Oral Health for MCAH Populations

Children’s Oral Health ProgramContra Costa Health Services

November 2008

Presentation Outline

• Overview

• Early childhood caries

• Periodontal disease and perinatal health

• Adolescent oral health: Oral piercing and grills

• Prevention of dental decay

• Access to oral health care

• Take-home messages

A Silent Epidemic

• Dental disease is the most common chronic and infectious disease affecting children in the U.S.

• Five times more common than asthma

• 7% of Contra Costa children miss school because of a dental problem

National Policy

• All children should see a dentist by age one or six months after the eruption of the first tooth– American Academy

of Pediatrics– American Academy

of Pediatric Dentistry

What are Early Childhood Caries

(ECC)?

• Previously known as Baby Bottle Tooth Decay (BBTD) or Nursing Caries

• Can appear as soon as the first tooth erupts (around 6 months of age)

ECC is an infectious and transmissible disease; however, it

is preventable

ECC is an infectious, transmissible disease• Mutans

streptococci, lactobacilli, and other acid-producing bacteria

• Transmission is both vertical and horizontal

Colonization

• Can begin even before the eruption of teeth

The Chain of DecayCariogenic Bacteria (S. mutans, lactobacilli)Cariogenic Bacteria (S. mutans, lactobacilli)

Sucrose, Glucose, Fructose, StarchSucrose, Glucose, Fructose, Starch

Acids dissolve tooth mineralAcids dissolve tooth mineral

CariesCaries No Caries No Caries

FluorideFluoride

White Spot Lesions

• The first visible sign of tooth decay

• Reversible with fluoride varnish

White Spot Lesions

Mild/Moderate ECC

Severe ECC

Risk Factors for Caries

• Having a mother with a high caries rate or a high bacterial count of cavity-causing germs

• Demonstrable caries, plaque, demineralization, and/or staining

• Being a later-order offspring

• Sleeping with a bottle or breastfeeding throughout the night

• Low socioeconomic status

• Lack of access to dental care

Children with Disabilities and Other

Special Needs • Reduced saliva

flow

• Sweetened medications

• Competing medical needs

The Effects of ECC

• Loss of primary teeth

• Pain

• Infection

• Self-esteem

Loss of Primary Teeth

• Primary teeth are important for:– Nutrition– Speech development– Holding spaces for permanent teeth

• Untreated decay in primary teeth can lead to decay in permanent teeth, or permanent teeth may not erupt at all

Primary and Permanent Teeth

Pain

• Children learn to live with the pain

• Missed preschool and school days

• Inability to concentrate; impairs school readiness

• Can affect sleep and overall health and well-being

Infection

• Failure to thrive and delayed growth patterns

Self-esteem

• Stainless steel crowns

• Unattractive smiles

Importance of Oral Health for Pregnant

Women• Periodontal disease in a pregnant

woman has been linked to increased risk for preterm delivery and having a low birth weight baby

• For mom: pain, infection, poor nutrition, sleep deprivation, inability to concentrate, work or take care of children

Bacteria in PDBacteria in PD

BloodBlood

PlacentaPlacenta

InflammationInflammation

Cervical Dilation and Uterine ContractionsCervical Dilation and Uterine Contractions

Possible Biological Pathway

Between PD and PTB/LBW

Periodontal Disease

• Gingivitis

• Periodontal Disease

Gingivitis• Early stage of gum

disease – only gums are infected

• Caused by bacterial plaque and host risk factors: smoking, diabetes, stress, genetics

• Bacteria in plaque create toxins that irritate the gums and cause redness, swelling, bleeding

• Reversible with good oral hygiene

Pregnancy Gingivitis

• Infection that is more superficial and brought on by hormonal changes during pregnancy

Periodontitis

• An inflammation and degeneration below the gum line (bone and tissues surrounding the teeth)

• Multi-factorial and episodic in nature

• Prevalence in women of childbearing age is 5-40%

• Destruction of the bone is not reversible

• If left untreated can cause tooth loss

Progression of Periodontitis

Severe Periodontitis - Gingival Recession in

Incisors

Treatment of Periodontal Disease

• Professional deep scaling and root planing

• Anti-microbial mouth rinse (chlorhexidine)

• Systemic and/or site-specific antibiotics

• Gum surgery

Adolescent Oral Health:

Oral Piercing• Potential consequences of oral piercing include:– Infection;– Prolonged or uncontrolled bleeding;– pain and swelling (in extreme cases, a severely

swollen tongue can close off the airway and restrict breathing);

– Chipped or cracked teeth;– Injury to the gums, possibly resulting in bone

loss and root decay;– Problems with chewing, swallowing, and

pronouncing words properly;– Blood-borne diseases including various strains of

hepatitis; and– Endocarditis, an inflammation of the heart

valves or tissues.

