Challenges with Key Messages

› Breastfeeding & bottle-feeding › Baby teeth matter › Benefits of fluoride to oral health

Access to Dental Care › Registering a child for non-insured health benefits (NIHB) › Where to go in Winnipeg › Where to go in rural regions – MDA website

Communication

› Motivational interviewing › Relaying information › Manitoba Poverty Tool

› Breastfeeding & bottle-feeding › Baby teeth matter › Benefits of fluoride to oral health

• Challenge: “I thought breast milk did not cause tooth decay… isn’t it healthy?”

• Breast milk is best

• However it also contains sugars which can increase the risk of early childhood caries (ECC)

• It is NOT the act of breastfeeding itself that

increases the risk for ECC

• It IS breastfeeding on demand without any home oral hygiene routine

that increases the risk of ECC

• Tooth decay happens when teeth are exposed to sugars for long

periods of time

Breastfeeding resource available

on our website!

• Remove baby from breast after feeding to ensure they swallow the last mouthful of milk

• Wipe along the gum line once daily with a warm cloth (for both breastfeeding and bottle-feeding)

• Optimal time to wipe gums is bed time OR bath time!

• Benefits of wiping the gums include a greater chance of a positive experience when the child sees the dentist

• Challenge: “I can’t seem to get my two year old to stop using the bottle…”

• Recommended age to wean off of the bottle is by age 1

• Children who continue to use a bottle after one year may increase the risk of damaging their smiles later in life

• Propping bottles also increase the risk for ECC as it keeps the drink around baby’s teeth where bacteria will get at them

• Challenge: “My child will only go to sleep with a milk

bottle!”

• If a bedtime/naptime bottle is necessary, give plain water only.

• Even formula and other healthy drinks lead to ECC if they are put in bedtime/naptime bottles

Milk Milk

Milk Milk

Water

Water

Water Water

Week 1 Week 2 Week 3 Week 4

• Those having trouble weaning a child off of a bottle by age 1or if the child is used to falling asleep with a bottle of milk can try gradually introducing water into the bottle and increasing that amount slightly around a 4-6 week period

• By week 4-6, the child will either continue taking the water bottle

or will avoid the bottle entirely reducing the risk for ECC

• Along with wiping milk off of the gum line, optimal time to check for signs of tooth decay is at bed time OR bath time!

• Current recommendation is to lift the lip once a

month

Brown areas Decayed spots are

present – see dentist right away

Severe Decay Visit dentist right away

Healthy teeth Visit dentist by 1st

birthday

Whitish lines Tooth decay could be starting – see dentist as

soon as possible

• Challenge: “I don’t need to take care of my baby’s teeth… don’t they just fall out anyway?”

• Baby teeth are very important to children for many reasons:

• Learning how to eat • Learning how to speak • Help shape the face • Guide the adult teeth to the right place in the mouth

• Early childhood caries (ECC) on baby teeth greatly affects a child’s health and wellness!

Growth & Development • Speech development • Height • Weight and Body Mass Index (BMI)

Common Pediatric Illnesses & Conditions • Otitis media • Respiratory tract infections • Iron deficiency & nutritional deficiencies

Quality of Life • Eating patterns • Pain • Sleep • Behaviour

Fluoride resource available on our

website!

Prevent ECC by brushing baby teeth with fluoride toothpaste! • Fluoride toothpaste is safe for

all ages and especially recommended for children under 3 years who are at high risk for decay

• Help the child brush their teeth until 8 years old

• Use appropriate amount of toothpaste!

• There are mixed messages even amongst dental professionals regarding the use of fluoride toothpaste for those under 3 years of age

• The Canadian Dental Association (CDA)’s position statement states: A grain of rice amount of fluoride toothpaste is recommended for those under 3 who are at HIGH RISK for tooth decay

• Those at HIGH RISK include:

• Living in a region without a fluoridated water supply

• Child regularly consumes sugar (even natural sugars) between meals

• Child’s teeth are brushed < once a day or they have special healthcare needs limiting cooperative abilities

• Parent or caregiver has tooth decay

• Child has visible plaque, cavity, notch, defect, or white chalky area on the teeth

• Child was born prematurely (birth weight <3 pounds)

• Challenge: “I’ve looked up fluoridated water online… is it actually necessary for optimal dental health?”

• Fluoride prevents tooth decay by inhibiting plaque bacteria and promotes remineralization of teeth therefore reducing the risk for caries

• An ideal public health initiative because it is: • Effective • Safe • Inexpensive • Requires no cooperative effort or direct action • Does not depend on access or availability of professional

services

• The entire population of the community benefits regardless of financial resources

• Challenge: “Doesn’t the addition of fluoride into the water cause risk?”

• Here is the TRUTH…

• Fluoride is VERY well controlled and a mandatory test is done daily to ensure safety

• Reports are sent to Manitoba Health and they are notified if levels are outside recommended range

• Dental fluorosis occurs when too much fluoride is ingested when teeth are developing (during childhood)

• Effects of dental fluorosis range from very mild

(white specks on the teeth) to pitting, brown discoloration of teeth

A child under 8 would have to drink 15 glasses of water DAILY for a prolonged period to get MILD dental fluorosis!

