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Upper Peninsula Children’s Oral Health Summit

Upper Peninsula Children’s Oral Health Summit. Erika J. Tyler R.D.H, D.D.S Northern Michigan University May 17, 2014. Lecture Goals. Aren’t they “just baby teeth?” Why should I care? What is a Pediatric Dentist? What is dental decay? What are some prevention ideas?.

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Upper Peninsula Children’s Oral Health Summit

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  1. Upper Peninsula Children’s Oral Health Summit Erika J. Tyler R.D.H, D.D.S Northern Michigan University May 17, 2014

  2. Lecture Goals • Aren’t they “just baby teeth?” • Why should I care? • What is a Pediatric Dentist? • What is dental decay? • What are some prevention ideas?

  3. Aren’t they “just baby teeth?” • Disease burden • Systemic infections • Growth problems • Low self esteem • Quality of life • Speech problems • Compromised esthetics • Pain • Economic loss

  4. Aren’t they “just baby teeth?” • ER visits, Hospitalizations • 52 million school hours lost per year for dental problems

  5. Public Health Points • Oral disease is common and has consequences for overall health • Most oral disease is preventable

  6. Public Health Points • A significant barrier to children’s access to dental care lies in the fact that approximately 90 percent of highest risk kids are enrolled in Medicaid • Many dentists have expressed a reluctance to work with kids who are covered by Medicaid

  7. Disparities and Oral Health • 28% of all preschoolers between the ages of 2 and 5 suffer from tooth decay • In HS programs, decay rates range from 30 to 40% of 3-yr-olds and 50 to 60% of 4-yr-olds**AAPD Head Start Dental Home Initiative, http://www.aapd.org

  8. Disparities and Oral Health • Ethnically diverse populations have more oral disease • Cultural dimensions of eating, sleeping, child-rearing, healthbehaviors in relation to oralhealth

  9. Disparities and Oral Health • Dental caries (tooth decay) most common chronic disease of childhood • Dental caries is 5x more common than asthma and 7x more common than hay-fever • Dental care most common unmet health need* *Vargas et al, 1998; Newacheck et al, 2000a, 2000b, Mouradian, Wehr and Crall, 2000

  10. Disparities and Oral Health • Dental insurance: children 2.5X more likely to lack dental coverage than medical coverage* • Medicaid: only 1/5 children accessed dental care* • 50% of tooth decay in low income children goes untreated *Vargas et al, 1998; Newacheck et al, 2000a, 2000b, Mouradian, Wehr and Crall, 2000

  11. U.S. Dental Workforce Issues • Number of dentists per capita declining (~200,000 in 2014) • Few pediatric dentists (9300 in 2014) • Acute shortagesin rural and underserved areas

  12. Gaps in Dental Training • Most dentists and hygienists are not adequately trained in oral health care of infants and young children, or those with special needs • Most medical education has limited dental education

  13. Defining the Issue: Michigan • ~ 113,000 live births/year (2012) • ~900K of Michigan’s 2.5 million kids are Medicaid eligible, (increasing) • 58% of Michigan 3rd Graders have caries • Decay rates are on the rise in pre-school kids (4% in last 10 years; CDC, 07)

  14. Dentistry in Michigan: By the Numbers • 115 (2012) pediatric dentists, of which an estimated 84% (~96) see 1 year olds • 5140 general dentists, (2012) • Evidence suggests that pediatric dentists migrate to upper income communities • There are not enough pediatric dentists • Most general dentists are not comfortable treating very young children

  15. Addressing the Needs of Michigan’s Infants • Currently: 113,000 live births =>981 new patients/pediatric dentist/year. • If all dentists accepted infants = ~22 infants/year. (If only half see infants = ~ 44 infants/year) • Conclusion: This is possible!

  16. What is a Pediatric Dentist? • Pediatric dentists are the pediatricians of dentistry. • A pediatric dentist has two to three years of specialty training following dental school and limits his/her practice to treating children only.

  17. What is a Pediatric Dentist? • Pediatric dentists are primary and specialty oral care providers for infants and children through adolescence, including those with special health needs • Children are not just smaller versions of adults • Kid’s teeth and mouths are not just smaller versions of adult teeth and mouths

  18. What is a Pediatric Dentist? • Kids are not always able to be patient and cooperative during a dental exam • Pediatric dentists examine and treat children in ways that make them comfortable • Pediatric dentists use specially designed equipment in offices that are arranged and decorated with children’s development in mind

  19. Pediatric Dentistry’s Role in Oral Health • Anticipatory guidance and counseling • Education of parent, child and community • Caries risk assessment • Oral screening exam • Applying fluoride varnish, as needed • Appropriate treatment, as needed • Establishing a Dental Home • Making Oral Health FUN!

