1 / 89

Oral Health and Primary Care

Oral Health and Primary Care. Lessons from the Tooth Fairy Suzanne Boulter, MD South Carolina Chapter Meeting July 23, 2011. Disclosures. No disclosures of financial nature Will mention off label use of product (fluoride varnish). Goals for Today. Review the importance of caries

hisa
Download Presentation

Oral Health and Primary Care

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Oral Health and Primary Care Lessons from the Tooth Fairy Suzanne Boulter, MD South Carolina Chapter Meeting July 23, 2011

  2. Disclosures • No disclosures of financial nature • Will mention off label use of product (fluoride varnish)

  3. Goals for Today • Review the importance of caries • Discuss etiology of early childhood caries • Learn about Bright Futures and AAP recommendations for oral health screening in your office

  4. Tooth Fairy Consultation • Four questions • Six lessons

  5. Question 1 • Most children can start brushing their own teeth without supervision at what age: • 2 years • 4 years • 6 years • 8 years

  6. Question 2 • Both the AAP and AAPD policy statements recommend that all children have their first dental visit by the following age: • 6 months • 1 year • 2 years • 3 years

  7. Question 3 • Early childhood caries requires which bacteria to develop: • Staph aureus • Strep mutans • Hemophilus influenzae • Lactobacillus species

  8. Question 4 • CDC recently updated its recommendation for public drinking water fluoridation to which of the following • 0.3 ppm • 0.7 ppm • 1.2 ppm

  9. Tooth Fairy Lesson 1 Overview of Early Childhood Caries – Prevalence and Significance

  10. Early Childhood Caries – What Is It? • A severe, rapidly progressing form of tooth decay in infants and young children • Affects teeth that erupt first, and are least protected by saliva

  11. Prevalence Dental caries is: • 5 times more common than asthma • 7 times more common than hay fever

  12. Children and Tooth Decay • 28% of US children age 2-5 have dental caries, increased from 24% in prior survey* • Possible factors • Parents too busy to supervise brushing • Changes in diet (more sugar) • Use of bottled water without added fluoride *“Trends in Oral Health Status: United States, 1994-1998 and 1999-2004”

  13. Significance of Caries • What is the importance of oral disease in the population?

  14. Oral Disease is Consequential • Missed work/school – 51 million school hours lost per year • Low income children missed 12 times more days than children from more affluent families • Distraction from normal activities including learning • Speech and eating dysfunction • Growth delay • Loss of wages and potential loss of job

  15. Oral Disease is Consequential • Pain & infection – cellulitis, abscess • High cost of surgery for severe ECC ($12,000/case) • Hospitalization, surgical intervention, death (Deamonte Driver) • Emergency room visits; antibiotics; pain medications; “See your dentist in the morning” ($400-$500/visit)

  16. Tooth Fairy Lesson 2 Pathophysiology of Caries

  17. Three Factors Needed for Caries • Bacteria • Teeth • Carbohydrates

  18. Factors Necessary for Caries

  19. Bacterial Biofilm (plaque) • Dental plaque, loaded with bacteria, covers tooth surfaces • Most mouth flora are benign; about 500 types of bacteria are present with about 25 potential pathogens • Microbiological shifts in the biofilm (plaque) can inhibit or promote caries • Caries is an infection initiated by the pathogenic bacteria – mainly Streptococcusmutans • Selwitz.R ,Ismail. N, Pitts.B: Dental Caries.Lancet Vol. 369 Jan 6, 2007

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

  21. Factors Necessary for Caries

  22. Tooth • Pathogenic bacterial colonization does not start until the eruption of teeth

  23. Primary Teeth Eruption

  24. Factors Necessary for Caries

  25. Substrate: You Are What You Eat • Caries development is promoted by carbohydrates which break down to acid • Acid causes demineralization of enamel

  26. You Are What You Drink - Sugar in 12 Ounce Can of Soda Pop Soda Pop: Sugar: (in teaspoons) • Orange Slice 11.9 • Minute Maid Orange 11.2 • Mountain Dew 11.0 • Barq’s Root Beer 10.7 • Pepsi 9.8 • Dr. Pepper 9.5 • Coca-Cola 9.3 • Sprite 9.0

  27. pH Safe zone Danger zone 6 7 8 9 10 11 12 1 Bottle Breakfast Snack Sippy-cup Sippy-cup Lunch Not Just What You Eat,But How Often • Acids produced by bacteria after sugar intake persist for 20-40 minutes • Frequency of sugar ingestion is more important than quantity

  28. Breastmilk as a Substrate • Unclear evidence whether breastmilk is cariogenic • Cautions on frequent night-time and on-demand breastfeeding after tooth eruption • Potential for early childhood caries (ECC) • exists with extended and repetitive feeding times without appropriate oral hygiene

  29. The Dynamic Balance Bacteria + Sugar + Reduced Saliva Flow Saliva + Fl, Ca, Antibacterials GOAL = Balance between remineralizing and demineralizing factors

  30. Tooth Fairy Lesson 3 Demographics of Caries Risk

  31. High-Risk Groups for Dental Caries • Children with special health care needs • Children whose caregivers and/or siblings have caries • Children with poor dietary and feeding habits

  32. High Risk for Dental Caries • Children with sub optimal exposure to topical or systemic fluoride • Children who are exposed to cigarette smoke at home (JAMA.2003;289:1258-1264) • Children eligible for Medicaid

  33. Common Issues Among CSHCN • Children with asthma and allergies are often on medications that dry salivary secretion increasing risk of caries • Children who are pre-term or Low Birth Weight (LBW) 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

  34. Children 2-4 Years Who Have Ever Had Caries in Primary Teeth, 1988-94 and 1999-2000 Percent 1999-2000 1988-94 2010 Target Female Male Total White Black Mexican American Obj. 21-1a Source: National Health and Nutrition Examination Survey, NCHS, CDC.

  35. Tooth Fairy Lesson 4 Oral Health Risk Assessment

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

  37. Bright Futures 3rd Edition Themes • Oral Health • Healthy Sexuality • Safety and Injury Prevention • Community Relationships and Resources • Child Development • Family Support • Mental Health and Emotional Well-Being • Nutritional Health • Physical Activity • Healthy Weight

  38. Bright Futures Recommendations • Oral health risk assessment performed • Anticipatory guidance given • Fluoride modalities addressed • Referral to dental home

  39. Assess Caretakers Risk Factors • Screen for dental home of parent/caretaker • History of parental decay in prior year • Refer caregiver to dental home

  40. Assess Child’s Risk Factors • Continual bottle/sippy cup use with any liquid other than water • Frequent snacking • Special health care needs • Medicaid eligible/low health literacy level

  41. Assess Clinical Factors • Lift the lip to inspect soft tissue and teeth • Assess for: • Presence of plaque • Presence of white spots or dental decay • Presence of enamel defects • Presence of dental crowding

  42. Child Assessment Position • Position child in caregiver’s lap facing caregiver • Sit with knees touching knees of caregiver • Lower the child’s head onto your lap

  43. Use gentle downward finger pressure behind lower lip on lower incisors to open the child’s mouth If child has a lot of plaque present, brush or wipe with gauze

  44. Check for Normal Healthy Teeth

  45. Check for Early Signs of Decay:White Spots

  46. Check for Later Signs of Decay:Brown Spots

  47. Check for Advanced /Severe Decay

  48. Assess for Fluoride • Systemic • Water fluoridation • Prescription supplements • Topical • Toothpaste • Varnish • Mouth rinse

  49. Systemic Fluoride Supplements and Tap water

More Related