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Dental Facts for the Frontline. Danielle G. Dooley, MD, MPhil, FAAP Pediatrician Unity Health Care. Is Your Child Care, Practice or Organization Dental-Friendly?. Education Preparation Prevention. Are You Advocating for Oral Health?. Ways child care providers can advocate:

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Dental Facts for the Frontline

Danielle G. Dooley, MD, MPhil, FAAP


Unity Health Care

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Is Your Child Care, Practice or Organization Dental-Friendly?

  • Education

  • Preparation

  • Prevention

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Are You Advocating for Oral Health? Dental-Friendly?

  • Ways child care providers can advocate:

    • Learn about oral health issues

    • Teach dental hygiene to the children you serve

  • Ways advocacy organizations can advocate:

    • Educate policy makers at local, state and federal level

    • Organize a dental advocacy campaign

  •  Ways doctors can advocate:

    • Learn updates on oral health care

    • Learn to do an oral health risk assessment

    • Talk to patients about oral health

    • Work with advocacy organizations to educate policymakers and the public

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Topics for Today Dental-Friendly?

  • Why early intervention matters

  • Tooth development and decay

  • Baby bottle tooth decay

  • Teeth grinding

  • Thumbsucking

  • Dental emergencies

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Good Oral Hygiene Habits Start EARLY! Dental-Friendly?

  • 90% of all cavities are preventable with good oral hygiene and dental care

  • The younger a child is when they develop dental caries, the more likely they are to have future dental disease

    Poland, Charles. Promoting Oral Health in Young Children.

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Teeth are in Jeopardy Dental-Friendly?

  • There is a silent epidemic of dental disease in our country

  • This epidemic affects poor and minority children the most- these children are 5X as likely to have untreated tooth decay than other kids

    Krol, David M. Educating Pediatricians on Children’s Oral Health: Past, Present, and Future. Pediatrics 2004;113:e487-492

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Why Are Teeth in Jeopardy? Dental-Friendly?

  • Dental caries, or cavities, is the most common chronic disease among children in the United States (5X more common than asthma!)

  • 50% of kids have at least one cavity by the time they start elementary school

  • Teenagers have an average of 8 cavities by the time they are 17 yrs old

    Poland, Charles. Promoting Oral Health in Young Children.

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Where do Kids Learn to Keep Their Teeth Healthy? Dental-Friendly?

  • Dentists

  • Pediatrician

  • Family

  • School/Child Care

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Dental Access is a Problem Dental-Friendly?

  • Many kids have never been to the dentist- 1 out of 10 kids between the ages of 5 and 10 have NEVER seen a dentist

  • There are not enough pediatric dentists in the United States to meet the health needs of children

  • Kids from low income families are 5X as likely to have untreated tooth decay due to poor access to dental services

    Poland, Charles. Promoting Oral Health in Young Children.

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Pediatricians Don’t Have the Training or the Time Dental-Friendly?

  • American Academy of Pediatrics declared in May 2003 that all pediatricians should be able to perform oral health risk assessments starting at 6 months of age

  • 60% of pediatricians have not received any oral health training

  • 75% of pediatricians consider their knowledge of oral health inadequate

    Krol, David M. Educating Pediatricians on Children’s Oral Health: Past, Present, and Future. Pediatrics 2004;113:e487-492

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There Just Isn’t Time! Dental-Friendly?

  • In a standard 15 minute well child visit, pediatricians must:

    • Talk with the parents

    • Examine the child

    • Address other topics such as violence and injury prevention, nutrition, breastfeeding, school issues, developmental issues

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What is a Tooth? Dental-Friendly?

  • Crown- above the gum

  • Root- below the gum; makes up 2/3 of the total length of the tooth!

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Enamel Dental-Friendly?

  • Enamel- white covering that protects tooth from wear and tear of chewing

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Dentin Dental-Friendly?

  • Dentin- supports the enamel; carries the nerve fibers that sense hot/cold/pain

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Pulp Dental-Friendly?

  • Pulp- center of the tooth; soft tissue containing blood, nerves. Carries nutrition to the tooth.

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Types of Teeth Dental-Friendly?

  • Incisors- teeth in the very front; sharpest; made to cut food and shovel it into mouth

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Types of Teeth Dental-Friendly?

  • Canine- corners of mouth; meant for grasping and tearing food

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Types of Teeth Dental-Friendly?

  • Molars- last teeth towards the back of the mouth; big flat surfaces for chewing and grinding food into smaller pieces

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Tooth Development Dental-Friendly?

  • At birth, children have 20 primary teeth

  • Teeth start erupting at about 6 months of age

  • Children shed their baby teeth starting at about 6 years of age

  • By age 21, they have all 32 of their permanent teeth

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Tooth Development Dental-Friendly?

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Why Are Baby Teeth Important? Dental-Friendly?

  • Baby teeth are important for:

    • Learning to eat

    • Learning to speak

    • Saving a space for the permanent teeth (if baby teeth are lost or decay early, then there is less space for the permanent teeth and this causes crowding)

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What is Tooth Decay? Dental-Friendly?

