Early Childhood Oral Health for MCH Professionals Julia Richman, DDS, MSD, MPH

Early Childhood Oral Health for MCH Professionals

Julia Richman, DDS, MSD, MPH

Who are we?

A. Medical care providers (ie MD, RN)

B. Dental care providers

C. Social services providers

D. Other public health professionals

Healthy People 2010

Oral Health Goal: Prevent and control oral and craniofacial diseases, conditions, and injuries and improve access to related services.

21-1 Dental caries experience

21-2 Untreated dental decay

21-3 No permanent tooth loss

21-4 Complete tooth loss

21-5 Periodontal diseases

21-6 Early detection of oral and pharyngeal cancers

21-7 Annual examinations for oral and pharyngeal cancers

21-8 Dental sealants

Healthy People 2010

21-9 Community water fluoridation

21-10 Use of oral health care system

21-11 Use of oral health care system by residents in long-term care facilities

21-12 Dental services for low-income children

21-13 School-based health centers with oral health component

21-14 Health centers with oral health service components

21-15 Referral for cleft lip or palate

21-16 Oral and craniofacial State-based surveillance system

21-17 Tribal, State, and local dental programs 

Dental Caries

• Dental caries is the most common chronic childhood disease – 5x more prevalent than asthma

• Entirely preventable and treatable• 80% of caries in permanent teeth affect 25% of

the children – NHANES III – Poor children disproportionately affected

• Early childhood caries: caries affecting teeth in a child under 72 months of age

Dental Caries

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Early Childhood CariesSequellae of dental caries• Pain

• Poor sleep due to pain

• Problems with school readiness and learning

• Poor nutrition due to pain eating

• Need for sedation or general anesthesia

– Problems with access to this care

• Negative dental experiences

• Emergency room care

• Hospitalization for severe dental infections

Early Childhood Caries

www.aafp.org/afp/20041201/2113_f1.jpg

Courtesy of Dr. Bryan Williams

Some Photos from My Practice

Sugar, dextrose, corn syrup, malic acid, citric acid,

buffered lactic acid, artificial flavor and color

Sugar, dextrose, corn syrup, malic acid, citric acid,

buffered lactic acid, artificial flavor and color

For Want of a Dentist

By Mary Otto, Washington Post Staff Writer Wednesday, February 28, 2007

Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

If his family had not lost its Medicaid.

If Medicaid dentists weren't so hard to find.

If his mother hadn't been focused on getting a dentist for his brother, who had six

rotted teeth.

By the time Deamonte's own aching tooth got any attention, the bacteria from the

abscess had spread to his brain, doctors said. After two operations and more

than six weeks of hospital care, the Prince George's County boy died.

Disparities in Untreated Caries

CDC. NHANES I and NHANES III 2002 Annual Report

Disparities in Untreated Caries

CDC. NHANES I and NHANES III 2002 Annual Report

Caries in Washington State

According to the WA Smile Survey 2005,

• Significant increases since 2000 in:– Caries experience (55.6% 59.0%)– Rampant caries (15.2% 22.6%) – Caries in permanent teeth (15.3% 22.1%)

• Caries disproportionately affects Native American children – 3-5 year olds in Head Start– 25% of HS children had untreated caries – 48% of Tribal HS children had untreated caries

Please use the text chat to share your experience.Please use the text chat to share your experience.

Questions

Have you had a recent frustrating experience with trying to help a family obtain dental care for a young child?

What barrier(s) to access did you encounter?

Barriers to Care

• Knowing when to seek dental care

• Finding a dentist who will take Medicaid

• Finding a dentist who will see a young child

• Transportation

• Geographical isolation

• Workforce shortage

• Need to take time off from work

• Language

• Finances

• Other barriers (dental fear, culture, health beliefs)

Medicaid

• An estimated 47 million children eligible but not enrolled (1996)

• Only 1 in 3 children enrolled in Medicaid visited the dentist in the past year

• Coverage does not guarantee access to oral health care.

GAO 2000

What Dentists Can Do

• Practice in rural or underserved areas• Accept Medicaid• See young children, or refer to pediatric

dentists• Provide anticipatory guidance to pregnant

moms• Be active in dental organizations• Be an active member in the community

What MCH Non-Dental Professionals Can Do

• Be aware of oral health issues affecting clients and refer to dentists

• Do not dismiss dental concerns as trivial• Be aware of the recommendation for the age

one dental visit• Work with dentists to improve access and

reduce barriers to care• Be an active member of the MCH community

and lobby for oral health

Oral Health: How to Keep Your Child’s

Teeth HealthyFebruary 11th, 2009

Julia Anne Richman, DDSJessica De Bord DDS

Penelope Leggott DDS MS

Department of Pediatric DentistryUniversity of Washington

Goals of this Presentation

Parents and families will learn

• About tooth eruption and dental development

• How to help keep children’s baby and permanent teeth healthy, and prevent cavities

• Why oral health is important for pregnant moms

• What things you need to go and see a dentist for

Primary (Baby) Tooth Development and Eruption

• Tooth development begins at 4-6 weeks after conception

• The first primary tooth comes in at approx 6 months

• The permanent teeth develop in close proximity to the primary teeth

Six year molar Eye tooth/cuspid

Differences between baby and permanent teeth

• Baby teeth are whiter and smaller than permanent teeth

• Baby teeth have thinner enamel (outer covering) and cavities can grow faster when the enamel is damaged

• The first permanent teeth to come in are the lower front incisors (age 6)

Baby teeth

Permanent teeth

How do I prevent my child from getting cavities?

