Dental health Lecture 3

1. Dental healthLecture 3 By Dr. Ebtisam Fetohy

2. Objectives of the lecture Upon completion of this lecture, students will be able to: • List signs and symptoms of teething • Discuss the benefits of non-nutritive sucking. • Summarize the AAP policy on pacifier use and Sudden Infant Death Syndrome (SIDS). • State the dental effects of non-nutritive sucking and the suggested age for intervention. • Describe the oral effects and suggested management of bruxism.

3. Irritability • Drooling الترويل • Mouthing objects • Sleep disturbances • Biting • Ear rubbing • Rash • Gum rubbing • Decreased appetite • Crying • Infections, fever, Diarreha ( as a result of mouthing objects)

4. Oral habits • Oral habits, including nonnutritive sucking, teeth grinding (bruxism), and nail biting, are extremely common in children and are often a source of concern for families and questions for pediatricians. • The information provided in this lecture is intended to help health professionals appropriately reassure parents, address concerns and, when necessary, intervene.

5. Nonnutritive Sucking • Sucking is a normal baby reflex, beginning around the 29th week of gestation. • Almost 100% of normal babies engage in nonnutritive sucking. • Babies may suck their thumb, fingers, hand, a pacifier, or other inanimate object such as a blanket or toy.

6. Nonnutritive Sucking, continued • Nonnutritive sucking has several benefits. • It is an early step in an infant's ability to self-regulate • emotions.  • It helps the child to relax and focus his or her • attention.  • It provides comfort and security. Sucking tends to • occur more often when the child is tired, bored, • anxious, or upset.

7. Nonnutritive Sucking, continued • Although most children discontinue nonnutritive sucking between 2 and • 4 years of age, more than 20% still engage in the habit at age 3. • Pacifier users typically discontinue • nonnutritive sucking earlier than • thumb suckers. • Older children who are thumb suckers are often motivated to quit by peer pressure at school.

8. Pacifiers and SIDS • The use of pacifiers has been shown to • decrease the incidence of Sudden • Infant Death Syndrome (SIDS). • In 2005, the American Academy of • Pediatrics (AAP) Task Force on Sudden • Infant Death Syndrome published • recommendations on pacifier use.

9. Pacifiers and SIDS, continued • Consider offering a pacifier at nap • time and bedtime. • Although the mechanism is not known, • the reduced risk of SIDS associated • with pacifier use during sleep is compelling. • The evidence that pacifier use interferes with breastfeeding or causes later dental complications is not.

10. Pacifier Recommendations • The task force recommends use of a pacifier throughout the first year of life, according to the following procedures:   • The pacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep.    • Pacifiers should not be coated in any sweet solution.   • Pacifiers should be cleaned often and replaced regularly.   • For breastfed infants, delay pacifier introduction until 1 month of age to • ensure that breastfeeding is firmly established.

11. Pacifier Recommendations, continued • Pacifiers should never be used to replace or • delay meals and should be offered when the • caregiver is certain the child is not hungry. • Pacifiers should have ventilation holes and a • shield wider than the child’s mouth (at least • 1¼ inches in diameter). • Pacifiers should be one piece and made of a durable material, • replaced when worn, and never tied by a string to the crib or • around a child’s neck or hand.

12. Dental Effects • The dental effects of nonnutritive • sucking directly correlate with the • frequency, intensity, duration, and • nature of the habit. • The most common effect is • movement of the central incisors • upward and anteriorly, which may • result in an anterior open bite.

13. Dental Effects, continued • Dental effects are generally reversible and • unlikely to cause any long-term problems if the habit is discontinued by the age of 5. • It is important to counsel families to help children break the habit before th permanent teeth erupt, preferably begin an intervention by age 4.

14. Intervention • When a child persists with a sucking habit, • consider the following approaches: • Tell the child in basic terms why you • want them to stop and that you believe • they can do so.   • Implement reminder therapy, the use of • aids such as rubber bands or string, to • help a child interrupt the habit. • Start a reward system. • Encourage the use of a stuffed animal or other comfort object. 

15. Physical Intervention • For physical intervention to work, the child must be ready and agreeable. • Techniques include: • Covering hands at night with mittens or socks • Dressing the child in a special shirt with the sleeves sewn closed • Placing a bandage or specialty plastic guard on the thumb or finger

16. Physical Intervention • If other methods are not effective, • an intra-oral appliance can be • placed by a dentist to prevent • sucking. • The appliance is removed after • the habit is broken.

17. Bruxism • Bruxism is the habitual grinding of teeth. It most often occurs at night but can occur when awake or asleep. • The etiology of bruxism includes: • habit, • emotional stress (response to anxiety, tension, anger, or pain), • neurologic abnormalities, • tooth malocclusion, and, • rarely, a medication side-effect. • Often, the etiology of bruxism is unknown.