  20. Pediatric Dentistry’s Role in Oral Health • Management of dental emergencies and simple trauma • Oral-systemic health interactions, especially for CSHCN, and patients with chronic illnesses • Identify and manage developmental and growth issues

  21. Dental Decay – Infectious, Transmittable Disease • The cariogenic bacteria of primary caregiver can be transferred to child by: • Wetting pacifier with saliva • Pre-chewing the child’s food • Tasting the child’s food • Kissing child on the lips

  22. What is Dental Decay??? • Biofilm (‘plaque’) is a living community of bacteria • Bacteria ferment carbohydrates and produce acid • Over time acid demineralizes enamel (white spot lesion) • REVERSIBLE! • The end result is caries which is non reversible

  23. Early Childhood Caries • Dental decay in primary teeth, kids < age 6 years old • Formerly known as “Baby bottle” tooth decay or Nursing/bottle caries

  24. Early Childhood Caries • A transmissible infection caused by Streptococcus Mutans • Diet dependent – fermentable carbohydrates with frequent exposure • Occurs on erupted susceptible teeth • Causes cavities to develop over time • ECC affected children are at higher risk for decay as adolescents and adults

  25. Dental Venn Diagrams

  26. Dental Venn Diagrams

  27. AAPD Guidelines for Caries Risk Caries risk is greater for children who are poor, rural, or minority or who have limited access to care. Factors for high caries risk include: • dmfs > the child’s age • numerous white spot lesions • high levels of mutans streptococci • low socioeconomic status • high caries rate in siblings/parents • diet high in sugar • and/or presence of dental appliances

  28. Food Lesson - Eating Frequency

  29. Ongoing Balance • No Caries • Protective Factors • Salivary flow • Fluoride • Caries • Pathologic Factors • + + Strep Mutans • Fermentable carbohydrates • Reduced salivary flow

  30. Early Childhood Caries - Maternal Transmission • Window of infectivity: 6 – 30 months • Transmission is a natural process • Don’t suggest mother decrease contact with infant • Help mother meet her oral health careneeds • Suggest other preventive measures

  31. Messages for Parents • Oral health - important to overall health • Primary teeth matter • Caries can start as soon as teeth erupt • Strep Mutans is transmissible • Stress importance of caretaker’s oral health • Advise pregnant moms to receive dental care • Avoid frequent intake of carbohydrates

  32. Evidence Based Prevention Recommendations • Personal: • Brush with fluoridated toothpaste • Limit sipping/snacking • Visit dentist regularly • Professional: • Sealants • Fl- varnishes • Fluoride supps • Dietary counseling

  33. Sources of Fluoride • Systemic • Water fluoridation • Fluoride supplements • Topical • Fluoride toothpastes • Gels • Fluoride varnish

  34. Fluoride Can Prevent and/or Reverse White Spot Lesions • Mechanisms of action: • Reduces enamel solubility • Promotes re-mineralization of enamel • Anti-bacterial activity in higher concentrations • Action is topical, in saliva

  35. Fluoride • Community water fluoridation should have 0.7-1.2 ppm fluoride to be effective • Fluoride supplements should be prescribed if the water supply does not have adequate fluoridation (naturally; lack of public fluoridation; home filters).

  36. Fluoride • Infants younger than six months do not require fluoride supplements • Infants six months and older who are breast-fed may have the greatest need for dietary fluoride supplements

  37. U.S. Fluoride Supplement Schedule, 1994 Community Fluoridation Level Age <0.3ppm 0.3-0.6ppm >0.6ppm 0 mos.- 6 mos. 0 0 0 6 mos.- 3 yrs. 0.25mg 0 0 3 yrs. - 6 yrs. 0.50mg 0.25mg 0 6 yrs. - 16 yrs. 1.0 mg 0.50mg 0 ADA, AAP, AAPD

  38. Caries Risk Assessment • HIGH RISK if by history: • Previous or current caries • Siblings or mom with caries • No fluoride in water • Chronic health condition and/or medication use • SES, cultural factors • CSHCN • Adapted, Bright Futures in Practice, Oral Health, 1996

  39. Age One Dental Visit • All children • Dental evaluation – by age 1 • Anticipatory guidance earlier • Prioritize dental needs: visible disease or high risk for disease • Pregnant women, mothers with disease need timely treatment • All children need a regular source of dental care (“dental home”)

  40. Often accompanied by bleeding Follows contour of gum-line Pre-Cavity Lesions: White Spot Lesions

  41. Brown Spots - Advancingdecay process

  42. Risk Assessment Do this: • 1. Apply fluoride varnish. • 2. Make referral to dentist. • 3. Explain the importance of regular tooth brushing with fluoride toothpaste. • 4. Emphasize early decay can be reversed.

  43. What is fluoride varnish? • Effective in preventing tooth decay in both the primary and permanent dentition • Fluoride varnish is a liquid coating that adheres to the dental • Enamel forms a depot from which fluoride is slowly released • Fluoride varnish was first introduced in Germany in 1964 • Over 30 years of clinical studies in Europe report 25- 45% caries reduction

  44. What is fluoride varnish? • More recent studies in the United States also support these findings • Introduced to United States in 1991 • FDA approved in the 1990’s as a desensitizing agent – Used “off label” for caries reduction • American Dental Association (ADA) endorses the use of fluoride varnish for caries prevention in May 2006

  45. Holm AK. Effect of a fluoride varnish (Duraphat) in preschool children. Community Dent OralEpidemiol 1979, 7:241-5. • 225 Swedish 3-year-olds • Semiannual application of fluoride varnish • 44% caries reduction after two years

  46. Fluoride Varnish • Protective coating that is painted on the surfaces of teeth to prevent new cavities from forming and to help stop cavities that have already started • Prevents caries on both smooth surface and pit and fissure sites • Minimal chance of ingestion • Protective effect of the fluoride varnish will continue to work for several months

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