What are cavities?

What are Cavities?• Cavities are caused by germs, or bacteria,

on the teeth

• Most of us carry these cavity-causing bacteria in our mouths

• The bacteria can be spread from a mother or caregiver to a baby

• When we don’t brush our teeth, bacteria build up on the teeth to become plaque, sticky white stuff that can cause cavities easily

Cavities

• The bacteria feed on the sugars in foods and make acids

• When children get lots of sugar exposures in a day (snacks and juice), the bacteria can make acids all day. The acids dissolve tooth surfaces, causing defects which become cavities over time

Dissolving tooth surface

Enamel defect

Cavity

Early Tooth DecayWhite Spots (pre-cavities)

You can stop pre-cavities from getting worse!

Cavities• Why are cavities bad for children?

– Pain

– Difficulty sleeping

– Difficulty concentrating at school

– Difficulty eating and speaking

– The need for fillings or crowns at a young age

– Teeth may need to be pulled (extracted)

• This can lead to future crowding of the teeth

– Teeth roots can get infected, called an abscess

– Sickness or death as a result of the infection

Why Fix Cavities in Baby Teeth?

• Cavities in baby teeth will not go away or get smaller- Cavities can spread to other teeth in the

mouth

- They need to be fixed to get rid of the disease

damaged enamel on developing permanent tooth

abscess

How do I prevent my child from getting cavities?

What are cavities?

Prevention

• Cavities are an infection that can be prevented with: – Good brushing – A diet low in sugary and starchy foods

• Healthy teeth don’t have cavitiesHealthy mouth

Healthy body

Prevention Tips for Parents

• Serve water, not pop or juice

• Give fruits and vegetables, not fruit snacks, chips, crackers, or sweets as snacks

• Brush twice a day and floss every day

• Take your child to the dentist every 6 months starting by age 1

• 3 meals and 2 tooth friendly snacks each day

• Wean from the bottle by age 12-14 months

Snacking

Snacks which are not healthy for children’s teeth:•Fruit juice•Soda pop•Gatorade•Crackers •Chips•Sweet snacks

•Gummy bears and fruit snacks

Starchy Snacks

Snacks like chips, pretzels, and crackers have starch or carbohydrates•Carbohydrates are a form of sugar•Carbohydrates turn into sugar in the mouth•Starchy snacks cause cavities just like sweet snacks•Children should not eat starchy snacks frequently•Teeth should be rinsed or brushed after children eat starchy snacks

Snacking

Healthy snacks for teeth and bodies are:• Vegetables like carrots, celery, cucumbers

• Fresh fruit

• Lean meat

• Cheese

• Nuts

• Water

Tooth Brushing Tips

• Start brushing your child’s teeth when they come in

• Brush twice a day using a small soft toothbrush

• A smear of fluoride toothpaste should be used

• Babies and young children may not like tooth brushing, but it is very important for health

When should I take my child to the dentist?

What kinds of things do I need to go to the dentist for?

A Visit to the Dentist

• Babies should visit the dentist no later than their 1st birthday

• At that visit, the dentist will check the teeth, brush them, and put fluoride on them

• The dentist will talk to you about how to take care of baby teeth

A Visit to the Dentist

• Some people think that young children are too young to go to the dentist

• Babies and toddlers will usually cry when their teeth are checked

• Even if a baby or toddler cries, the visit to the dentist is very important for their health

• A pediatric dentist, or child dentist, has special training to take care of young children

How does the dentist fix cavities in a young child?

•Small cavities can be fixed easily and quickly in the office

•If a child has a lot of cavities or has big cavities, they may need medicine to make them sleep when the cavities are fixed

•This medicine is called general anesthesia

When should I take my child to the dentist?

What kinds of things do I need to go to the dentist

for?

See a dentist as soon as possible for:• Pain, swelling, fever• Chipped or loose tooth (injury)• Gums are very red and bleed easily

See a dentist in the next few days:• Gums bleed when teeth are brushed• Something looks like a cavity (no pain)• Teeth aren’t coming in straight• Loose tooth

abscess

Did You Know?

• Taking care of your mouth while you are pregnant is very important for you AND your baby.

• Children born early (< 33 weeks), are 12 times more likely to have cavities at ages 3-5 years

• Cavity-causing bacteria can be spread from a mother to her baby

• 28% of children age 2-5 years have cavities

Take Home Messages!

• Children’s oral health is part of their overall health

• Cavities are preventable• Limit “sugar” exposures• Take your child to get

his/her teeth checked by age one

www.cliffordbeers.org/ www.hazelwood.k12.mo.us

Thank You!