Children’s Oral Health & the Primary Care Provider
This presentation is the property of its rightful owner.
Sponsored Links
1 / 23

Children’s Oral Health & the Primary Care Provider PowerPoint PPT Presentation


  • 74 Views
  • Uploaded on
  • Presentation posted in: General

Children’s Oral Health & the Primary Care Provider. Oral Screening Exam Module 3. Module 3 Objectives:. Learn to perform a knee-to-knee oral screening exam for infants & toddlers

Download Presentation

Children’s Oral Health & the Primary Care Provider

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Children s oral health the primary care provider

Children’s Oral Health & the Primary Care Provider

Oral Screening Exam

Module 3


Module 3 objectives

Module 3 Objectives:

  • Learn to perform a knee-to-knee oral screening exam for infants & toddlers

  • Learn helpful tips to gain access to a child’s mouth & restrain a child’s body movements during an oral screening exam

  • Learn to identify clinical findings predictive of high caries risk for infants & toddlers

  • Learn to identify caries in its different stages

    (non-cavitated (white spots) vs. cavitated lesions)


Knee to knee oral screening exam

Knee-to-Knee Oral Screening Exam

Step 1: Child is held facing caregiver

in a straddle position

Step 2: Child leans back onto examiner while caregiver holds child’s hands and legs

Step 3: Provider performs exam while caregiver effectively restrains child’s hands and legs


Equipment for the oral screening exam

Equipment for the Oral Screening Exam

  • Disposable gloves

  • Good light source

  • Disposable mirror (optional)

  • Toothbrush or gauze (for plaque removal)


Performing an oral screening exam

Performing an Oral Screening Exam

  • Place the child in the knee-to-knee position

  • Restrain child’s head and body movements

  • Lift the child’s upper lip and lower child’s lower lip

Lift-the-Lip Procedure


Knee to knee position dental setting

Knee-to-Knee Position: Dental Setting

Double-click the picture to begin the video clip


Knee to knee position medical setting

Knee-to-Knee Position: Medical Setting

Double-click the picture to begin the video clip


What clinical findings are predictive of high caries risk

What Clinical Findings Are Predictive of High Caries Risk?


Previous caries experience

Previous Caries Experience

  • One of best predictors of future caries

  • For children under age 5, a history of decay should automatically classify a child as high risk

  • Not useful caries-risk predictor

    for infants and toddlers

    (insufficient time for ECC

    to be expressed)


Visible plaque

Dental Plaque

Dental Plaque

Visible Plaque

  • One of the best predictors of future caries risk in young children

  • Screening for visible plaque is easy and inexpensive


White spot lesions

White Spot Lesions

  • Also referred to as non-cavitated lesions

  • Initial stage (precursor) of the caries process

  • Equivalent to caries for infants and toddlers

Chalky, white spots on primary teeth are demineralized areas and are considered early decay


White spot lesions1

White Spot Lesions

Are often:

  • Observed next to the gum line

  • Accompanied by plaque

  • Accompanied by bleeding gums (gingivitis)

Chalky, white spots on primary teeth are demineralized areas and are considered early decay


From white spots to frank caries

Figure 1

Figure 2

Figure 3

From White Spots to Frank Caries


Children s oral health the primary care provider

  • Yellow arrows show white spot lesions (non-cavitated) close to the gum line

  • Green arrow and circle show an area where the enamel is starting to break down and a frank cavity (cavitated lesion) is starting to develop


Children s oral health the primary care provider

  • Yellow arrows show white spot lesions

    (non-cavitated lesions)

  • Green arrow show frank cavities

    (cavitated lesions)


Children s oral health the primary care provider

  • All pictures show advanced frank cavities (cavitated lesions) that have reached the nerve (pulp) of the teeth. These children are in pain and need immediate and/or emergency dental treatment

  • Green arrow shows the presence of an abscess due to a necrotic tooth


Enamel defects stained pits and fissures

Enamel Hypoplasia

Stained Pits

and Fissures

Enamel Defects & Stained Pits and Fissures

  • Enamel hypoplasia

  • Stained pit and fissure surfaces of primary teeth

  • Consider these indicative of increased caries risk


Presence of braces and oral appliances

Presence of Braces and Oral Appliances


Caries risk assessment and management

Caries Risk Assessment and Management

  • Any observable decay or demineralization (white spots):

    - Refer for dental care as soon as possible

  • Any factors on the oral screen (or parent interview) that increase the child’s risk for caries:

    - Refer for dental care

  • Uncertain caries risk:

    - Refer for dental care

  • Refer to your I-Smile Coordinator for care, assistance with referrals & to ensure dental care is established

  • Re-assess to ensure the child has been evaluated by a dentist & has established regular dental care


I smile coordinators

I-Smile Coordinators

I-Smile coordinators are dental hygienists who serve as prevention experts and liaisons between families, health care professionals, and dental offices to ensure completion of dental care. Coordinators are located in regional public health agencies and provide local community support throughout Iowa. I-Smile Coordinators can:

  • Assist with dental referrals for young children.

  • Provide Medicaid dental billing information.

  • Offer education for healthcare professionals regarding children’s oral health, including screening and fluoride varnish training.

I-Smile Coordinator contact information can be found at: www.idph.state.ia.us/hpcdp/oral_health.asp or

I-Smile hotline 1-866-528-4020


Summary oral screening exam

Summary: Oral Screening Exam

Use the knee-to-knee position for oral screening exams

Clinical findings predictive of high caries risk for infants and toddlers:

previous caries experience

visible plaque

white spot lesions

enamel defects

stained pits and fissures

oral appliances


Children s oral health the primary care provider

Summary: Oral Screening Exam

  • During an oral screening exam remember to:

    • Restrain the child’s head and body movements

    • “Lift-the-lip”: lift the upper lip & pull down the lower lip to examine the child’s teeth

    • Dry the child’s teeth to examine for white spot lesions

    • Remove plaque using a toothbrush or gauze to examine for possible white spot lesions under plaque


Children s oral health the primary care provider

Summary: Oral Screening Exam

  • Refer a child for dental care as soon as possible if any caries or white spot lesions are observed

  • Refer for dental care if any of the clinical findings predictive of high caries risk are observed and/or if you are uncertain of the child’s caries risk

  • Refer to your I-Smile Coordinator for care & to ensure dental care is established


  • Login