preventive pediatric dentistry – the continued care model dr. charles lekic ddm, msc, phd, frcd(c)...

PREVENTIVE PEDIATRIC PREVENTIVE PEDIATRIC DENTISTRY – THE DENTISTRY – THE

CONTINUED CARE MODELCONTINUED CARE MODEL

Dr. Charles Lekic DDM, MSc, PhD, FRCD(C)

1426 McPhillips Street, Winnipeg, MB

Pediatric Preventive DentistryPediatric Preventive Dentistry

Dental caries presents a Dental caries presents a major dental health major dental health problem in childrenproblem in children

Etiology of caries:Etiology of caries: tooth susceptibility, tooth susceptibility,

bacterial plaque, bacterial plaque, carbohydrates, time, oral carbohydrates, time, oral sugar clearance,saliva flow sugar clearance,saliva flow & pH& pH


Most important factors in caries prevention are:Most important factors in caries prevention are:– Oral Hygiene, Diet, Fluoride therapy and Fissure sealantsOral Hygiene, Diet, Fluoride therapy and Fissure sealants

Oral Health EducationOral Health Education

Plaque removal & DietPlaque removal & Diet are the most important are the most important factors in oral health factors in oral health educationeducation


Plaque RemovalPlaque Removal– Use of Disclosing Use of Disclosing

AgentsAgents– Caries Activity TestsCaries Activity Tests– Tooth brushingTooth brushing


Plaque Removal (Cont’d)Plaque Removal (Cont’d)

Flossing (once posterior Flossing (once posterior contacts close)contacts close)

Oral Rinsing- removes only Oral Rinsing- removes only soft debris, recommended in soft debris, recommended in patients with ortho patients with ortho appliancesappliances


Plaque Removal (Cont’d)Plaque Removal (Cont’d)Chemotherapeutic agents- Chemotherapeutic agents-

e.g. Chlorhexidine- short e.g. Chlorhexidine- short term benefitsterm benefits

Chewing gums- Trident, Chewing gums- Trident, CDA approvedCDA approved


ToothbrushingToothbrushing– Roll methodRoll method– Horizontal scrub- most successful for Horizontal scrub- most successful for

childrenchildren– Modified BassModified Bass


DietDiet

--Instruct Patient/Parent to write down what he/she Instruct Patient/Parent to write down what he/she eats or drinks for 3 consecutive days.eats or drinks for 3 consecutive days.

-Analyze with the patient/parent and make -Analyze with the patient/parent and make recommendationsrecommendations::

Reduce sucrose consumption Reduce sucrose consumption Sweets are not to be eaten between meals or at bedtimeSweets are not to be eaten between meals or at bedtime Emphasize foods that require chewing, stay away from Emphasize foods that require chewing, stay away from

soft/sticky foodssoft/sticky foods Brush teeth after meals and ALWAYS at BedtimeBrush teeth after meals and ALWAYS at Bedtime Discuss the danger of “hidden” sugars such as starchy Discuss the danger of “hidden” sugars such as starchy

foods (bread)foods (bread)

Fluoride TherapyFluoride Therapy

Systemic FluoridesSystemic Fluorides– Provided by water fluoridation and by supplemental Provided by water fluoridation and by supplemental

therapytherapy

Water FluoridationWater Fluoridation– Concentration of 1 ppm of fluorides in drinking water Concentration of 1 ppm of fluorides in drinking water

is considered optimal in reducing caries prevalenceis considered optimal in reducing caries prevalence

– Optimal fluoride concentration reduces caries up to Optimal fluoride concentration reduces caries up to 50%50%

– Commonly use sodium fluoride, hydrofluosilic acid and Commonly use sodium fluoride, hydrofluosilic acid and sodium silicofluoridesodium silicofluoride


Water Fluoridation (Cont’d)Water Fluoridation (Cont’d)– Effect of systemic fluorides is greater on smooth Effect of systemic fluorides is greater on smooth

enamel surfacesenamel surfaces

– Most effective method in caries preventionMost effective method in caries prevention

Supplemental Fluoride TherapySupplemental Fluoride Therapy– Before prescribing supplemental fluoride, must know:Before prescribing supplemental fluoride, must know:

– The fluoride content in child’s drinking waterThe fluoride content in child’s drinking water

– Child’s weightChild’s weight

– Overall fluoride intakeOverall fluoride intake


Topical FluoridesTopical Fluorides

– Delivered via gels, varnishes, Delivered via gels, varnishes, mouthrinses, prophy pastes and mouthrinses, prophy pastes and dentifricesdentifrices

– No need for topical fluoride in No need for topical fluoride in patients with low risk and/or patients with low risk and/or residing in optimally fluoridated residing in optimally fluoridated areas- use of a fluoridated areas- use of a fluoridated toothpaste should be sufficient.toothpaste should be sufficient.

