Ontario Curriculum, Grades 1—8: Health and Physical Education, 2009.

GRADE

FOUR ORAL HEALTH CURRICULUM

The dental public health professional association, Ontario Association of Public Health Dentistry (OAPHD), has specially created the following Grade 4 oral health module to align with the new Ontario Curriculum, Grades 1—8: Health and Physical Education, 2009.

OAPHD would like to acknowledge the following Ontario Public Health Units for their collaborative effort in the development of this resource:

Brant County Health Unit

Chatham-Kent Health Unit

Public Health Services City of Hamilton

Haldimand-Norfolk Health Unit

Haliburton Kawartha Pine Ridge District Health Unit

Halton Region

Hastings and Prince Edward Counties Health Unit

Niagara Region Public Health

Oxford County

Region of Peel – Public Health

Porcupine Health Unit

Region of Waterloo Public Health

Simcoe Muskoka District Health Unit

Sudbury and District Health Unit

Wellington-Dufferin-Guelph Health Unit

York Region (Grade 7 Mouth guards)

OAPHD is very interested in your feedback on the following module. Please take a few moments to complete the following survey: http://www.surveymonkey.com/s/VL2QLV9

General Topic – Grade 4 - Healthy Eating

This section covers the following expectations from The Ontario Curriculum, Grades 1—8: Health and Physical Education, 2010.

• C1.1 identify the key nutrients (e.g., fat, carbohydrates, protein, vitamins, minerals) provided by foods and beverages, and describe their importance for growth, health, learning, and physical performance

• C3.1 identify ways of promoting healthier food choices in a variety of settings and situations (e.g., school, arena, recreation centre, stores, food courts, special events; when camping, having a snack or meal at a friend’s house, eating on weekends versus weekdays)

• C3.2 Describe the short- and long-term effects of first- and second-hand smoke on smokers and on people around them.

Activities

• Label Reading: Understanding the contents of food and beverages, and the implications on oral health (This activity can also be linked with a lesson on nutrition.)

• Make a Menu (This activity can also be linked with a lesson on nutrition.)

• Healthy Teeth Scramble

• Creative Writing – What Would Your Body Say? (This activity can also be linked with a creative writing or health lesson.)

• Draw a Picture – Something Fun You Can Do When Not Using Tobacco (This activity can also be linked with an art or health lesson.)

Additional Resources:

• Canadian Diabetes and Dieticians of Canada:

o Fact sheets, information: http://www.healthyeatingisinstore.ca/

o Virtual grocery store: http://www.healthyeatingisinstore.ca/virtual_grocery.asp

• Health Canada: www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/beverage-boisson/index_e.html

o Food Label Quiz: http://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/interactive-eng.php

o Brushing and Flossing Video: http://www.hc-sc.gc.ca/hl-vs/oral-bucco/care-soin/techniques-eng.php

o Youth Zone (Tobacco): http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/youth-jeunes/index-eng.php

o Canada’s Food Guide: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php

• Eat Right Ontario: http://www.eatrightontario.ca/en/ViewDocument.aspx?id=63&Topic=5&Cat=216

(Please note that the location of URL’s can change over time.)

Healthy Tooth Formation

Tooth Growth and Formation

• By now, you should have all of your primary (or baby) teeth; and, by age six or seven, your first adult (or permanent) teeth have started to come in.

• The first teeth that come in are known as your “first molars” or the six-year molars. These teeth do not replace your primary or baby teeth; they are new ones and come in at the back of your mouth.

• Also, at around age 6, you started to lose your primary or baby teeth. You will lose all of your primary teeth by about 12 years of age.

• By 13 years of age, you will have 28 adult or permanent teeth. The chart below highlights the tooth name and the approximate age that the tooth comes in at.

Tooth Name Approximate Age Tooth

Comes In

Central Incisor 7-8 years

Lateral Incisor 8-9 years

Canine 11-12 years

First Premolar 10-11 years

Second Premolar 10-12 years

First Molar 6-7 years

Second Molar 12-13 years

Food for Healthy Tooth Formation Your bodies need lots of vitamins and nutrients to grow healthy and strong. This includes your teeth too! To ensure healthy growth and development, your teeth need:

• Calcium: the main component of strong teeth (with help from phosphorus and Vitamin D), and can be found in yogurt, milk, and cheese

o Phosphorus: eggs, beef, poultry, halibut, and bread

o Vitamin D: trout, mackerel, salmon, tuna, milk, and egg yolk

• Vitamin A: is necessary for the formation of the strong outer layer of your teeth (enamel), and can be found in liver, pumpkin, carrots, sweet potato, mango, spinach, and broccoli

• Vitamin C: is essential for healthy gums, and can be found in citrus fruits (oranges, grapefruit), cantaloupe, strawberries, tomatoes, and cabbage

Tooth Decay

• A main cause of tooth decay is dietary sugar, which mixes with bacteria (plaque: clear sticky film that clings to your teeth) in your mouth to create acid. This acid weakens the hard outer layer of your tooth (enamel).

