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Susan Woodley RDH
Manager, Professional Education
Western Canada
[email protected]
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Womb to Grow :
Great Beginnings: Prenatal to Preschool
Interdisciplinary Care—Vital for overall wellness management of prenatal
patient—key for optimal growth and development of fetus
Low Birth Weight < 5lbs 8oz
Smoking- Less oxygen for fetal development Alcohol– No safe amount
©2018 Philips Oral Healthcare
Preterm Birth < 37 weeks gestation
Extremely Preterm < 28 weeks
Very Preterm 28 - <32 weeks
Moderate to Late Preterm 32— <37 weeks
Adverse Pregnancy Outcomes
Vital Nutrition
Smoking and Alcohol
Oral Changes
Research Updates
Solutions
Image: https://www.drugabuse.gov/publications/research-reports/heroin/how-does-heroin-abuse-affect-pregnant-women
Emerging Research
Kangaroo Care:
Maintains babies body warmth
Promotes mothers milk production
Regulates heart rate and breathing
Pre Natal Risk : Assessing for Abuse
• 300,000/yr abused while pregnant
• Screening may be a key intervention
It is not our job to prove abuse happened, it is our job to recognize there may be a problem and report it. You can report anonymously. Remember, you may be saving a life.
The patients records should include:
• Clinical findings
• Description of injury
• Radiographs of areas
• Photographs of injury
What to look for:
•Trouble swallowing •Voice change •Evasive •Contusions, abrasions,
lacerations •TMJ Discomfort •Chronic pain, headaches •Depression
•Substance abuse
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©2018 Philips Oral Healthcare
Theory of Adverse Outcomes 2013 review reported association between GCF inflammatory
mediator levels and adverse pregnancy outcomes
Mediators enter systemic circulation and raise C- Reactive Protein
levels
• Increased CRP levels induce production of PgE2
Bi-directional Relationship
• Studies reveal pregnancy influenced periodontal status
• Pre-pregnancy periodontitis could lead to increased severity during
pregnancy
• Hormonal changes exacerbate gingival inflammation
• Induces a selective growth of periodontal pathogens
“Comprehensive dental care is considered both safe and necessary during
pregnancy and can be crucial to the well-being of pregnant women and
their offspring.”
Dimensions of Dental Hygiene : February 2017
Effect of Periodontal Treatment - 2015 Study
• Statistical reduction of CRP
• Studies suggest that treatment is safe and beneficial Sleep Apnea– Pregnancy
not sleep on back — tape tennis ball back of your pajama top
saline spray or rinse for apnea from congestion
humidifier
adhesive breathing strips
CPAP
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Impact of oral disease
Early Childhood Caries
Sippy cups and snacks
Research updates
Solutions
https://lucinacare.com/intro
Impact of Oral Disease with Children
Early tooth loss– failure to thrive - impaired speech—low self esteem—
poor school performance—absences from school—inability to concentrate—
systemic consequences
©2018 Philips Oral Healthcare
Collaborate /Refer
Anticipatory Guidance
Establish a Dental
Home
Examination of Child
Assign Risk Level Re-evaluation
Individualized Home Care
Recommendations
Individualized Treatment
Based on Risk
Parent Interview
Establishing a Dental Home
How to Perform a “Knee to Knee” Exam: After Parent Interview
Laps become the examination area
Don’t need to be in a traditional clinical area Child remains comfortable with caregiver close
Lay child forward into clinician's lap
Caregiver supports hands/feet
Quiet, confident, comforting parent without actual interaction ”Calm assertive”
Clinician uses lift the lip to observe
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Risk Assessment:
Mom / sibling dental history (biggest influencer on risk; active de-
cay in parent/caregiver automatically places as high risk)
Low health literacy of primary caregiver
Low socioeconomic levels
Clinically observe OH compliance issues
Poor plaque control, biological presence of S.
mutans,
gingival bleeding present
Frequent exposure to cariogenic agents
©2018 Philips Oral Healthcare
Accessing for Abuse
Dental Professionals—mandated reporters
Head and neck injuries occur in >50% of child abuse
34% of abuse victims under age 4, highest under age 1
• 34% of abuse victims under 4, highest under age 1
80% of fatal victims under the age 4
Contributing:
Antibiotics/immature immune system
Transmittable:
Baby to nipple - nipple to baby
Symptoms:
Drowsiness, dilated pupils ; increased irritability while feeding
Clinical Presentation:
White velvety patches, do not rub off
Affected areas :
Tongue, palate, buccal mucosa
Pacifiers
1-12 months helps reduce ear infections
Over 12 months increased risk of ear infections
Stop pacifier habit before age 2.5-3 for orthognathic reasons
Thumb/finger Sucking
Most common sucking habit in children
Increased Risk for malocclusion
Time, intensity, direction and degree of forces dictates character and
degree of malocclusion
Teething
Caution!
Etiology: Candida Albicans
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Pediatric Sleep Disordered Breathing
©2018 Philips Oral Healthcare
New Paradigm treating childhood caries
Silver Diamine Fluoride (38%)
Caries arrest and prevention, low cost and no drill
Cons: bad taste, black stains, mouth sore
Fluoride
5,000 ppm products contraindicated
Fluoride supplements as required, only when NO other fluoride expo-sure
Fluoride varnish applied every six months is effective in preventing caries in primary and permanent dentition
Two or more annual applications of varnish effective in high-risk
populations
How much toothpaste to apply?
Grain of rice or “smear” kids under age 3
1/2 pea for kids age 3-5
Pea size for kid over age 5
Tidbits on Tooth brushing
Under age 7—most need supervision
“Can she/he color perfectly in the lines?
