Children’s Oral Health & the Children’s Oral Health & the Primary Care ProviderPrimary Care Provider

Oral Screening Exam Oral Screening Exam

Module 3Module 3

Learn to perform a knee-to-knee oral screening exam for infants & toddlers

Learn helpful tips to gain access to a child’s mouth & restrain a child’s body movements during an oral screening exam

Learn to identify clinical findings predictive of high caries risk for infants & toddlers

Learn to identify caries in its different stages

(non-cavitated (white spots) vs. cavitated lesions)

Module 3 Objectives:Module 3 Objectives:

Knee-to-Knee Oral Knee-to-Knee Oral Screening ExamScreening ExamStep 1: Child is held facing

caregiverin a straddle position

Step 2: Child leans back onto examiner while caregiver holds child’s hands and legs

Step 3: Provider performs exam while caregiver effectively restrains child’s hands and legs

Equipment for the Oral Equipment for the Oral Screening ExamScreening Exam

Disposable gloves

Good light source

Disposable mirror (optional)

Toothbrush or gauze (for plaque

removal)

Performing an Oral Screening Performing an Oral Screening ExamExam

Place the child in the knee-to-knee

position

Restrain child’s head and body

movements

Lift the child’s upper lip and lower

child’s lower lip

Lift-the-Lip Procedure

Knee-to-Knee Position: Dental Knee-to-Knee Position: Dental SettingSetting

Double-click the picture to begin the video clip

Knee-to-Knee Position: Medical Knee-to-Knee Position: Medical SettingSetting

Double-click the picture to begin the video clip

What Clinical Findings Are What Clinical Findings Are

Predictive of High Caries Predictive of High Caries

Risk?Risk?

Previous Caries Previous Caries ExperienceExperience

One of best predictors of future caries

For children under age 5, a history of decay

should automatically classify a child as high risk

Not useful caries-risk predictor

for infants and toddlers

(insufficient time for ECC

to be expressed)

Visible PlaqueVisible Plaque One of the best predictors of future caries

risk in young children

Screening for visible plaque is easy and inexpensive

Dental Plaque Dental Plaque

Also referred to as non-cavitated lesions Initial stage (precursor) of the caries

process Equivalent to caries for infants and

toddlers

Chalky, white spots on primary teeth are demineralized areas and are considered early

decay

White Spot LesionsWhite Spot Lesions

Are often: Observed next to the gum line Accompanied by plaque Accompanied by bleeding gums

(gingivitis)

Chalky, white spots on primary teeth are demineralized areas and are considered early

decay

White Spot LesionsWhite Spot Lesions

From White Spots From White Spots to to

Frank CariesFrank Caries

Figure 1

Figure 2

Figure 3

Yellow arrows show white spot lesions (non-cavitated) close to the gum line

Green arrow and circle show an area where the enamel is starting to break down and a frank cavity (cavitated lesion) is starting to develop

Yellow arrows show white spot lesions (non-cavitated lesions)

Green arrow show frank cavities (cavitated lesions)

All pictures show advanced frank cavities (cavitated lesions) that have reached the nerve (pulp) of the teeth. These children are in pain and need immediate and/or emergency dental treatment

Green arrow shows the presence of an abscess due to a necrotic tooth

Enamel Defects & Enamel Defects & Stained Pits and FissuresStained Pits and Fissures

Enamel hypoplasia

Stained pit and fissure surfaces of primary

teeth

Consider these indicative of increased caries

risk

Stained Pits and Fissures

Enamel Hypoplasia

Presence of Braces Presence of Braces and Oral Appliancesand Oral Appliances

Caries Risk Assessment Caries Risk Assessment and Managementand Management Any observable decay or demineralization (white

spots):- Refer for dental care as soon as possible

Any factors on the oral screen (or parent interview) that increase the child’s risk for caries:- Refer for dental care

Uncertain caries risk:- Refer for dental care

Refer to your I-Smile Coordinator for care, assistance with referrals & to ensure dental care is established

Re-assess to ensure the child has been evaluated by a dentist & has established regular dental care

I-Smile Coordinators I-Smile Coordinators

I-Smile coordinators are dental hygienists who serve as prevention experts and liaisons between families, health care professionals, and dental offices to ensure completion of dental care. Coordinators are located in regional public health agencies and provide local community support throughout Iowa. I-Smile Coordinators can:

I-Smile Coordinator contact information can be found at: www.idph.state.ia.us/hpcdp/oral_health.asp or

I-Smile hotline 1-866-528-4020

• Assist with dental referrals for young children.• Provide Medicaid dental billing information.• Offer education for healthcare professionals regarding

children’s oral health, including screening and fluoride

varnish training.

Summary: Oral Screening Exam Summary: Oral Screening Exam Use the knee-to-knee position for oral screening

exams

Clinical findings predictive of high caries risk for infants and toddlers: previous caries experience

visible plaque

white spot lesions

enamel defects

stained pits and fissures

oral appliances

During an oral screening exam remember to: Restrain the child’s head and body

movements “Lift-the-lip”: lift the upper lip & pull down

the lower lip to examine the child’s teeth Dry the child’s teeth to examine for white

spot lesions Remove plaque using a toothbrush or

gauze to examine for possible white spot lesions under plaque

Summary: Oral Screening ExamSummary: Oral Screening Exam

Refer a child for dental care as soon as

possible if any caries or white spot lesions

are observed

Refer for dental care if any of the clinical

findings predictive of high caries risk are

observed and/or if you are uncertain of the

child’s caries risk

Refer to your I-Smile Coordinator for care &

to ensure dental care is established

Summary: Oral Screening ExamSummary: Oral Screening Exam