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Dental Facts for the FrontlineDental Facts for the Frontline

Danielle G. Dooley, MD, MPhil, FAAPPediatrician

Unity Health Care

Is Your Child Care, Practice or Is Your Child Care, Practice or Organization Dental-Friendly?Organization Dental-Friendly?

Education Preparation Prevention

Are You Advocating for Oral Are You Advocating for Oral Health?Health?

Ways child care providers can advocate:– Learn about oral health issues – Teach dental hygiene to the children you serve

Ways advocacy organizations can advocate:– Educate policy makers at local, state and federal

level – Organize a dental advocacy campaign

 Ways doctors can advocate:– Learn updates on oral health care – Learn to do an oral health risk assessment – Talk to patients about oral health – Work with advocacy organizations to educate

policymakers and the public

Topics for TodayTopics for Today

Why early intervention matters Tooth development and decay Baby bottle tooth decay Teeth grinding Thumbsucking Dental emergencies

Good Oral Hygiene Habits Good Oral Hygiene Habits Start EARLY!Start EARLY!

90% of all cavities are preventable with good oral hygiene and dental care

The younger a child is when they develop dental caries, the more likely they are to have future dental disease

Poland, Charles. Promoting Oral Health in Young Children. http://www.aapd.org.

Teeth are in JeopardyTeeth are in Jeopardy

There is a silent epidemic of dental disease in our country

This epidemic affects poor and minority children the most- these children are 5X as likely to have untreated tooth decay than other kids

Krol, David M. Educating Pediatricians on Children’s Oral Health: Past, Present, and Future. Pediatrics 2004;113:e487-492

Why Are Teeth in Jeopardy?Why Are Teeth in Jeopardy?

Dental caries, or cavities, is the most common chronic disease among children in the United States (5X more common than asthma!)

50% of kids have at least one cavity by the time they start elementary school

Teenagers have an average of 8 cavities by the time they are 17 yrs old

Poland, Charles. Promoting Oral Health in Young Children. http://www.aapd.org

Where do Kids Learn to Keep Where do Kids Learn to Keep Their Teeth Healthy?Their Teeth Healthy?

Dentists Pediatrician Family School/Child Care

Dental Access is a ProblemDental Access is a Problem

Many kids have never been to the dentist- 1 out of 10 kids between the ages of 5 and 10 have NEVER seen a dentist

There are not enough pediatric dentists in the United States to meet the health needs of children

Kids from low income families are 5X as likely to have untreated tooth decay due to poor access to dental services

Poland, Charles. Promoting Oral Health in Young Children. http://www.aapd.org

Pediatricians Don’t Have the Pediatricians Don’t Have the Training or the TimeTraining or the Time

American Academy of Pediatrics declared in May 2003 that all pediatricians should be able to perform oral health risk assessments starting at 6 months of age

60% of pediatricians have not received any oral health training

75% of pediatricians consider their knowledge of oral health inadequate

Krol, David M. Educating Pediatricians on Children’s Oral Health: Past, Present, and Future. Pediatrics 2004;113:e487-492

There Just Isn’t Time!There Just Isn’t Time!

In a standard 15 minute well child visit, pediatricians must:– Talk with the parents– Examine the child– Address other topics such as violence and

injury prevention, nutrition, breastfeeding, school issues, developmental issues

What is a Tooth?What is a Tooth?

Crown- above the gum

Root- below the gum; makes up 2/3 of the total length of the tooth!

EnamelEnamel

Enamel- white covering that protects tooth from wear and tear of chewing

DentinDentin

Dentin- supports the enamel; carries the nerve fibers that sense hot/cold/pain

PulpPulp

Pulp- center of the tooth; soft tissue containing blood, nerves. Carries nutrition to the tooth.

Types of TeethTypes of Teeth

Incisors- teeth in the very front; sharpest; made to cut food and shovel it into mouth

Types of TeethTypes of Teeth

Canine- corners of mouth; meant for grasping and tearing food

Types of TeethTypes of Teeth

Molars- last teeth towards the back of the mouth; big flat surfaces for chewing and grinding food into smaller pieces

Tooth DevelopmentTooth Development

At birth, children have 20 primary teeth Teeth start erupting at about 6 months

of age Children shed their baby teeth starting

at about 6 years of age By age 21, they have all 32 of their

permanent teeth

Tooth DevelopmentTooth Development

                                                                                  

                                          

Why Are Baby Teeth Why Are Baby Teeth Important?Important?

Baby teeth are important for:– Learning to eat– Learning to speak– Saving a space for the permanent teeth (if

baby teeth are lost or decay early, then there is less space for the permanent teeth and this causes crowding)

What is Tooth Decay?What is Tooth Decay?