– Fluoridated dentifrices are not Fluoridated dentifrices are not recommended in small children recommended in small children (<3 years)(<3 years)


Topical Fluorides (Cont’d)Topical Fluorides (Cont’d)– Parents should always supervise brushing so that Parents should always supervise brushing so that

the toothpaste and saliva are expectoratedthe toothpaste and saliva are expectorated

– Acidulated phosphate fluoride (0.5%) and stannous Acidulated phosphate fluoride (0.5%) and stannous fluoride (0.4%) are most common for topical usefluoride (0.4%) are most common for topical use

Fluoride ToxicityFluoride Toxicity

Chronic ToxicityChronic Toxicity– Only a pea-sized amount of Only a pea-sized amount of

toothpaste should be usedtoothpaste should be used

– Not recommended to use Not recommended to use fluoridated dentifrice in fluoridated dentifrice in children younger than 3 yrs.children younger than 3 yrs.

– Use the “cup test” to check if Use the “cup test” to check if the child could rinse and spit the child could rinse and spit without swallowing without swallowing

Chronic ToxicityChronic Toxicity

– Repeated ingestion of lesser amounts of fluoride may result Repeated ingestion of lesser amounts of fluoride may result in chronic fluoride toxicity, the most common of which is in chronic fluoride toxicity, the most common of which is dental fluorosis dental fluorosis

– To prevent chronic fluoride toxicity, parents should: Make To prevent chronic fluoride toxicity, parents should: Make sure their child thoroughly expectorates toothpaste after sure their child thoroughly expectorates toothpaste after brushingbrushing

Acute Fluoride ToxicityAcute Fluoride Toxicity

Acute ToxicityAcute Toxicity– Results from the accidental ingestion of excessive Results from the accidental ingestion of excessive

amounts of fluorideamounts of fluoride– Common symptoms include nausea and vomitingCommon symptoms include nausea and vomiting– Lethal dose for a 3 yr. old child approx. 500 mg of Lethal dose for a 3 yr. old child approx. 500 mg of

fluoride ingested at one timefluoride ingested at one time– In the event of accidental ingestion of excessive In the event of accidental ingestion of excessive

amounts, vomiting should be induced (2 teaspoons of amounts, vomiting should be induced (2 teaspoons of Ipecac Syrup)Ipecac Syrup)

– Administer milk to slow absorption and form Administer milk to slow absorption and form complexes with the fluoridecomplexes with the fluoride

– Consider transporting the child to a poison control Consider transporting the child to a poison control centrecentre


Dental diseases are largely preventable and Dental diseases are largely preventable and increased emphasis on prevention should be the increased emphasis on prevention should be the goal of every dental practicegoal of every dental practice

The role of Manitoba dentist’s in The role of Manitoba dentist’s in promoting children’s oral healthpromoting children’s oral health

It is important to It is important to increase the general increase the general awareness regarding awareness regarding oral health and more oral health and more particularly for the particularly for the economically economically disadvantaged disadvantaged portion of the child portion of the child population.population.


At a present time At a present time there are very few there are very few programs aiming at programs aiming at increasing the increasing the awareness regarding awareness regarding child’s oral health.child’s oral health.

In dental offices In dental offices there is little there is little understanding if and understanding if and in what capacity in what capacity private practitioners private practitioners could be involved in could be involved in the implementation the implementation of such programs. of such programs.


Therefore, it is important for every Therefore, it is important for every dental practice to assess if and in what dental practice to assess if and in what capacity they could be involved in capacity they could be involved in reaching out to both the children and reaching out to both the children and their parents and guiding them toward their parents and guiding them toward improved child’s oral health. improved child’s oral health.