18. Bruxism • Bruxism can result in enamel wearing of the front and back teeth. • If severe, bruxism can result in tooth sensitivity or root exposure, which requires treatment. • Bruxism may also contribute to temporomandibular joint disorder and headaches.

19. Bruxism, continued • For children younger than 8 years, • treatment is usually not required. • If the bruxism appears to be a stress • response, stress management, or behavioral therapy may be effective. • For older children, a dentist may • recommend a mouth guard be worn at night.

20. Question #1 The parents of an 18-month-old inquire about their son's thumb sucking habit. What is your most appropriate reply? A. Suggest that they try to substitute a pacifier for the thumb sucking.  B. Reassure that this is a normal habit and the child will stop on his own when he is ready.   C. Reassure that this is a normal habit for this developmental age and intervention should be reserved until after age 4.   D. Attempt to break the habit now to prevent damage to the erupting teeth, using a distasteful liquid applied to the thumb or a barrier method (eg, socks or gloves), especially at night.   E. Recommend they speak to the child's dentist and follow his or her recommendations.

21. Answer The parents of an 18-month-old inquire about their son's thumb sucking habit. What is your most appropriate reply? A. Suggest that they try to substitute a pacifier for the thumb sucking.  B. Reassure that this is a normal habit and the child will stop on his own when he is ready.   C. Reassure that this is a normal habit for this developmental age and intervention should be reserved until after age 4.   D. Attempt to break the habit now to prevent damage to the erupting teeth, using a distasteful liquid applied to the thumb or a barrier method (eg, socks or gloves), especially at night.   E. Recommend they speak to the child's dentist and follow his or her recommendations.

22. Question #2 Which of the following statements about bruxism is not true? A. It tends to occur most often at night.  B. Approximately 30% of children develop bruxism during the early school years.  C. It can result in enamel wearing of the front and back teeth.  D. It is often caused by habit or stress, although sometimes the etiology is unknown.   E. It requires treatment regardless of the age of the child.

23. Answer Which of the following statements about bruxism is not true? A. It tends to occur most often at night.  B. Approximately 30% of children develop bruxism during the early school years.  C. It can result in enamel wearing of the front and back teeth.  D. It is often caused by habit or stress, although sometimes the etiology is unknown.   E. It requires treatment regardless of the age of the child.

24. Question #3 True or False? Nonnutritive sucking occurs in approximately 50% of all babies. A. True.  B. False.

25. Answer True or False? Nonnutritive sucking occurs in approximately 50% of all babies. A. True.  B. False.

26. Question #4 Which of the following factors have been shown to be associated with a prolonged nonnutritive sucking habit? A. First-born child.  B. Younger maternal age.  C. Less education by primary caregivers.  D. Breastfeeding.  E. All of the above.

27. Answer Which of the following factors have been shown to be associated with a prolonged nonnutritive sucking habit? A. First-born child. B. Younger maternal age.  C. Less education by primary caregivers.  D. Breastfeeding.  E. All of the above.

28. Question #5 Which of the following is the most common effect of a prolonged thumb sucking habit? A. Maxillary constriction.  B. Posterior open bite.  C. Upward movement of central incisors.  D. Temporomandibular Joint Disorder.  E. All of the above.

29. Answer Which of the following is the most common effect of a prolonged thumb sucking habit? A. Maxillary constriction.  B. Posterior open bite.  C. Upward movement of central incisors.  D. Temporomandibular Joint Disorder.  E. All of the above.

30. Educational messages • Mothers who have chosen to replacement feed should be given instructions on how to cup feed their infants and the fact that cup feeding has less risk of infection than bottle-feeding.

31. Talk with the child. • Use reminder therapy. • Use a reward system.. • Physically interrupt the habit.

32. Bottle • Certain foods • Mothers nipple

33. Give the infant aged 6 months or older fluoride supplements only as recommended by a dentist or physician based on the infant's risk for developing tooth decay and the known level of fluoride in the infant's drinking water. • If the infant has sore gums caused by tooth eruption, give the infant a clean teething ring, cool spoon, or cold wet washcloth. Other options include giving the infant a chilled مبردةteething ring or simply rubbing the infant's gums with a clean finger.

34. Become familiar with the normal appearance of the infant's gums and teeth so that problems can be identified if they occur. Check the infant's gums and teeth about once a month by lifting the infant's lip to look for decay on the outsideand inside surfaces of the teeth.