Adolescent Oral Health:

Oral Piercing• Because of the risks involved even

after an initial oral piercing wound has healed, the ADA recommends that both teens and adults avoid oral piercing.

Adolescent Oral Health:Grills

• Made from gold, silver, or jewel-encrusted precious metals

• Use of permanent cement not intended for internal use

• Do-it-yourself kits and unlicensed jewelers

Adolescent Oral Health:Grills

• Grills can wear away the enamel on the opposing teeth and inflame the gums; cement can damage teeth and gum tissues

• Food collects tooth decay

• ADA recommends that youth avoid wearing grills, but if they are considering it, youth should:– talk to their dentists first– find out what materials the grills are made of– limit the time the grills are worn– remove the grills when eating– practice good oral hygiene

Prevention of Dental Decay

• Regular dental visits starting at age 1– Referral by medical providers

• Oral hygiene

• Fluoride

• Dental Sealants

• Healthy feeding practices

• Modifying caregiver’s oral health: Xylitol

Oral Hygiene: Infants

• Before teeth come in, wipe gums clean with gauze or washcloth, before or after last feeding at night

Oral Hygiene: “Lift the Lip”

• When teeth are in, “lift the lip” monthly to check for chalky white spots or brown spots

Oral Hygiene: Brushing

• Begins when first tooth erupts

• An adult should help brush a child’s teeth until child is around 8 years old

Fluoride Toothpaste

• Encourage daily use in the morning and before bed

• A small smear is the appropriate amount

• Apply toothpaste across width, not length of toothbrush

Fluoride Varnish

• Brown resin that sets on contact with moisture in the mouth

• Prevents ECC

• Easy application

• Contains 5% of NaF

Community Water Fluoridation

• Only about 30% of Californians have fluoridated drinking water (vs. 67% nationwide)

• San Francisco Public Utilities Commission areas all fluoridated

• All of Contra Costa is fluoridated except Bay Point, Byron, Knightsen, and Brentwood

Dental Sealants

• Plastic coatings that dentists apply to the chewing surfaces of the molars

• Make it difficult for plaque to adhere to the grooves of these teeth, reducing the risk of developing cavities

• Most effective in children who have newly developed molars (ages six and 12)

• Last for several years

Dental Sealant Placement

Healthy Feeding Practices

• Eat healthy foods and avoid sticky, starchy foods between meals

• Don’t let infants and toddlers go to bed with a bottle or sipper cup or carry one around during the day, unless it contains only water

Caregiver’s Oral Health

• Modify caregiver’s dental flora during the period from birth until the child is 2 years old

• Use anti-bacterials like xylitol

Xylitol

• An antibacterial, non-cariogenic sweetener

• Used in some foods, chewing gum, candies; available over-the-counter and online

• Caries-causing bacteria cannot feed on xylitol (it does not produce acid)

• Increases saliva flow

• Studies show that when used by mothers, there is a 30 to 60% reduction in tooth decay in their children

Prevention ofPeriodontal Disease

• Regular brushing and flossing

• Regular dental exams and professional cleanings

• Eliminating tobacco use

• Reducing stress

Access to Oral Health Care

• 21% of children (0-17) and 35% of adults (18+) in CA do not have dental insurance (’05 & ’03 CHIS)

• Many employers do not cover dental insurance

• Lack of dentists and specialists accepting Medi-Cal

• County and community clinics overburdened

• Need more dentists to see young children and pregnant women

• Lack of dental specialists

• Regular threats by state to cut or eliminate Medi-Cal dental benefits for pregnant women & children

Take-home Messages

• Oral health is integral part of total health

• Dental disease is very common

• Dental disease is infectious and transmissible, but it is preventable in many ways

• Dental visit by age one

• Access to care barriers can be very significant, especially for low-income families