Oral HealthOral Healthfor Childrenfor Children

Lori Ellington, RDH, BSDHLori Ellington, RDH, BSDH

East Tennessee State UniversityEast Tennessee State University

Masters of Allied Health ProgramMasters of Allied Health Program

Facts & Figures Facts & Figures Children with Dental Caries Children with Dental Caries

Most common childhood diseaseMost common childhood disease Over ½ of children by 2Over ½ of children by 2ndnd grade have caries grade have caries Number of carious lesions in primary teeth has increasedNumber of carious lesions in primary teeth has increased Number of carious lesions in permanent teeth decreasedNumber of carious lesions in permanent teeth decreased Oral health is dictated by sociodemographic aspectsOral health is dictated by sociodemographic aspects

Dental care most prevalent unmet need in poor Dental care most prevalent unmet need in poor children of all ages in the USchildren of all ages in the US

Other RamificationsOther Ramifications Low body weightLow body weight Lost school hours & parent work hoursLost school hours & parent work hours

Barriers to Dental CareBarriers to Dental Care

AgeAge Dentist does not treat childrenDentist does not treat children

Cultural conflictCultural conflict Beliefs, values, attitudes, perceptionsBeliefs, values, attitudes, perceptions

LanguageLanguage No access to translator No access to translator

Barriers to Dental CareBarriers to Dental Care

DisabilitiesDisabilities Epilepsy, autism, cerebral palsy, mental retardationEpilepsy, autism, cerebral palsy, mental retardation

TransportationTransportation Can use public, state, or friend to & from Can use public, state, or friend to & from

appointment appointment FinancialFinancial

Low income, Medicare insuranceLow income, Medicare insurance

Risk Factors associated withRisk Factors associated withDental CariesDental Caries

Familial FactorsFamilial Factors Low socioeconomic status & Low socioeconomic status &

minoritiesminorities No knowledge or belief of No knowledge or belief of

dental preventiondental prevention No topical or systemic No topical or systemic

fluoridefluoride Dental fearDental fear Family members with active Family members with active

cariescaries Lack of dental knowledge & Lack of dental knowledge &

infrequent visitsinfrequent visits

Risk FactorsRisk Factors

Health ConcernHealth Concern Premature/low birth weight babiesPremature/low birth weight babies Severe and chronic illness Severe and chronic illness Early hospitalization/surgeryEarly hospitalization/surgery Developmental disabilities, dental defectsDevelopmental disabilities, dental defects Using sweetened medicationsUsing sweetened medications Using antihistamines Using antihistamines causescauses dry mouth dry mouth Early Childhood caries Early Childhood caries

Risk FactorsRisk Factors

Dietary ConcernDietary Concern Low fluoride levels in water supplyLow fluoride levels in water supply Take bottles to bed with sweetened liquidTake bottles to bed with sweetened liquid Extended breast & bottle useExtended breast & bottle use Prolonged use of bottles & sippy cupsProlonged use of bottles & sippy cups Frequent sugary snacksFrequent sugary snacks High carbohydrate dietHigh carbohydrate diet

Caries Prevention MethodsCaries Prevention Methods

Brushing teeth at least twice dailyBrushing teeth at least twice daily Flossing dailyFlossing daily Use of fluorideUse of fluoride Education on proper care of teethEducation on proper care of teeth Regular dental visitsRegular dental visits Eating a well balanced dietEating a well balanced diet

Powered ToothbrushPowered Toothbrush

Powered BrushPowered Brush Can be more effective in Can be more effective in

children having trouble children having trouble with manual brushwith manual brush

Encourage good oral Encourage good oral habitshabits

Manual BrushingManual Brushing

Helps develop manual Helps develop manual dexteritydexterity

Child size brushes with Child size brushes with soft bristles are bestsoft bristles are best

Bright color or fun Bright color or fun shape and pattern help shape and pattern help encourage continued useencourage continued use

ToothpasteToothpaste

Great taste encourages Great taste encourages useuse

Use a pea size amount Use a pea size amount on toothbrushon toothbrush

Easy to use tube make it Easy to use tube make it easier for childreneasier for children

Fluoride toothpaste is a Fluoride toothpaste is a MUSTMUST

Fluorides & Their SourcesFluorides & Their Sources

Most effective method for caries prevention Most effective method for caries prevention and controland control Topical sourcesTopical sources

ToothpasteToothpaste Mouth rinseMouth rinse Fluoride treatment at dentistFluoride treatment at dentist

Systemic sourcesSystemic sources FoodFood Drinking waterDrinking water Fluoride tabletsFluoride tablets

Microbial Screening KitMicrobial Screening Kit

Orion Diagnostica’s Orion Diagnostica’s DentocultDentocult® SM Strip ® SM Strip mutansmutans Determines caries Determines caries

risk in childrenrisk in children Test is well-tolerated, Test is well-tolerated,

rapid, easy to rapid, easy to conductconduct

Microbial Screening KitMicrobial Screening Kit

Test procedureTest procedure Test strip is placed in patient’s salivaTest strip is placed in patient’s saliva Strip is incubated at 36ºC for 48 hoursStrip is incubated at 36ºC for 48 hours Bacterial growth cause a color change on stripBacterial growth cause a color change on strip Bacterial load determined by comparing with Bacterial load determined by comparing with

standard color chartstandard color chart

DietDiet

Good dietary habitsGood dietary habits Small mealsSmall meals

Healthy Snacks Healthy Snacks Fruits, popcorn, vegetablesFruits, popcorn, vegetables