35. Dental caries, begins first inside the tooth. A white spot appears on the enamel where the tooth has started to weaken inside. • At this stage, the tooth can repair the weakened area with the help of fluoride and minerals in saliva. • But if the decay continues and breaks through the surface of the enamel, the damage is permanent. • The decay must be cleaned out and the cavity filled by a dentist. • Left untreated, the decay will worsen and destroy a tooth all the way through the outer enamel layer, through the inside dentin layer and down to the pulp or nerve of the tooth

36. Older adults sometimes have chronic caries: • Cavities that don't seem to get any worse or do so at a very slow rate. • Teeth with chronic caries will tend to be darker in color because the edges of the cavities become stained from normal eating and drinking.

37. Root caries (decay in the roots of the teeth) is more common in older adults. Older adults are more likely to have gums that have receded from years of hard brushing or periodontal disease. They also are more likely to have dry mouth (xerostomia), which increases the risk of decay. • Decay can form beneath fillings or other restorations, such as crowns. • Sometimes, bacteria and food particles can slip ينزلقinto a tooth if a filling hasn't been placed properly or if the filling cracks يتصدع or pulls away ينسحب from the tooth, leaving a gap.

38. There are two things to prevent teeth from decaying, — strengthen teeth's defenses with fluoride and sealants, and reduce the number of bacteria in the mouth. • Fluoride strengthens teeth by penetrating the tooth structure and replacing lost minerals to repair acid damage. Everyone should brush with a fluoride toothpaste every day. • Sealants مانعات التسرب are protective coatings placed over the tops of chewing teeth — molars and premolars. They block bacteria and acids from sticking in the tiny grooves الاخاديد on the chewing surfaces of these teeth. Children should get sealants soon after their teeth erupt into the mouth.

39. by : • Brushing regularly • Flossing daily, • Visiting a dentist and dental hygienist regularly for a thorough cleaning and check-up, • Reducing the number of times each day that we consume fermentable carbohydrates.

40. All carbohydrate foods eventually break down into simple sugars: glucose, fructose, maltose and lactose. • Fermentable carbohydrates break down in the mouth. Other foods don't break down until they move further down the digestive tract.

41. It's the fermentable carbohydrates that work with bacteria to form acids that begin the decay process and eventually destroy teeth. • They include the obvious sugary foods, such as cookies, cakes, soft drinks and candy. But they also include less obvious foods, such as bread, crackers, bananas and breakfast cereals.

42. Certain bacteria on teeth use the sugars from these foods and produce acids. The acids dissolve minerals inside the tooth enamel. The process is called demineralization.

43. Teeth also can regain minerals. This natural process is called remineralization. Saliva helps minerals to build back up in teeth. So do fluoride and some foods. • Dental decay begins inside the tooth enamel when minerals are being lost faster than they are being regained.

44. The longer food stays near the bacteria on the tooth, the more acids will be produced. So sticky carbohydrates, such as raisinsزبيب , can do more acid damage. But other foods that pack تحشرinto crevices الشقوقin the tooth also can cause decay. Potato chips are a terrific رائع example • The acids stick around for the next half-hour

45. Studies have shown that people who eat sweets as snacks between meals have higher rates of decay than people who eat the same amount of sweets with their meals.

46. Some foods actually help to protect teeth from decay. That's because they increase saliva flow and neutralize the acids produced by bacteria. This makes it less likely that the enamel will lose minerals. For example, aged cheese

47. Some prescription mouthwashes (those that contain Chlorhexidine) can help prevent decay by reducing the number of bacteria in the mouth. • Chewing sugarless gums, especially those with xylitol, can help reduce decay and increase the flow of saliva.

48. Eat whole grains daily instead of refined grains. Whole grains include brown rice, oatmeal and whole wheat bread. Refined grains include white bread and white rice. • Eat healthier vegetables, including dark green and orange vegetables. • Eat a variety of fruits. • Choose a diet with plenty of grain products, fruits and vegetables. • Choose fish, beans, nuts and seeds for some of your protein needs. • Choose beverages and foods to moderate your intake of sugars. • Choose and prepare foods with less salt • Aim for a healthy weight and be physically active each day • If you drink alcoholic beverages, do so in moderation. • http://www.cnpp.usda.gov/DGAs2005Guidelines.htm

49. Fewer snacks mean less acid exposure for teeth • Best choices—Cheese, chicken or other meats, or nuts. • These foods actually may help protect tooth enamel. • They do this by neutralizing acids or by providing the calcium and phosphorus needed to put minerals back in the teeth.

50. Moderate choices—Firm fruits such as apples and pears and vegetables. • Firm fruits contain natural sugars. However, their high water content dilutes the effects of the sugars. • These fruits also stimulate the flow of saliva, which fights bacteria and helps protect against decay. Vegetables do not contain enough carbohydrates to be dangerous.