  • Tooth destruction caused by interaction between teeth, food, and bacteria

  • Streptococcus Mutans is the main bacteria involved in tooth decay

  • Bacteria in the saliva sticks to teeth in a thick film called plaque

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Tooth Decay Dental-Friendly?

  • When kids eat starchy foods, the bacteria break down the starch to produce acids that attack the tooth enamel

  • Repeated acid attacks cause the tooth to decay in the form of a cavity, or pit in the tooth

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Is the Bacteria that Causes Tooth Decay Contagious? Dental-Friendly?

  • YES

  • Adults have a high concentration of S. mutans in their mouths which can be spread in saliva

  • Sharing forks, spoons; allowing children to put fingers into adult’s mouth; testing the temperature of a bottle with the mouth

  • Caregivers need to practice good oral hygiene too!

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Who is at Increased Risk for Tooth Decay? Dental-Friendly?

  • Children in communities without fluoridated water or where kids drink mostly bottled water

  • Children from low income families

  • Children from racial and ethnic minority groups

  • Children with limited or no dental insurance

  • Children with special health care needs- Down’s syndrome, cleft palate

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Is There a Familial Component to Tooth Decay? Dental-Friendly?

  • YES!

  • In 71% of mother-infant pairs, identical genotypes of S. mutans have been found

  • Children of mothers with high caries rates are at a higher risk of decay

  • Proper dental hygiene in mothers has been shown to decrease the rate of caries in kids

    Section on Pediatric Dentistry. Oral Health Risk Assessment Timing and Establishment of the Dental Home. Pediatrics 2003;111:1113-1116

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How to Prevent Tooth Decay? Dental-Friendly?

  • Proper brushing

  • Proper snacking

  • Fluoride

  • Regular dental visits

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Cleaning Infant Teeth Dental-Friendly?

  • Begin cleaning an infant’s teeth as soon as the first tooth erupts

  • Use a soft cloth to wipe the tooth down or a very soft toothbrush with plain water

  • No toothpaste!

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Cleaning Toddler Teeth Dental-Friendly?

  • Ages 2 and up

  • Brush with a pea sized amount of toothpaste using a soft toothbrush

  • Have the child spit out the toothpaste after brushing but do not rinse with water

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When Can Kids Brush by Themselves? Dental-Friendly?

  • It is important for young children to participate in tooth brushing by helping to hold the toothbrush

  • They have the fine motor skills to clean their teeth well by age 7 or 8 years

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Snacks that are Good for Smiles Dental-Friendly?

  • Avoid sticky, sugary snacks- cookies, cake, candy, sodas

  • Fruits, vegetables, whole grain snacks are best

  • Snack at regular times- don’t allow all-day snacking!

  • Offer the child plenty of water (not juice!), especially with snacks

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What is Fluoride? healthy smiles!

  • Mineral that increases tooth strength

  • Main source of fluoride is public water systems; it is also found in toothpaste

  • Exposure to fluoride can reduce tooth decay by 50-70%

  • Most important method of preventing tooth decay

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Why Don’t Our Kids Get Enough Fluoride? healthy smiles!

  • Most bottled water contains no fluoride

  • Due to lead service lines in the District of Columbia, many families are opting to use bottled water for their kids

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Is There Such a Thing as Too Much Fluoride? healthy smiles!

  • YES

  • Don’t give fluoride toothpaste to kids under 2 years- if they swallow too much toothpaste the fluoride can cause spots on their teeth

  • Avoid fluoride mouth rinses in kids under 6 years- they will get more than enough fluoride from their toothpaste

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When Should Kids go to the Dentist? healthy smiles!

  • Recommendation from the ADA and AAP is that kids have their first visit to the dentist by age 1 year

  • Reality is that many families do not have access to dental services and there is a shortage of pediatric dentists

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Baby Bottle Tooth Decay healthy smiles!

  • Occurs when kids are put to bed with a bottle or allowed to have bottle in their mouth for long periods of time

  • Parents and caregivers often give a bottle to encourage sleep or quiet the child and feel it is cruel to deny food to the infant

  • Affects 5-10% of children

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Baby Bottle Tooth Decay healthy smiles!

  • Milk or juice pools in the child’s mouth around the teeth and remains there for long periods, allowing dental cavities to form

  • There is not a lot of saliva produced in the mouth during sleep, so there is nothing to wash away the milk or juice

  • The bacteria in the mouth interact with the sugars in the liquid to produce acid and cause tooth decay

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What does Baby Bottle Tooth Decay Look Like? healthy smiles!

  • Upper front teeth and incisors are affected most

  • Loss of glossy appearance to enamel- white spot lesions

  • Flat brown, yellow spots

  • Occasionally teeth are broken

Very early tooth decay

Tooth decay

Severe tooth decay

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What About Breastfed Babies? healthy smiles!

  • Breastfeeding does not automatically protect babies from dental caries

  • If breastfed babies feed for extended periods of time, they develop the same pattern of caries as bottle fed babies

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Baby Bottle Tooth Decay is Preventable! healthy smiles!