Bottles and Sippy Cup—Exposure Risk
Bottle recommendations from AAPD/CAPD: All babies weaned from
bottle by age one
Sippy cups are transitional, temporary, training devices
Recommended to transition to traditional cup as soon as possible
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©2018 Philips Oral Healthcare
Intuitive Brushing
RFID Technology (Radio
Frequency ID)
Personalized Coaching
Pregnancy is the one of the most motivating times in a women’s life.
She is open to making changes to improve her health and ultimately
the health of her baby. This provides us, as dental professionals, with a
unique opportunity to provide guidance on the most effective way to
achieve and maintain good oral health. We can start the conversation
with a simple question: “What are you currently using, on a daily basis,
to keep your mouth healthy?”
Great option during pregnancy
Prevents stimulation of gag reflex
Added microbial support for treatment and reduction of
pregnancy gingivitis
Sonicare For Kids
DiamondClean Smart
Get Connected, Stay Connected
Interproximal Cleaning - AirFloss Pro
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Resources: Pre Natal -www.who.int/mediacentre/factsheets/fs363/en/index.html
-De Chateau P. The influence of early contact on maternal and infant behavior in primiparae. Birth and the Family Journal 1976;3:149-55 Moore, ER; Bergman, N; Anderson, GC; Medley, N (25 November 2016). "Early skin-to-skin contact for mothers and their healthy newborn infants.".
The Cochrane database of systematic reviews. 11: CD003519. i:10.1002/14651858.CD003519.pub4. PMID 27885658http://
domesticviolencestatistics.org/domestic-violence-statistics
-http://www.sheltersafe.ca/
-www.cdc.gov/reproductivehealth/violence/IntimatePartnerViolence/sld001.htm
Oral Health / Pregnancy / Effect of Periodontal Treatment
-Silk Hugh et al. Oral Health During Pregnancy. Am Fam Physician, 2008; 77(8):1139-1144
-http://journal.frontiersin.org/article/10.3389/fimmu.2017.00139/full
-Offenbacher S et al. Potential pathogenic mechanisms of periodontitis associated pregnancy complications. Ann Periodontol. 1998; 3:233-50.
-http://journal.frontiersin.org/article/10.3389/fimmu.2017.00139/full
-Jeffcoat et al Periodontal infection and preterm birth JADA, Vol 132, July 2001: 875-880
-Reza KM, Hamissi JH, Naeini SR, Karimi M. The relationship between maternal periodontal status of and preterm and low birth weight infants in Iran:
a case control study. Glob J Health Sci (2015) 8(5):184–8.10.5539/gjhs.v8n5p184 (PMC free article) Pub Med, Cross Ref
-www.dimensionsofdentalhygiene.com/2017/02_February/Features/Supporting_Oral_Health_in_Pregnancy.aspx
Sleep Apnea Pregnancy— https://www.whattoexpect.com/pregnancy/obstructive-sleep-apnea-during-pregnancy—https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC4818216/
Establishing a Dental Home www.aapd.org/advocacy/dentalhome http://onlinelibrary.wiley.com/doi/10.1034/j.1600-9657.2002.00153.x/full
Knee to Knee Exam www.youtube.com/watch?v=HCKyR-zS7J0 Risk Assessment & Impact of Oral Disease Law V et al. Factors influencing oral colonization of mutans streptococci in young children. Aust Dent J. 2007 Jun;52(2):93-100 Marrs J et al. Early Childhood Caries: Determining the risk factors and assessing the prevention strategies for nursing intervention. Cont Nursing Ed 2011; 37 (1), 9-15
Abuse http://www.cdc.gov— National Child Abuse Help Line– 1-800-4-A-Child-
https://www.canada.ca/en/public-health/services/health-promotion/stop-family-violence/prevention-resource-centre/children/child-maltreatment-
what-guide-professionals-who-work-children.html
Candida Albicans
www.medicalnewstoday.com/articles/179069.php?page=2
Pacifier/Thumb Sucking/Oral Habits Warrn JJ. Bishara SE Steinbock Kl, Yonezu Tl Nowak AJ. Effects of oral habits duration on dental characteristics in the primary dentition. J.Am Dent Assoc 2001132 (12):1685-93 https://www.aap.org/en-us/about-the-aap/aap-press-room/aap-press-room-media-center/Pages/Weaning-from-the-Bottle.aspx Sippy Cups www.aap.org/en-us/about-the-aap/aap-press-room/aap-press-room-media-center/Pages/Weaning-from-the-Bottle.aspx Tooth Brushing www.aapd.org/media/Policies_Guidelines/G_fluoridetherapy.pdf www.philipsoralhealthcare.com
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Resources:
Fluoride www.aapd.org/media/Policies_Guidelines/G_FluorideTherapy.pdf S Department of Health and Human Services. HHS and EPA announce new scientific assessments and actions on fluoride Berg J et al. Evidence-based clinical recommendations regarding fluoride intake from reconstituted infant formula and enamel fluorosis: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2011; 142:79-87. Silver Diamine Fluoride Horst JA, Ellenikiotis H, Milgrom PL. UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent. J Calif Dent Assoc 2016;44(1):16-28. U.S. National Institutes of Health. ClinicalTrials.gov search for silver diamine fluoride Sleep Apnea in Children www.entnet.org/content/pediatric-sleep-disordered-breathingobstructive-sleep-apnea
www.sleepapnea.org/treat/childrens-sleep-apnea/
www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/basics/definition/con-20035990
https://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs
Role of oral health professional in pediatric obstructive sleep apnea: Sanjeev Kumar Verma, Sandhya Maheshwari, Naresh Kumar Sharma, K. C.
Prabhat:Natl J Maxillofac Surg. 2010 Jan-Jun; 1(1): 35–40. doi: 10.4103/0975-5950.69162: PMCID: PMC3304178
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