CHS 483 Lecture 2 By Dr. Ebtisam Fetohy

1. CHS 483 Lecture 2 By Dr. Ebtisam Fetohy

2. Health professionals should refer infants to a dentist for an oral examination 6 months after the first tooth erupts or by age 12 months (whichever comes first). • Health professionals can promote the oral health of infants and children by learning about oral development, oral diseases, oral hygiene, fluoride, nutrition, and injury and violence prevention and by sharing information with parents and working in partnership with oral health professionals.

3. By age 6 months, every infant should begin to receive oral health risk assessments from a health professional. • One of the most important ways for health professionals to ensure that infants and young children enjoy optimal oral health is by performing risk assessments to identify those at risk for oral health problems, including: dental caries (the disease process leading to tooth decay), periodontal disease, malocclusion (improper alignment of the jaws and teeth), and injury.

4. Dental caries, begins early in an infant’s or child’s life, and it is now recognized as a bacterial infection that can be transmitted from a parent or another intimate to an infant or child. Since the most likely source of such infection in infants is the mother or another caregiver, health professionals should identify women at high risk for dental caries as early as possible (preferably during pregnancy) to provide anticipatory guidance (e.g., on oral hygiene and feeding practices) and early intervention.

5. This section of the lecture addresses the following topics: • Child Health Professional’s Role in Promoting Oral Health • AAP Recommendations for an Oral Health Risk Assessment • Learning Objectives

6. Child Health Professionals’ Role in Promoting Oral Health • See children early and regularly. • Become experts in oral health prevention strategies. • Advocate for child health: Oral health is part of overall health!

7. American Academy of Pediatrics (AAP) Recommendations for an Oral Health Risk Assessment • Assess mothers’/caregivers’ oral health • Assess oral health risks of infants/children • Recognize signs and symptoms of caries. • Assess child’s exposure to fluoride. • Provide anticipatory guidance brush/floss (oral hygiene instructions). • Make timely referral to a dental home.

8. Learning Objectives • Understand the role of the child health professional in assessing children’s oral health. • Understand the pathogenesis of caries. • Conduct an oral health risk assessment. • Identify prevention strategies. • Understand the need for establishing a dental home. • Provide appropriate oral health education to families.

9. Overview of Dental Caries and Early Childhood Caries This section addresses the following topics: • Prevalence of Dental Caries • Early Childhood Caries • Early Childhood Caries Can Lead to … • Consequences of Dental Caries

10. Prevalence of Dental Caries • 5 times more common than asthma • 7 times more common than hay fever Caries Rate • 18% aged 2 to 4 years • 52% aged 6 to 8 years • 67% aged 12 to 17 years

11. Early Childhood Caries • A severe, rapidly progressing form of tooth decay in infants and young children • Affects teeth that erupt first, and are least protected by saliva Initial lesions—white decalcification with beginning enamel breakdown Late stage lesions—moderate to severe enamel and dentin destruction

12. Early Childhood Caries Can Lead to… • Extreme pain • Spread of infection • Difficulty chewing, poor weight gain • Falling off the growth curve • Extensive and costly dental treatment • Risk of dental decay in adult teeth • Crooked bite (malocclusion)

13. Consequences of Dental Caries • Missed school days • Impaired language development • Inability to concentrate in school • Reduced self-esteem • Possible facial cellulitis requiring hospitalization • Possible systemic illness for children with special health care needs

14. Pathophysiology of Caries Process This section addresses the following topics: • Factors Necessary for Caries • Tooth • Oral Flora • Oral Flora: Pathogenesis of Caries • Oral Flora: How Does Infection Occur? • Fluoride’s Influence on Oral Flora • Substrate: You Are What You Eat • Substrate: Environmental Influences • Not Just What You Eat, But How Often

15. Factors Necessary for Caries

16. The susceptibility of teeth varies with: age, fluoride exposure, morphology, crowding, nutritional status (including trace elements), and presence of acid (carbonic acid). • The enamel of the tooth is the portion of the tooth where the caries process begins. • Enamel is composed mainly of minerals in the form of hydroxyapatite. • Primary tooth enamel is thinner than permanent tooth enamel.