• Common sources of dietary sugar include: chocolate, cookies, cakes, and pastries, as well as drinks with added sugar, for example, fruit drinks, carbonated beverages (pop), and sports and energy drinks. But, “sugar” doesn’t always appear on your food labels, so it is important to check for these common “hidden sugars”. There are many types of sugars (commonly ending in “ose”) used in products, a few examples that you may see on a food label include:

o Corn sweeteners

o Maltose

o Dextrose

o Fructose

o Glucose

o Honey

o Maple syrup

o Molasses

o Sucrose

• Glucose (dextrose, grape or corn sugar): is less sweet than table sugar and is common in sweet fruit and vegetables, such as berries, oranges, carrots, and corn

• Fructose (fruit sugar): is much sweeter than cane sugar and is found in honey and ripe fruit

• Sucrose (table sugar): is found in cane or beet sugar, brown sugar, and molasses

• Lactose (milk sugar): is produced by animals and is found in milk

• Maltose (malt sugar): is found in malted breakfast cereals and some infant formulas

• Although white milk, chocolate milk, and 100% fruit and vegetable juices are healthy beverage options, they do contain naturally occurring sugar that can contribute to the risk of tooth decay if they come in contact with teeth for a prolonged amount of time. With regard to the affect it has on teeth, naturally occurring sugar is no different than added sugar.

• How often you consume sugar (frequency: continuously sipping drinks with added sugar, like pop and fruit drinks, or drinks with naturally occurring sugar, such as milk or 100% fruit juice) and how long sugar lingers in your mouth (duration: continuously sucking on hard candies) contributes to the risk of tooth decay. The more sugary foods you eat and drink, and the longer these foods and drinks stay in your mouth, the more likely you are to develop tooth decay.

• Sugary foods and carbohydrates that are sticky (i.e. dried fruit, granola bars, gummies, and toffee) cling to your tooth’s surface, increasing the duration of sugar on the tooth and the tooth’s exposure to decay-causing acid.

The Process of Tooth Decay

• Tooth decay occurs when sugary foods are frequently left on your teeth. The bacteria (plaque) already in your mouth feed on the sugar and produce acid. This acid attacks the hard outer layer of your tooth (enamel), which weakens it and causes tooth decay.

Plaque + Sugar = Acid ���� Acid + Tooth = Decay

• If the affected tooth is left untreated, the decay can spread into the dentin, which is the slightly softer layer under the enamel that forms the bulk of the tooth.

• If still not treated, the decay penetrates to the pulp, which is the soft centre tissue of the tooth containing blood vessels and nerve tissue. An abscess (infection) may form at the root of the tooth. At this point, if the tooth is not treated by root canal therapy, the tooth may be destroyed.

Preventing Tooth Decay – Making Healthy Choices

• Choose foods that increase saliva flow to help cleanse your teeth and dilute the sugar in your mouth, for example:

o Eggs

o Plain yogurt (recommend < 2% M.F. [Milk Fat])

o Fish/meat/poultry

o Seeds

o Plain popcorn

o Fruit (hard and crisp, like apples)

o Vegetables

o Cheese (recommend < 20% M.F. [Milk Fat])

o Sugarless gum

• Limit sugary foods, for example sweets, and serve them only at mealtime, when your saliva levels are high. Again, your saliva will help cleanse your teeth and dilute the sugar in your mouth.

• Snacking between meals, when saliva levels are low, can leave your teeth susceptible to acid. Choose nutritious snacks between meals that work to cleanse your teeth (listed above). Also, drink water for thirst between meals. Water is a sugar-free way to keep hydrated, and is the only drink that is completely safe for your teeth (it cannot cause tooth decay). Plus, water is also good overall health too.

Enamel

Dentin

Pulp (nerve)

• Limit how often (frequency) you consume sugar (both added and naturally occurring) and how long (duration) sugar is in your mouth. Avoid sucking on hard candies (duration) and sipping drinks with added or naturally occurring sugar (frequency), as these can increase your risk of tooth decay.

• Avoid sticky foods, for example dried fruit, granola bars, gummies, and toffee, because they cling to your teeth longer and increase your exposure to decay-causing acid.

