to enamel- white spot lesions
Flat brown, yellow spots
Occasionally teeth are broken
Very early tooth decay
Tooth decay
Severe tooth decay
What About Breastfed Babies?What About Breastfed Babies?
Breastfeeding does not automatically protect babies from dental caries
If breastfed babies feed for extended periods of time, they develop the same pattern of caries as bottle fed babies
Baby Bottle Tooth Decay is Baby Bottle Tooth Decay is Preventable!Preventable!
Educate parents not to put baby to bed with a bottle- by 4 months of age, most babies do not need feedings during the night
Don’t use the bottle as a pacifier- allow kids to have it only at mealtime
Transition kids from a bottle to a cup by 1 year of age
What if the Baby Really Needs What if the Baby Really Needs the Bottle to go to Sleep?the Bottle to go to Sleep?
Alternatives to bottles to calm an infant or help them get to sleep:– Favorite blanket or toy– Clean pacifier– Holding, patting, rocking the infant– Reading to the infant– Softly talking or singing to the infant
Teeth GrindingTeeth Grinding
Also known as bruxism Usually occurs during sleep, pattern of
jaw clenching and teeth grinding 3/10 kids have this problem, most are
under 5 years of age
What Causes Teeth Grinding?What Causes Teeth Grinding?
No one really knows Some possible causes are:
– Stress- situations at home or school that cause tension or anger
– Improper alignment of top and bottom teeth
– Response to pain such as earache or teething pain
What are the Effects of Teeth What are the Effects of Teeth Grinding?Grinding?
Usually it is more bothersome to the parents than the child
In severe cases, can wear down tooth enamel, chip teeth, cause facial pain
Most kids outgrow teeth grinding
How is Teeth Grinding How is Teeth Grinding Treated?Treated?
Visit the dentist, who will examine the child’s teeth for chipped enamel and proper alignment
If either of these exist, then the dentist may make a special mouthguard for the child to wear at night
Try to address stressful circumstances in the child’s life and help them relax before going to bed
ThumbsuckingThumbsucking
Many children suck their thumbs, fingers, or a pacifier
Natural reflex for infants Soothing Induces sleep Helps them to explore the world around
them by sucking on their fingers or other objects
ThumbsuckingThumbsucking
Most children give up this habit between the ages of 2-4 years
If kids still have a sucking habit after age 4, they should see a dentist
Most problems from sucking habits start around age 6, when the permanent front teeth come in
ThumbsuckingThumbsucking
Intensity of sucking determines whether children develop problems with their teeth
Kids who rest their thumb in their mouth are less likely to develop dental problems
Problems caused include misalignment of the teeth and changes in the roof of the mouth
ThumbsuckingThumbsucking
Upper front teeth flare out and tip upward
Lower front teeth move inward
Roof of mouth becomes arched or caved in
Tips to End a Thumbsucking Tips to End a Thumbsucking HabitHabit
Praise children for NOT sucking their thumb or pacifier
Address the child’s anxiety or discomfort so they don’t need to suck to soothe themselves
Pick certain times during the day when kids cannot suck their thumb
Common Dental EmergenciesCommon Dental Emergencies
Toothache– Call the parent– Suggest they take the child to a dentist as
soon as possible
Cut or Bitten Tongue, Lip, Cut or Bitten Tongue, Lip, CheekCheek
Apply ice to area If bleeding is present, apply pressure
with a clean cloth If bleeding does not stop after 15
minutes, notify parent and take the child to the doctor or ER
Knocked-Out Permanent ToothKnocked-Out Permanent Tooth
Try to find the tooth Handle it by the top, not the root Rinse the tooth briefly in water Try to reinsert the tooth in the socket and
have the child hold it there by biting on a clean piece of cloth
If it cannot be reinserted, transport the tooth in a cup of milk
Go to the dentist immediately
Broken ToothBroken Tooth
Rinse dirt from tooth and injured area with water
Place cold compresses on face in area of injury
Try to locate and save any tooth fragments
Go to the dentist immediately
Bleeding after a Baby Tooth Falls Bleeding after a Baby Tooth Falls OutOut
Place clean gauze over the bleeding area
Have the child bite on the gauze with pressure for 15 minutes
If bleeding continues after 15 minutes, take the child to the dentist
Current LegislationCurrent Legislation
Oral Health Promotion Act of 2005 (HR 594 IH), Rep. Bernard Sanders (VT).– Amends SCHIP to add dental services.– Allows States the option of using Federal SCHIP funds
to cover dental expenses for a child eligible for Medicaid.
– Establishes the Community Oral Health Expansion Fund to expand the availability of oral health services through community-based centers. Funds may be used for demonstration projects and demonstration partnerships with Head Start programs.
– Requires States to contribute, directly or indirectly, up to 10% of demonstration project costs.
– As of February 25, 2005, the bill was referred to House subcommittee on Health.
Source: Library of Congress. HR 594 IH. May 31, 2005. www.loc.gov.
Is Your Child Care, Practice or Is Your Child Care, Practice or Organization Dental-Friendly?Organization Dental-Friendly?
Education Preparation Prevention Advocacy
AcknowledgementsAcknowledgements
For more information about this presentation or for additional resources, please contact Docs For Tots:
Docs For Tots1522 K Street NW, Suite 600Washington, DC 20005www.docsfortots.orgDft@docsfortots.org
A Nationwide Network of Doctors Advocating for Young Children
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