17. Factors Necessary for Caries • Caries can occur if oral flora contain acid-producing bacteria such as Streptococcus mutans. • The growth of the bacteria is determined by: • frequency of exposure, • amount and kind of substrate available for metabolism, • the state of oral hygiene, and • presence of fluoride.

18. Oral Flora • Normal oral flora = billions of bacteria. • Intraoral bacterial colonization occurs before the eruption of the first tooth.

19. Oral Flora: Pathogenesis of Caries • An infectiousprocess • Initiated by pathogenic bacteria—Streptococcus mutans and Streptococcus sobrinus

20. Oral Flora: How Does Infection Occur? • Transmitted mainly from mother or primary caregiver to infant • Window of infectivity is first 2 years of life • Earlier child colonized, the higher the risk of caries

21. Fluoride’s Influence on Oral Flora • Promotes remineralization of enamel, and may arrest or reverse early caries • Decreases enamel solubility • Inhibits the growth of cariogenic organisms, thus decreasing acid production • Concentrated in dental plaque • Primarily topical even when given systemically

22. Substrate: You Are What You Eat • Caries is promoted by carbohydrates, which break down to acid. • Acid causes demineralization of enamel. • Frequent snacking promotes acid attack. • Foods with complex carbohydrates (breads, cereals, pastas) are major sources of “hidden” sugars. • High sugar content in sodas is a source of these substrates.

23. Substrate: Environmental Influences • Saliva inhibits bacterial growth. • Unremoved plaque promotes the caries process. Red disclosing tablet reveals plaque

24. Not Just What You Eat, But How Often • Acids produced by bacteria after sugar intake persist for 20 to 40 minutes. • Frequency of sugar ingestion is more important than quantity.

25. Breastfeeding • The American Academy of Pediatric (AAP) and American Academy of Pediatric Dentistry (AAPD) strongly endorse يؤيدbreastfeeding. • Although breastmilk alone is not cariogenic, it may be when combined with other carbohydrate sources. • For frequent nighttime feedings with anything but water after tooth eruption, consider an early dental home referral.

26. History: Determining Caries Risk This section addresses the following topics: • High-Risk Groups for Caries • Children With Special HealthCare Needs (CSHCN) • Common Issues Among Children With Special Health Care Needs • Socioeconomic Factors • Ethnocultural Factors • Fluoride Exposure

27. High-Risk Groups for Caries • Children with special health care needs • Children from low socioeconomic and ethnocultural groups • Children with suboptimal exposure to topical or systemic fluoride • Children with poor dietary and feeding habits • Children whose caregivers and/or siblings have caries • Children with visible caries, white spots, plaque, or decay

28. Children With Special Health Care Needs (CSHCN) Recommendations for Child Health Professionals: • Be aware of oral health problems or complications associated with medical conditions. • Monitor impact of oral medications and therapies. • Choose non–sugar-containing medicationsif given repeatedly or for chronic conditions. • Refer early for dental care (before or by age 1 year) and collaboration with a pediatric dentist is especially important for CSHCN.. • Emphasize preventive measures (fluoride, oral hygiene, healthy feeding/dietary habits). Damage caused by holding medications in mouth

29. Common Issues Among Children With Special Health Care Needs • Children with asthma and allergies are often on medications that dry salivary secretions as antidepressants, and other psychoactive drugs, increasing risk of caries. • Children who are preterm or low birthweight have a much higher rate of enamel defects and are at increased risk of caries. • Children with congenital heart disease are at risk for systemic infection from untreated oral disease.

30. Socioeconomic Factors The rate of early childhood dental caries is near epidemic proportion in populations with low socioeconomic status: • No health insurance and/or dental insurance • Parental education level less than high school or GED • Families lacking usual source of dental care • Families living in rural areas. Rural areas are often Health Professional Shortage Areas (HPSA).