Sugar Contents of Common Drinks The table below highlights the sugar contents of some of your favourite drinks.

Nutrition Facts Labels

• Watch your labels. The ingredients are listed in descending order of quantity. The ingredient present in the largest quantity is listed first and the ingredient in the smallest quantity is listed last.

• Watch for added sugars (same examples as listed above: corn sweeteners, maltose, dextrose, fructose, sucrose, glucose, molasses, and honey). Limit your consumption of foods and beverages with these ingredients, particularly when sugar or its other chemical names appear high on the ingredients list.

Drink (600 ml)

Actual

Water 0 tsp

Milk 8 tsp (natural)

100% Fruit juice 18 tsp (natural)

Flavoured milk 16 tsp (8 added + 8 natural)

Sports drink 12 tsp (added)

Fruit drink 18 tsp (16 added + 2 natural)

Chocolate bar milkshake 23 tsp (14 added + 9 natural)

Pop 17 tsp (added)

Energy drink 16 tsp (added)

2 L – pop 58 tsp (added)

• It is important for you to look at your labels closely, as they can often be misleading; sometimes the label gives you the nutrition information for only part of the container/package, for example: nutritional label reads 250ml for a drink bottle size of 500ml. (This means that there is more than one serving in the container and the nutrition facts need to be interpreted accordingly.)

• To determine the total amount of sugar and calories in your food and drinks, you must multiply totals on the label with the number of servings you are going to eat or drink.

o Example:

� Bottle size: 500ml of pop

� Serving size: 250ml of pop

� Sugar (based on 250ml serving): 25g

• Servings of pop consumed: = bottle size ÷ serving size

= 500 ÷ 250

= 2

• Amount of sugar consumed: = sugar X number of servings

= 25g X 2

= 50g

• Number of teaspoons of sugar = grams of sugar ÷ 4

= 50g ÷ 4

= 12.5 teaspoons

o Therefore, based on the example above, if you drank the entire 500ml of pop, you consumed two servings, which is equal to 50g of sugar.

• Avoid drinks with added sugar (e.g. fruit drinks, pop, sports drinks, and energy drinks). These drinks should only be consumed occasionally and at mealtime when saliva levels are high; this will help neutralize the acid caused by the high sugar contents.

• Healthy drink choices with naturally occurring sugar, like 100% fruit juice or milk should be saved for mealtime. Remember, naturally occurring sugar has the same effect on the teeth as added sugar!

Tobacco and Oral Health

Using tobacco products, including smoking tobacco and smokeless tobacco (snuff/spit) can have serious adverse effects on your overall health, including your oral health.

Smoke Tobacco

Side effects of smoke tobacco on your oral health include:

• Nicotine addiction

• Reduced sense of smell

• Reduced sense of taste

• Bad breath, stained teeth, and recession of the gum line

• Accumulation of tartar (calculus) and plaque

• Increased sensitivity to hot and cold foods and drinks

• Delayed healing after dental work

• Increased heart rate

Smokeless Tobacco

Smokeless tobacco can also be referred to as “snuff” and “spit”. Smokeless tobacco is held in the mouth between the teeth and cheek. Smokeless tobacco is absorbed rapidly into the bloodstream, making it more addictive than regular, smoking tobacco.

Side effects of smokeless tobacco on your oral health include:

• Nicotine addiction - chewing an average amount for 30 minutes is like smoking four cigarettes

• Reduced sense of smell

• Reduced sense of taste

• Bad breath, stained teeth, and recession of the gum line

• Changes in the colour and texture of the tissue in the mouth

• Accumulation of tartar (calculus) and plaque

• Ulcers, upset stomach, and increased bowel activity

• Increased sensitivity to hot and cold foods and drinks

• Delayed healing after dental work

• Increased heart rate

Oral Hygiene

• Proper oral hygiene is the best way to prevent tooth decay. Brush your teeth twice daily with a pea-sized amount of fluoridated toothpaste for two minutes each time, and floss your teeth once daily.

• Your teeth affect your life in many ways. A healthy mouth allows you to chew and swallow foods and drinks, as well as speak and smile. To achieve and maintain a healthy smile, you must keep your teeth clean.

• Keeping your teeth clean is critical to maintaining a healthy smile and preventing cavities. The plaque (clear sticky film) bacteria (already present in your mouth) mix with sugar (from the foods and drinks you consume) to produce acid. It is this acid that wears away the hard outer layer of your teeth (enamel), and produces a cavity. Therefore, we must work hard to remove the bacteria that cling to your teeth by brushing and flossing daily.

