You Can Make a Positive Impact

on a Child’s Oral Health!

Division of Dental Health Virginia

Department of Health 109 Governor Street Richmond, Virginia

23219 804-864-7775 www.vahealth.org/dental

Oral Health Care for Very Young Children and

Children with Special Health Care Needs

Oral Health Care For Very Young Children and Children With

Special Health Care Needs(CSHCN)

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

804-864-7804

kami.piscitelli@vdh.virginia.govFunded 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

Topics

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?

Background

•Tooth decay is the most common chronic childhood disease.

•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

oral disease and infection systemic infection; can threaten life; unsuccessful organ transplant; surgery delay

periodontal disease diabetes, bacterial pneumonia, low-birth weight, heart disease, stroke

tooth decay malnutrition, failure to thrive, pain, loss of concentration, emotional/psychological stress

malocclusion difficulty speaking/chewing, infections due to difficult oral hygiene

In the Mouth Overall Health

General Health Affects Oral Health

gastric reflux / vomiting erosion of teeth, sensitivity

medications reduced saliva, enlarged gums, decay

special diets (soft, high carb)

decay, periodontal disease

oral habits trauma, injury

chronic infections reduces ability to fight oral infections

antibiotic therapy oral fungal infections

physical abuse often seen as oral trauma

Health Factors Oral Health

Two Most Common Dental Diseases

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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

age/condition Often requires oral sedation or general anesthesia

Factors Necessary for Tooth Decay

1. Bacteria: Streptococcus mutans 2. Food: fermentable carbohydrates (break

down quickly)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 processWindow 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, strawsTesting food temperatures“Cleaning” pacifierPre-chewing food

2. Food: Fermentable Carbohydrates

Simple or complex carbs: sugars, starchesBacteria uses the food to produce an acidAcid ‘demineralizes’ or eats away at the

surface enamel, starting the disease process‘White spot’ appears, normally at gumline

Snacks

• 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 exposure

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 eruption enamel is then more resistant to decay

process

Fluoride

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

Systemic: through bloodstream

Topical: outside the tooth / enamel

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 applyApplied by nurses, doctors, dentists, and

dental hygienists

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

Gingivitis

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 treat

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 disorderso Older children may need a night guard

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

Reflux/vomiting o Erosion of teeth, increased cavitieso 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 head Bean bag or pillows Child sitting on floor and you sit in chair right

behind 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 decay

Disease Identification

Disease Identification

Disease Identification

Disease Identification

Disease Identification

Disease Identification

Fungal/Viral Infection

Gingival overgrowth

Periodontal (Gum) Disease

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

toothpasteToddlers and Preschool (older than 2 years)

Brush teeth at least twice daily Use pea sized (or a kernel of corn sized)

amount of fluoride toothpasteParent supervision and help with brushing until age

7-10 years Depends on skill level of the individual child

How To Brush

Use clean handsUse a soft bristled brushBrush the front, back, & biting surfaces of

each toothUse same pattern each time so you don’t miss

teethAngle the brush toward the gums and brush

with a circular motionInclude 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 touching

Most children cannot floss on their own until 8-10 years, some CSHCN may need flossing done for them

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 toothAsk a dentist or hygienist for help

Flossing

Oral Hygiene Modifications

Toothbrushes and floss may need modification for CSHCN 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 medicines

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 birthdayCSHCN may need to visit dentist every 2-6

monthsTell dentist what works and doesn’t work at

homeBring a favorite blanket, toy, music, etc.Encourage a consultation between your

physician and dentist

Finding A Dentist

DentaQuest (formerly DORAL): Smiles for Childrenwww.dmas.virginia.gov/dental-home.htmSome listings will specify special needs:

yes/no

Phone book, word of mouth, parent organizationsWhen 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 Healthwww.vahealth.org/dental/ Virginia dentist directory – click on

“Find A Dentist”

Click here to find a

dentist

Click here to find more oral health information on CSHCN

Click Advanced Search for the most options

Click here when you have made your selections

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 www.aapd.org

American Academy of Pediatrics www.healthychildren.org – type in ‘oral health’

American Dental Associationwww.ada.org

The Center for CSHCN, Washington State www.cshcn.org – type in ‘oral health’

Additional Resource

http://hfgrotto.org/ 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

Questions???????