31. Ethnocultural Factors • Beliefs about: • Health, • Disease , diet, and • Hygiene in different cultures May create additional oral health risk factors through: • Dietary/feeding practices and • Child-rearing habits.

32. Ethnocultural Factors/2 • For example, high-risk behaviors might include: • acidic snacks in Hispanic populations and • pre-mastication of children’s food in some AI/AN groups and Asian populations. • In some cultures, it is common for extended families to live in one household. These families may find it preferable to feed infants in the night rather than tolerate crying that disturbs other family members.

33. Ethnocultural Factors/3 For example, high-risk behaviors might include/2: D. Some families who live in fluoridated communities in the US may chose to drink bottled water that may not contain fluoride because they believe community water quality is poor like in their country of origin. In general, community water supplies are completely safe—bottled water is not necessary.

34. Physical: Oral Health Assessment This section addresses the following topics: • Maternal Primary Caregiver Screening • Child Oral Health Assessment • Positioning Child for Oral Examination • Primary Teeth Eruption • What to Look For • Check for Normal Healthy Teeth • Check for Early Signs of Decay: White Spots • Check for Early Signs of Decay: Brown Spots • Check for Advanced/Severe Decay • American Academy of Pediatric Dentistry (AAPD) Caries Risk Assessment Tool (CAT)

35. Fluoride Exposure • Determine fluoride exposure:systemic versus topical • Fluoridated water • 58% of total population • Optimal level is 0.7 to1.2 ppm • Significant state variability • CDC fluoridation map

36. Maternal/Primary Caregiver Screening • Assess mother’s/caregiver’s oral history. • Document involved quadrants. • Refer to dental home if untreated oral health disease.

37. Maternal/Primary Caregiver Screening/2 • Although child health professionals may not be used to assessing maternal health issues, they routinely take a health history when assessing medical conditions that are heritable or transmissible. • Because cariogenic bacteria can be transmitted from primary caregiver to child, an oral health history provides an opportunity for: • The child health professional to better understand a child’s risk for early colonization and also provides • Educating the caregiver about caries prevention.

38. Maternal/Primary Caregiver Screening/3 A mother’s/caregiver’s oral assessment does not need to involve a physical examination, but can be done by asking key questions such as: • How are your teeth? • Have you had a lot of cavities? • Do you have a regular dentist? • When was your last visit to the dentist? • Have you ever had a tooth filled? • Have you had a lot of dental work done?

39. Primary Teeth Eruption

40. What to Look For • Lift the lip to inspect soft tissue and teeth • Assess for - Presence of plaque or debris on teeth (oral hygiene) - Presence of white spots or dental decay - Presence of tooth defects (enamel) - Presence of dental crowding • Provide education on brushing using the appropriate-sized toothbrush and diet during examination.

41. Check for Normal Healthy Teeth

42. Check for Early Signs of Decay: White Spots

43. Check for Later Signs of Decay: Brown Spots

44. Check for Advanced/Severe Decay

45. AAPD Caries Risk Assessment Tool (CAT)

46. AAPD Caries Risk Assessment Tool (CAT)

47. AAPD Caries Risk Assessment Tool (CAT)

48. Anticipatory Guidance This section addresses the following topics: • Anticipatoryتوقعي Guidance • Minimize Risk for Infection • Xylitol for Mothers • Substrate: Contributing Dietary and Feeding Habits • Toothbrushing Recommendations • Toothpaste and Children • Toothpaste • Optimizing Oral Hygiene: Flossing

49. Minimize Risk for Infection • Address active oral health disease in mother/caregiver. • Educate mother/caregiver about the mechanism of cariogenic bacteria transmission. • Mother/caregiver should model positive oral hygiene behaviors for their children. • Recommend xylitol chewing gum to mothers/caregiver.

50. Anticipatory Guidance • Minimize risk of infection. • Optimize oral hygiene. • Reduce dietary sugars. • Remove existing dental decay. • Administer fluorides judiciouslyبتعقل .