Children’s Dental World Model of Children’s Dental World Model of Continued CareContinued Care

Children’s Dental World has been Children’s Dental World has been specifically interested in designing a specifically interested in designing a program, including a reward\motivation program, including a reward\motivation system that benefits the child and a system that benefits the child and a somewhat of a counseling\guidance somewhat of a counseling\guidance system that will frequently remind and system that will frequently remind and help the caregiver maintain the child’s help the caregiver maintain the child’s oral health. oral health.

Continued Care ModelContinued Care Model

Every child will after booking a recall Every child will after booking a recall appointment be classified, in regard to appointment be classified, in regard to the completed restorative treatment, the completed restorative treatment, into:into:

1. Low risk (0-1 rest. treat.) 1. Low risk (0-1 rest. treat.)

2. Moderate risk (2-4 rest. treat.)2. Moderate risk (2-4 rest. treat.)

3. High risk (3. High risk (≥5 rest. treat.)≥5 rest. treat.)


Children’s Dental World recall patients Children’s Dental World recall patients are receiving, every 6 weeks, health are receiving, every 6 weeks, health promotion material related to child’s age promotion material related to child’s age and the risk factors involved.and the risk factors involved.

Parents are at the same time asked to Parents are at the same time asked to answer two to three questions and mail answer two to three questions and mail them in the envelope provided.them in the envelope provided.

Continued Care Model (0-1 yr)Continued Care Model (0-1 yr)

Continued Care Model (1-3 yrs, Continued Care Model (1-3 yrs, low risk) low risk)

Continued Care Model (1-3 yrs, Continued Care Model (1-3 yrs, moderate risk)moderate risk)

Continued Care Model (1-3 yrs, Continued Care Model (1-3 yrs, high risk)high risk)

Continued Care Model (3-6 yrs, Continued Care Model (3-6 yrs, low risk)low risk)

Continued Care Model (6-12 yrs, Continued Care Model (6-12 yrs, moderate risk)moderate risk)

Continued Care Model (>12 yrs, Continued Care Model (>12 yrs, high risk)high risk)


Following the first round of preventive Following the first round of preventive letters letters ≈≈25% of parents responded, 25% of parents responded, answering the questions.answering the questions.

We expect this percentage to increase We expect this percentage to increase following the next rounds of letters and following the next rounds of letters and more especially following the next recall more especially following the next recall visit.visit.


At the next recall At the next recall visit if the child visit if the child will present with will present with healthy teeth healthy teeth he/she will earn he/she will earn the membership the membership to “the No Cavity to “the No Cavity Club”. Club”.

No Cavity ClubNo Cavity Club


The child will be The child will be able to use this able to use this card in Toys R card in Toys R Us stores and the Us stores and the cash value for cash value for the first cavity the first cavity free recall visit free recall visit will be $15.00 will be $15.00



At the subsequent At the subsequent recall visits if the child recall visits if the child continues to have continues to have healthy teeth the cash healthy teeth the cash award will increase by award will increase by $5.00 and will raise up $5.00 and will raise up to the full amount to the full amount reduced only for the reduced only for the actual cost of the actual cost of the recall visit.recall visit.



No Cavity Club membership and the No Cavity Club membership and the health promotion letters, that are to be health promotion letters, that are to be sent to the parents, are designed to sent to the parents, are designed to increase the awareness regarding oral increase the awareness regarding oral health and to award and motivate health and to award and motivate children and parents in achieving and children and parents in achieving and maintaining health.maintaining health.


Continued Care Model is a true Continued Care Model is a true investment in health and is a unique investment in health and is a unique model to North America.model to North America.

Further research will provide evidence Further research will provide evidence regarding the effectiveness of the regarding the effectiveness of the program and the dental profession will program and the dental profession will be given this information as soon as it be given this information as soon as it becomes availablebecomes available


At the end of the At the end of the day what is more day what is more rewarding then a rewarding then a healthy smile on a healthy smile on a pediatric dental pediatric dental patient?patient?

Thanks for your Thanks for your attentionattention

preventive pediatric dentistry – the continued care model dr. charles lekic ddm, msc, phd, frcd(c)...

Documents

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oral health education

childs oral health

oral health education

children n etiology

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