Tooth destruction caused by interaction between teeth, food, and bacteria

Streptococcus Mutans is the main bacteria involved in tooth decay

Bacteria in the saliva sticks to teeth in a thick film called plaque

Tooth DecayTooth Decay

When kids eat starchy foods, the bacteria break down the starch to produce acids that attack the tooth enamel

Repeated acid attacks cause the tooth to decay in the form of a cavity, or pit in the tooth

Is the Bacteria that Causes Is the Bacteria that Causes Tooth Decay Contagious?Tooth Decay Contagious?

YES Adults have a high concentration of S. mutans

in their mouths which can be spread in saliva Sharing forks, spoons; allowing children to put

fingers into adult’s mouth; testing the temperature of a bottle with the mouth

Caregivers need to practice good oral hygiene too!

Who is at Increased Risk for Who is at Increased Risk for Tooth Decay?Tooth Decay?

Children in communities without fluoridated water or where kids drink mostly bottled water

Children from low income families Children from racial and ethnic minority

groups Children with limited or no dental insurance Children with special health care needs-

Down’s syndrome, cleft palate

Is There a Familial Component Is There a Familial Component to Tooth Decay?to Tooth Decay?

YES! In 71% of mother-infant pairs, identical

genotypes of S. mutans have been found Children of mothers with high caries rates are

at a higher risk of decay Proper dental hygiene in mothers has been

shown to decrease the rate of caries in kids

Section on Pediatric Dentistry. Oral Health Risk Assessment Timing and Establishment of the Dental Home. Pediatrics 2003;111:1113-1116

How to Prevent Tooth Decay?How to Prevent Tooth Decay?

Proper brushing Proper snacking Fluoride Regular dental visits

Cleaning Infant TeethCleaning Infant Teeth

Begin cleaning an infant’s teeth as soon as the first tooth erupts

Use a soft cloth to wipe the tooth down or a very soft toothbrush with plain water

No toothpaste!

Cleaning Toddler TeethCleaning Toddler Teeth

Ages 2 and up Brush with a pea sized

amount of toothpaste using a soft toothbrush

Have the child spit out the toothpaste after brushing but do not rinse with water

When Can Kids Brush by When Can Kids Brush by Themselves?Themselves?

It is important for young children to participate in tooth brushing by helping to hold the toothbrush

They have the fine motor skills to clean their teeth well by age 7 or 8 years

Snacks that are Good for Snacks that are Good for SmilesSmiles

Avoid sticky, sugary snacks- cookies, cake, candy, sodas

Fruits, vegetables, whole grain snacks are best

Snack at regular times- don’t allow all-day snacking!

Offer the child plenty of water (not juice!), especially with snacks

Fruits, grains, dairy products provide excellent snacks for healthy smiles!

What is Fluoride?What is Fluoride?

Mineral that increases tooth strength Main source of fluoride is public water

systems; it is also found in toothpaste Exposure to fluoride can reduce tooth

decay by 50-70% Most important method of preventing

tooth decay

Why Don’t Our Kids Get Why Don’t Our Kids Get Enough Fluoride?Enough Fluoride?

Most bottled water contains no fluoride Due to lead service lines in the District

of Columbia, many families are opting to use bottled water for their kids

Is There Such a Thing as Too Is There Such a Thing as Too Much Fluoride?Much Fluoride?

YES Don’t give fluoride toothpaste to kids

under 2 years- if they swallow too much toothpaste the fluoride can cause spots on their teeth

Avoid fluoride mouth rinses in kids under 6 years- they will get more than enough fluoride from their toothpaste

When Should Kids go to the When Should Kids go to the Dentist?Dentist?

Recommendation from the ADA and AAP is that kids have their first visit to the dentist by age 1 year

Reality is that many families do not have access to dental services and there is a shortage of pediatric dentists

Baby Bottle Tooth DecayBaby Bottle Tooth Decay

Occurs when kids are put to bed with a bottle or allowed to have bottle in their mouth for long periods of time

Parents and caregivers often give a bottle to encourage sleep or quiet the child and feel it is cruel to deny food to the infant

Affects 5-10% of children

Baby Bottle Tooth DecayBaby Bottle Tooth Decay

Milk or juice pools in the child’s mouth around the teeth and remains there for long periods, allowing dental cavities to form

There is not a lot of saliva produced in the mouth during sleep, so there is nothing to wash away the milk or juice

The bacteria in the mouth interact with the sugars in the liquid to produce acid and cause tooth decay

What does Baby Bottle Tooth What does Baby Bottle Tooth Decay Look Like?Decay Look Like?

Upper front teeth and incisors are affected most

Loss of glossy appearance to enamel- white spot lesions

Flat brown, yellow spots

Occasionally teeth are broken

Very early tooth decay

Tooth decay

Severe tooth decay

What About Breastfed Babies?What About Breastfed Babies?