Limit intake ofLimit intake of Sugary drinks and Sugary drinks and

carbohydratescarbohydrates Fruit juicesFruit juices

Avoid using food for Avoid using food for behavior alterationbehavior alteration

Dental VisitsDental Visits

Child’s first dental visit by 1 year oldChild’s first dental visit by 1 year old Every 6 months thereafterEvery 6 months thereafter

The dental visit checks forThe dental visit checks for Good oral careGood oral care Good dietary practicesGood dietary practices

Fun, positive & educational visitsFun, positive & educational visits Both for child and parentBoth for child and parent Support good oral habitsSupport good oral habits

Ramifications of noRamifications of noDental visitsDental visits

Reluctance to smileReluctance to smile Self-conscious of teethSelf-conscious of teeth Pain and infectionPain and infection Impaired speech developmentImpaired speech development Reduced self-esteemReduced self-esteem Failure to thriveFailure to thrive

Brushing InstructionsBrushing Instructions

Brushing techniqueBrushing technique Brush teeth in small Brush teeth in small

circlescircles Outer & inner surfaces Outer & inner surfaces

of mandibular & of mandibular & maxillary teethmaxillary teeth

Chewing surfaces (tops Chewing surfaces (tops of teeth)of teeth)

Brush tongueBrush tongue TimerTimer

Flossing InstructionsFlossing Instructions

FlossingFlossing Once a dayOnce a day Wrap 18” of floss around Wrap 18” of floss around

middle fingers, hold 1” middle fingers, hold 1” between thumb and between thumb and index finger, move floss index finger, move floss up & down against toothup & down against tooth

Child flossersChild flossers

Brushing & FlossingBrushing & FlossingVideoVideo

BibliographyBibliography Lepeau, N. S. (2005). Pediatric Oral Health Care: Infancy throught Age 5. In E.M. Wilkins (Ed.), Lepeau, N. S. (2005). Pediatric Oral Health Care: Infancy throught Age 5. In E.M. Wilkins (Ed.),

Clinical Practice of the Dental HygienistClinical Practice of the Dental Hygienist (9th ed., pp. 782-802). Philadelphia, PA: Lippincott (9th ed., pp. 782-802). Philadelphia, PA: Lippincott Williams & Wilkins.Williams & Wilkins.

Matttana, D. J. (2005). Fluorides. In E.M. Wilkins (Ed.), Matttana, D. J. (2005). Fluorides. In E.M. Wilkins (Ed.), Clinical Practice of the Dental Clinical Practice of the Dental HygienistHygienist (9th ed., pp. 542-568). Philadelphia, PA: Lippincott Williams & Wilkins. (9th ed., pp. 542-568). Philadelphia, PA: Lippincott Williams & Wilkins.

Nathe, C. N. (2005). Target Populations. In (Ed.), Nathe, C. N. (2005). Target Populations. In (Ed.), Dental Public HealthDental Public Health (2nd ed., pp. 143-156). (2nd ed., pp. 143-156). Upper Saddle River, NJ: Pearson Prentice Hall.Upper Saddle River, NJ: Pearson Prentice Hall.

Orion Diagnostica. (2005). Orion Diagnostica. (2005). Dentocult SM Strip mutansDentocult SM Strip mutans. Retrieved July 1, 2006, from . Retrieved July 1, 2006, from http://www.oriondiagnostica.fihttp://www.oriondiagnostica.fi

Proctor and Gamble. (2002). Proctor and Gamble. (2002). A Parent's Guide Caring for Children's TeethA Parent's Guide Caring for Children's Teeth [Brochure]. OH [Brochure]. OH Ray, T. S. (2005). Oral Infection Control: Toothbrushes and Toothbrushing. In E.M. Wilkins Ray, T. S. (2005). Oral Infection Control: Toothbrushes and Toothbrushing. In E.M. Wilkins

(Ed.), (Ed.), Clinical Practice of the Dental HygienistClinical Practice of the Dental Hygienist (9th ed., pp. 402-425). Philadelphia, PA: (9th ed., pp. 402-425). Philadelphia, PA: Lippincott Williams & Wilkins.Lippincott Williams & Wilkins.

Rethman, J. (2002). Pediatric Patients: Questions and Controversies. Interview with Dr. Marvin Rethman, J. (2002). Pediatric Patients: Questions and Controversies. Interview with Dr. Marvin H. Berman. H. Berman. Practical Hygiene, 11Practical Hygiene, 11(1), 19-22.(1), 19-22.

Savage, M. F., Lee, J. Y., Kotch, J. B., & Vann, W. F. (2004). Early Preventive Dental Visits: Savage, M. F., Lee, J. Y., Kotch, J. B., & Vann, W. F. (2004). Early Preventive Dental Visits: Effects on Subsequent Utilization and Cost. Effects on Subsequent Utilization and Cost. Pediatrics, 114Pediatrics, 114(4), e418-e423. Retrieved July 1, (4), e418-e423. Retrieved July 1, 2006, from American Academy of Pediatrics Web Site: 2006, from American Academy of Pediatrics Web Site: http://wwwpediatrics.org/cgi/doi/10.1542/peds.2003-0469-Fhttp://wwwpediatrics.org/cgi/doi/10.1542/peds.2003-0469-F

U.S. Food And Drug Administration. (06). U.S. Food And Drug Administration. (06). Establishment Registration DatabaseEstablishment Registration Database. Retrieved July . Retrieved July 2, 2006, from Center for Device and Radiological Health Web Site: 2, 2006, from Center for Device and Radiological Health Web Site: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/Registration.cfm?ID=6091http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/Registration.cfm?ID=6091