Brushing

• You should brush your teeth two times a day for two minutes each time (hard scrubbing should be avoided – to prevent gum recession and tooth sensitivity) with a pea-sized amount of fluoride toothpaste.

• Ask your parent/caregiver to help to make sure you are doing a good job. (The Canadian Dental Association recommends to continue supervising until your child can write (not print) on their own.)

• Hold your toothbrush at a 45-degree angle and gently brush in circular strokes from where the tooth and gum meet to the tip of the tooth. Be sure to brush all outside and inside surfaces of each tooth.

• Clean the pits and crevices on the chewing surface of your teeth with short sweeping strokes. And, brush your tongue to remove bacteria and to freshen your breath.

Style of toothbrush

• When selecting a toothbrush, remember the following:

o Your toothbrush should have a small head so it is easy to move around inside your mouth, and should fit comfortably in your hand.

o Your toothbrush should have soft bristles.

Toothbrush Maintenance

• Rinse your toothbrush with water after every use and let air dry.

• Replace your toothbrush when it has become visibly worn or frayed (typically after 3 months).

• Replace your toothbrush after any illness, cold, or flu.

Flossing

• Flossing is also important to keep your mouth clean and free from bacteria. Flossing helps remove bacteria from in between your teeth – where your toothbrush cannot reach.

• It is important to have your parent/caregiver help you floss.

• To floss, start with a 30-35 cm (elbow’s length) piece of floss and wrap the floss around your two middle fingers.

• For your upper teeth, use your two index fingers and thumbs to guide the floss. Your thumbs should be on the outside.

• For your lower teeth, use your two index fingers; when guiding the floss, your fingers should be no more than 2.5cm apart.

• Gently guide the floss between your teeth using a “see-saw” motion.

• Move the floss up and down on the side in of the tooth in a “C” shape motion 2-3 times or until clean.

Financial Assistance for Oral Care There are limited programs available in Ontario for children and youth with no dental insurance. The following list provides a description of what is available.

• Children In Need Of Treatment (CINOT) dental program provides emergency dental treatment for children 0-17 years of age whose families are not on social assistance, do not have insurance, and cannot afford to pay for their dental treatment. (http://www.mhp.gov.on.ca/en/healthy-communities/dental/default.asp)

• Healthy Smiles Ontario (HSO) is a new program for children and youth

0-17 years of age who do not have access to any form of dental coverage. This is a preventive and basic dental care program. Children and youth who are members of a household with an Adjusted Family Net Income of $20,000 per year or below may be eligible. (http://www.health.gov.on.ca/en/public/programs/dental/)

References American Dental Association. (2005). Watch your smile. Retrieved from http://www.ada.org/3257.aspx#top American Dental Association. (2002). Diet and tooth decay. Journal of the American Dental Association, 133, 527. Calgary Health Region. (2009). Community oral health re-think your drink. Retrieved from http://www.calgaryhealthregion.ca/programs/dental/pdf/rtyd/rtyd_display07.pdf Canadian Dental Association. (2005). Tobacco and oral health. Retrieved from http://www.cda-adc.ca/en/oral_health/complications/tobacco/index.asp Health Canada. (2008). The effects of oral health on overall health. Retrieved from http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/life-vie/dent-eng.php Ministry of Health and Long-Term Care. (2010). Healthy Smiles Ontario. Retrieved from http://www.health.gov.on.ca/en/public/programs/dental/ Ministry of Health Promotion and Sport. (2010). Dental Health (CINOT). Retrieved from http://www.mhp.gov.on.ca/en/healthy-communities/dental/default.asp Ontario Dental Association. (2010). Food and your teeth. Retrieved from http://www.youroralhealth.ca/food-a-your-teeth.html

Activity 1: Label Reading

Materials Needed:

• Food and beverage labels (assorted) • Copies of the attached “Look at the label” handout

Preparation:

Teacher Students

• Bring to class additional food and beverage labels for variety (ensure to collect labels for sticky sweet foods and drinks with added and naturally occurring sugar)

• Print attached “Look at the label” handout for each student

• Bring to class one food or beverage label

Activity:

Teacher Students Time Required

Introduction: • Divide the class into small

groups (3 to 4 students) Content: • Distribute the “Look at the label”

handout. • Have students work together to

analyze their food and beverage labels, considering their oral health and overall health

Conclusion: • Discuss the food and beverage

labels, and how these items affect their oral and overall health (i.e. hidden sugars [1 tsp or sugar = 4 grams of sugar])