• Safety aspects of water fluoridation have been extensively

studied and the concentration used is not toxic or harmful

• The optimal range of fluoride use for water fluoridation already has a built-in margin of safety that takes into account other sources of fluoride use such as toothpaste and rinses

› Registering a child for non-insured health benefits (NIHB) › Where to go in Winnipeg › Where to go in rural areas – MDA website

• Those with First Nations or Inuit status qualify for non-insured health benefits (NIHB) which cover health services not covered by the province, country, or other private insurance plans

• NIHB cover a variety of dental services ranging from preventive to restorative treatment

• People may have difficulty registering their infant under their status which poses challenges for the dental team to promote first dental visit

• Challenge: “How do I register my child for benefits?”

• First Nations and Inuit may register their child at any Aboriginal Affairs and Northern Development Canada (AANDC) Regional Office or at any First Nation office:

• Manitoba Regional Office located at: 365 Hargrave Street Winnipeg, Manitoba R3B 3A3

• Or register via phone: 1-800-567-9604

• Or online (must choose correct form) at AANDC Government website: http://www.aadnc-aandc.gc.ca

• Many dental centers in Winnipeg offer services at a reduced cost

• Some centers offer services to those without dental insurance

• WRHA interpreters are available

to assist clients if needed

“Where to Go” resource available at Healthy Smile Happy Child’s website:

http://www.wrha.mb.ca/healthinfo/preventill/oral_child.php

General dentistry includes: diagnostic services, preventive care, fillings, extractions, and other basic care

EIA = Employment & income assistance NIHB = Non-insured health benefits

IFH = Interim Federal Health Program (Refugees) VAC = Veteran Affairs Canada PI = Private insurance

General dentistry includes: diagnostic services, preventive care, fillings, extractions, and other basic care

EIA = Employment & income assistance NIHB = Non-insured health benefits

IFH = Interim Federal Health Program (Refugees) VAC = Veteran Affairs Canada PI = Private insurance

General dentistry includes: diagnostic services, preventive care, fillings, extractions, and other basic care

EIA = Employment & income assistance NIHB = Non-insured health benefits

IFH = Interim Federal Health Program (Refugees) VAC = Veteran Affairs Canada PI = Private insurance

Check out http://www.manitobadentist.ca to go to the Manitoba Dental Association’s official website. Select the “Find a Professional”

link to search for dental professionals in your area

Search for dental professionals in your region by postal code, city, specialty, as well as those offering a free first visit for children under 3

years of age

› Motivational interviewing › Relaying information › Manitoba Poverty Tool

• Defined as “a collaborative conversation to strengthen a person’s own motivation for and commitment to change”

• Involves guiding instead of directing, and listening just as much as telling

• NOT a technique to trick people into thinking what the practitioner wants them to think

• Three basic elements include:

• Collaboration (vs. Confrontation) • Evocation

(Drawing out vs. Imposing ideas) • Autonomy (vs. Authority)

• Motivational interviewing (MI) is evidence based and includes many dimensions for patient care

• We will briefly discuss four strategies to assist practitioners with communication through motivational interviewing

• The four strategies (O.A.R.S.) are:

• Open ended questions

• Affirmations

• Reflective listening

• Summarize

• Gather broad descriptive information • Facilitate dialogue • Often start with words like “how” or “what” or “tell me about” • Avoid asking questions where the response is a yes or no Eg: “Tell me more about John’s current tooth brushing routine.”

Strategy #1: Open Ended Questions

Strategy #2: Affirmation • Recognize the client’s strengths • Be sincere • Support and promote self-efficacy • Acknowledge any difficulties • Validate

Eg: “I think it’s wonderful that you are working hard at brushing John’s teeth even though it’s not easy. It sounds like his oral health is very important to you.”

• Begins with a way of listening • Includes an interest in what the person has to say and a desire to truly

understand how the person sees things or how they feel • What you think a person means may not be what they actually mean

Eg: “You mentioned that you have difficulty brushing John’s teeth in the morning.” Strategy #4: Summarize

Strategy #3: Reflective Listening

• Repeating back what the client has said • Communicates interest and understanding • Shows that you have been listening carefully

and prepares the client to move on

Eg: “It sounds like you have been having difficulty brushing John’s teeth because John isn’t very cooperative and there isn’t much time before school starts.”

More information on Motivational Interviewing can be found at HSHC website

• An effective strategy for communicating with clients is through the use of imitating and demonstrations

• Being able to act out proper technique helps clients to fully understand the messages and lowers the risk of misinterpretations

• Gives parent/caregiver the opportunity to try out the technique themselves • One example of an excellent demonstration is the “knee to knee” demonstration

• Allows practitioners to show parents/caregivers how to effectively brush their child’s teeth

• May also be used to show “lift the lip” to check for early signs of tooth decay

• Messages communicated to clients should be:

• Simple & short sentences

• Personalized for each client

• At a Grade 8 reading level or lower

• Include the use of props whenever possible

• The Manitoba College of Family Physicians published a clinical tool including three ways to address poverty:

• Screen Everybody! • Adjust the risk Consider poverty as

a risk factor when assessing health • Intervene Do they have benefits?

Refer to appropriate services

• A number of income referral websites are also listed to support clients including:

• Easy to use government websites (eg. Service Canada)

• One on one services (eg. Community Financial Counselling Services)

• Advocacy-oriented services (eg. Community Unemployed Help Centre)

The Manitoba Poverty Tool document can be found at: http://www.gov.mb.ca/health/primarycare/providers/docs/clinicaltool.pdf