Breastfeeding does not automatically protect babies from dental caries

If breastfed babies feed for extended periods of time, they develop the same pattern of caries as bottle fed babies

Baby Bottle Tooth Decay is Baby Bottle Tooth Decay is Preventable!Preventable!

Educate parents not to put baby to bed with a bottle- by 4 months of age, most babies do not need feedings during the night

Don’t use the bottle as a pacifier- allow kids to have it only at mealtime

Transition kids from a bottle to a cup by 1 year of age

What if the Baby Really Needs What if the Baby Really Needs the Bottle to go to Sleep?the Bottle to go to Sleep?

Alternatives to bottles to calm an infant or help them get to sleep:– Favorite blanket or toy– Clean pacifier– Holding, patting, rocking the infant– Reading to the infant– Softly talking or singing to the infant

Teeth GrindingTeeth Grinding

Also known as bruxism Usually occurs during sleep, pattern of

jaw clenching and teeth grinding 3/10 kids have this problem, most are

under 5 years of age

What Causes Teeth Grinding?What Causes Teeth Grinding?

No one really knows Some possible causes are:

– Stress- situations at home or school that cause tension or anger

– Improper alignment of top and bottom teeth

– Response to pain such as earache or teething pain

What are the Effects of Teeth What are the Effects of Teeth Grinding?Grinding?

Usually it is more bothersome to the parents than the child

In severe cases, can wear down tooth enamel, chip teeth, cause facial pain

Most kids outgrow teeth grinding

How is Teeth Grinding How is Teeth Grinding Treated?Treated?

Visit the dentist, who will examine the child’s teeth for chipped enamel and proper alignment

If either of these exist, then the dentist may make a special mouthguard for the child to wear at night

Try to address stressful circumstances in the child’s life and help them relax before going to bed

ThumbsuckingThumbsucking

Many children suck their thumbs, fingers, or a pacifier

Natural reflex for infants Soothing Induces sleep Helps them to explore the world around

them by sucking on their fingers or other objects

ThumbsuckingThumbsucking

Most children give up this habit between the ages of 2-4 years

If kids still have a sucking habit after age 4, they should see a dentist

Most problems from sucking habits start around age 6, when the permanent front teeth come in

ThumbsuckingThumbsucking

Intensity of sucking determines whether children develop problems with their teeth

Kids who rest their thumb in their mouth are less likely to develop dental problems

Problems caused include misalignment of the teeth and changes in the roof of the mouth

ThumbsuckingThumbsucking

Upper front teeth flare out and tip upward

Lower front teeth move inward

Roof of mouth becomes arched or caved in

Tips to End a Thumbsucking Tips to End a Thumbsucking HabitHabit

Praise children for NOT sucking their thumb or pacifier

Address the child’s anxiety or discomfort so they don’t need to suck to soothe themselves

Pick certain times during the day when kids cannot suck their thumb

Common Dental EmergenciesCommon Dental Emergencies

Toothache– Call the parent– Suggest they take the child to a dentist as

soon as possible

Cut or Bitten Tongue, Lip, Cut or Bitten Tongue, Lip, CheekCheek

Apply ice to area If bleeding is present, apply pressure

with a clean cloth If bleeding does not stop after 15

minutes, notify parent and take the child to the doctor or ER

Knocked-Out Permanent ToothKnocked-Out Permanent Tooth

Try to find the tooth Handle it by the top, not the root Rinse the tooth briefly in water Try to reinsert the tooth in the socket and

have the child hold it there by biting on a clean piece of cloth

If it cannot be reinserted, transport the tooth in a cup of milk

Go to the dentist immediately

Broken ToothBroken Tooth

Rinse dirt from tooth and injured area with water

Place cold compresses on face in area of injury

Try to locate and save any tooth fragments

Go to the dentist immediately

Bleeding after a Baby Tooth Falls Bleeding after a Baby Tooth Falls OutOut

Place clean gauze over the bleeding area

Have the child bite on the gauze with pressure for 15 minutes

If bleeding continues after 15 minutes, take the child to the dentist

Current LegislationCurrent Legislation

Oral Health Promotion Act of 2005 (HR 594 IH), Rep. Bernard Sanders (VT).– Amends SCHIP to add dental services.– Allows States the option of using Federal SCHIP funds

to cover dental expenses for a child eligible for Medicaid.

– Establishes the Community Oral Health Expansion Fund to expand the availability of oral health services through community-based centers. Funds may be used for demonstration projects and demonstration partnerships with Head Start programs.

– Requires States to contribute, directly or indirectly, up to 10% of demonstration project costs.

– As of February 25, 2005, the bill was referred to House subcommittee on Health.

Source: Library of Congress. HR 594 IH. May 31, 2005. www.loc.gov.

Is Your Child Care, Practice or Is Your Child Care, Practice or Organization Dental-Friendly?Organization Dental-Friendly?

Education Preparation Prevention Advocacy

AcknowledgementsAcknowledgements

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