• Discuss how the consumption of these foods and beverages (i.e. frequency and duration) can

• Students will be divided

into small groups • Students will work

together to analyze their food and beverage labels using the “Look at the label” handout

• Students will discuss

which food and beverage labels contained the most sugar and identify hidden sugars (i.e. honey, molasses, sugars ending in “ose”)

• 1 hour (30

minutes for group work and 30 minutes for discussion)

have further implications on their oral health

Activity 2: Make a Menu

Materials Needed:

• Copies of attached menu template • Canada’s Food Guide (as a reference): http://www.hc-sc.gc.ca/fn-an/food-

guide-aliment/index-eng.php

Preparation:

Teacher

• Print copies of attached menu template for each group

Activity:

Teacher Students Time Required

Introduction: • Divide the class into small

groups (3 to 4 students) Content: • Have students work together,

using Canada’s Food Guide and the information in the lesson plan, to make a menu (template included) of three balanced meals and three snack options that are healthy for both their oral and overall health

• Encourage students to consider drinks with both added and naturally occurring sugar and sticky foods that can cling to teeth

Conclusion: • Discuss the students’ choices,

and how nutritious foods benefit their oral and overall health

• Students will be divided

into small groups • Students will work

together to make a menu of three balanced meals and three snack options that are healthy for both their oral and overall health

• Students will discuss

their menus and explain how the meal and snack options are healthy for both their oral and overall health

• 1 hour (30

minutes for group work and 30 minutes for discussion

Activity 3: Healthy Snacks Scramble

Materials Needed:

• Copies of the attached activity sheet

Preparation:

Teacher

• Print attached activity sheet for each student

Activity:

Teacher Activities Student Activities Time Required

Introduction: • Distribute the activity sheet to

students to work independently Content: • Review the importance of eating

healthy foods and drinking healthy beverages for strong teeth

• Students will work

independently

• 15 minutes

Activity 4: Creative Writing – What Would Your Body Say?

Materials Needed:

• Copies of the attached writing sheet

Preparation:

Teacher

• Print attached writing sheet for each student

Activity:

Teacher Activities Student Activities Time Required

Introduction: • Distribute the activity sheet to

students to work independently Content: • Review the importance of living a

healthy lifestyle – one that does not include tobacco. Encourage students to think about the effect of tobacco (smoke and smokeless) on their mouth, as well as the rest of their body.

Conclusion: • Have students volunteer to read

their creative writing piece aloud, as well as generate discussion on the adverse health effects of tobacco

• Students will work

independently

• 30 minutes

Activity 5: Draw a Picture – Something You Can Do When Not Using Tobacco

Materials Needed:

• Copies of the attached drawing sheet

Preparation:

Teacher

• Print attached drawing sheet for each student

Activity:

Teacher Activities Student Activities Time Required

Introduction: • Distribute the drawing sheet to

students to work independently Content: • Review the importance of living a

healthy lifestyle – one that does not include tobacco. Encourage students to think about the effect of tobacco (smoke and smokeless) on their mouth, as well as the rest of their body. Encourage students to think of activities that they can do when not influenced by tobacco

Conclusion: • Have students share their

pictures, discussing different activities they can do when not using/being around tobacco

• Students will work

independently

• 30 minutes

Make a Menu

In small groups, design a menu (breakfast, lunch, dinner, and three

snack options) that includes healthy foods and beverages that benefit

your oral and overall health.

Breakfast Lunch Dinner

Snack 1 Snack 2 Snack 3

Healthy Teeth Scramble

mcuialc

___ ___ ___ ___ ___ ___ ___

lmki

___ ___ ___ ___

seehce

___ ___ ___ ___ ___ ___

sminvati

___ ___ ___ ___ ___ ___ ___ ___

racsotr

___ ___ ___ ___ ___ ___ ___

gesg

___ ___ ___ ___

prpshhoous ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

sihf

___ ___ ___ ___

raenog

___ ___ ___ ___ ___ ___

ehett

___ ___ ___ ___ ___

Healthy Teeth Scramble

Answer Guide

mcuialc calcium

lmki milk

seehce cheese

sminvati vitamins

racsotr carrots

gesg eggs

prpshhoous phosphorus

sihf fish

raenog orange

ehett teeth

What Would Your Body Say?

If it could talk, what would your body say about

breathing someone else’s tobacco smoke?

_______________________________________

_______________________________________

_______________________________________

_______________________________________

_______________________________________

_______________________________________

_______________________________________

_______________________________________

_______________________________________

_______________________________________

Instead of using or being around

tobacco, I like to…