  • Educate parents not to put baby to bed with a bottle- by 4 months of age, most babies do not need feedings during the night

  • Don’t use the bottle as a pacifier- allow kids to have it only at mealtime

  • Transition kids from a bottle to a cup by 1 year of age

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What if the Baby Really Needs the Bottle to go to Sleep? healthy smiles!

  • Alternatives to bottles to calm an infant or help them get to sleep:

    • Favorite blanket or toy

    • Clean pacifier

    • Holding, patting, rocking the infant

    • Reading to the infant

    • Softly talking or singing to the infant

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Teeth Grinding healthy smiles!

  • Also known as bruxism

  • Usually occurs during sleep, pattern of jaw clenching and teeth grinding

  • 3/10 kids have this problem, most are under 5 years of age

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What Causes Teeth Grinding? healthy smiles!

  • No one really knows

  • Some possible causes are:

    • Stress- situations at home or school that cause tension or anger

    • Improper alignment of top and bottom teeth

    • Response to pain such as earache or teething pain

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What are the Effects of Teeth Grinding? healthy smiles!

  • Usually it is more bothersome to the parents than the child

  • In severe cases, can wear down tooth enamel, chip teeth, cause facial pain

  • Most kids outgrow teeth grinding

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How is Teeth Grinding Treated? healthy smiles!

  • Visit the dentist, who will examine the child’s teeth for chipped enamel and proper alignment

  • If either of these exist, then the dentist may make a special mouthguard for the child to wear at night

  • Try to address stressful circumstances in the child’s life and help them relax before going to bed

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Thumbsucking healthy smiles!

  • Many children suck their thumbs, fingers, or a pacifier

  • Natural reflex for infants

  • Soothing

  • Induces sleep

  • Helps them to explore the world around them by sucking on their fingers or other objects

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Thumbsucking healthy smiles!

  • Most children give up this habit between the ages of 2-4 years

  • If kids still have a sucking habit after age 4, they should see a dentist

  • Most problems from sucking habits start around age 6, when the permanent front teeth come in

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Thumbsucking healthy smiles!

  • Intensity of sucking determines whether children develop problems with their teeth

  • Kids who rest their thumb in their mouth are less likely to develop dental problems

  • Problems caused include misalignment of the teeth and changes in the roof of the mouth

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Thumbsucking healthy smiles!

  • Upper front teeth flare out and tip upward

  • Lower front teeth move inward

  • Roof of mouth becomes arched or caved in

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Tips to End a Thumbsucking Habit healthy smiles!

  • Praise children for NOT sucking their thumb or pacifier

  • Address the child’s anxiety or discomfort so they don’t need to suck to soothe themselves

  • Pick certain times during the day when kids cannot suck their thumb

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Common Dental Emergencies healthy smiles!

  • Toothache

    • Call the parent

    • Suggest they take the child to a dentist as soon as possible

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Cut or Bitten Tongue, Lip, Cheek healthy smiles!

  • Apply ice to area

  • If bleeding is present, apply pressure with a clean cloth

  • If bleeding does not stop after 15 minutes, notify parent and take the child to the doctor or ER

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Knocked-Out Permanent Tooth healthy smiles!

  • Try to find the tooth

  • Handle it by the top, not the root

  • Rinse the tooth briefly in water

  • Try to reinsert the tooth in the socket and have the child hold it there by biting on a clean piece of cloth

  • If it cannot be reinserted, transport the tooth in a cup of milk

  • Go to the dentist immediately

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Broken Tooth healthy smiles!

  • Rinse dirt from tooth and injured area with water

  • Place cold compresses on face in area of injury

  • Try to locate and save any tooth fragments

  • Go to the dentist immediately

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Bleeding after a Baby Tooth Falls Out healthy smiles!

  • Place clean gauze over the bleeding area

  • Have the child bite on the gauze with pressure for 15 minutes

  • If bleeding continues after 15 minutes, take the child to the dentist

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Current Legislation healthy smiles!

  • Oral Health Promotion Act of 2005 (HR 594 IH), Rep. Bernard Sanders (VT).

    • Amends SCHIP to add dental services.

    • Allows States the option of using Federal SCHIP funds to cover dental expenses for a child eligible for Medicaid.

    • Establishes the Community Oral Health Expansion Fund to expand the availability of oral health services through community-based centers. Funds may be used for demonstration projects and demonstration partnerships with Head Start programs.

    • Requires States to contribute, directly or indirectly, up to 10% of demonstration project costs.

    • As of February 25, 2005, the bill was referred to House subcommittee on Health.

Source: Library of Congress. HR 594 IH. May 31, 2005.

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Is Your Child Care, Practice or Organization Dental-Friendly?

  • Education

  • Preparation

  • Prevention

  • Advocacy

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Acknowledgements Dental-Friendly?

For more information about this presentation or for additional resources, please contact Docs For Tots:

Docs For Tots

1522 K Street NW, Suite 600

Washington, DC 20005

A Nationwide Network of Doctors Advocating for Young Children