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Oral Health for MCAH Populations. Children’s Oral Health Program Contra Costa Health Services November 2008. Presentation Outline. Overview Early childhood caries Periodontal disease and perinatal health Adolescent oral health: Oral piercing and grills Prevention of dental decay

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Oral health for mcah populations

Oral Health for MCAH Populations

Children’s Oral Health Program

Contra Costa Health Services

November 2008

Presentation outline
Presentation Outline

  • Overview

  • Early childhood caries

  • Periodontal disease and perinatal health

  • Adolescent oral health: Oral piercing and grills

  • Prevention of dental decay

  • Access to oral health care

  • Take-home messages

A silent epidemic
A Silent Epidemic

  • Dental disease is the most common chronic and infectious disease affecting children in the U.S.

  • Five times more common than asthma

  • 7% of Contra Costa children miss school because of a dental problem

National policy
National Policy

  • All children should see a dentist by age one or six months after the eruption of the first tooth

    • American Academy of Pediatrics

    • American Academy of Pediatric Dentistry

What are early childhood caries ecc
What are Early Childhood Caries (ECC)?

  • Previously known as Baby Bottle Tooth Decay (BBTD) or Nursing Caries

  • Can appear as soon as the first tooth erupts (around 6 months of age)

ECC is an infectious and transmissible disease; however, it is preventable

Ecc is an infectious transmissible disease
ECC is an infectious, transmissible disease

  • Mutans streptococci, lactobacilli, and other acid-producing bacteria

  • Transmission is both vertical and horizontal


  • Can begin even before the eruption of teeth

The chain of decay
The Chain of Decay

Cariogenic Bacteria (S. mutans, lactobacilli)

Sucrose, Glucose, Fructose, Starch

Acids dissolve tooth mineral


Caries No Caries

White spot lesions
White Spot Lesions

  • The first visible sign of tooth decay

  • Reversible with fluoride varnish

Risk factors for caries

Having a mother with a high caries rate or a high bacterial count of cavity-causing germs

Demonstrable caries, plaque, demineralization, and/or staining

Being a later-order offspring

Sleeping with a bottle or breastfeeding throughout the night

Low socioeconomic status

Lack of access to dental care

Risk Factors for Caries

Children with disabilities and other special needs
Children with Disabilities and Other Special Needs count of cavity-causing germs

  • Reduced saliva flow

  • Sweetened medications

  • Competing medical needs

The effects of ecc
The Effects of ECC count of cavity-causing germs

  • Loss of primary teeth

  • Pain

  • Infection

  • Self-esteem

Loss of primary teeth
Loss of Primary Teeth count of cavity-causing germs

  • Primary teeth are important for:

    • Nutrition

    • Speech development

    • Holding spaces for permanent teeth

  • Untreated decay in primary teeth can lead to decay in permanent teeth, or permanent teeth may not erupt at all

Primary and permanent teeth
Primary and Permanent Teeth count of cavity-causing germs

Pain count of cavity-causing germs

  • Children learn to live with the pain

  • Missed preschool and school days

  • Inability to concentrate; impairs school readiness

  • Can affect sleep and overall health and well-being

Infection count of cavity-causing germs

  • Failure to thrive and delayed growth patterns

Self esteem
Self-esteem count of cavity-causing germs

  • Stainless steel crowns

  • Unattractive smiles

Importance of oral health for pregnant women
Importance of Oral Health for Pregnant Women count of cavity-causing germs

  • Periodontal disease in a pregnant woman has been linked to increased risk for preterm delivery and having a low birth weight baby

  • For mom: pain, infection, poor nutrition, sleep deprivation, inability to concentrate, work or take care of children

Possible biological pathway between pd and ptb lbw

Bacteria in PD count of cavity-causing germs




Cervical Dilation and Uterine Contractions

Possible Biological PathwayBetween PD and PTB/LBW

Periodontal disease
Periodontal Disease count of cavity-causing germs

  • Gingivitis

  • Periodontal Disease

Gingivitis count of cavity-causing germs

  • Early stage of gum disease – only gums are infected

  • Caused by bacterial plaque and host risk factors: smoking, diabetes, stress, genetics

  • Bacteria in plaque create toxins that irritate the gums and cause redness, swelling, bleeding

  • Reversible with good oral hygiene

Pregnancy gingivitis
Pregnancy Gingivitis count of cavity-causing germs

  • Infection that is more superficial and brought on by hormonal changes during pregnancy

Periodontitis count of cavity-causing germs

  • An inflammation and degeneration below the gum line (bone and tissues surrounding the teeth)

  • Multi-factorial and episodic in nature

  • Prevalence in women of childbearing age is 5-40%

  • Destruction of the bone is not reversible

  • If left untreated can cause tooth loss

Progression of periodontitis
Progression of Periodontitis count of cavity-causing germs

Treatment of periodontal disease
Treatment of Periodontal Disease count of cavity-causing germs

  • Professional deep scaling and root planing

  • Anti-microbial mouth rinse (chlorhexidine)

  • Systemic and/or site-specific antibiotics

  • Gum surgery

Adolescent oral health oral piercing
Adolescent Oral Health: count of cavity-causing germsOral Piercing

  • Potential consequences of oral piercing include:

    • Infection;

    • Prolonged or uncontrolled bleeding;

    • pain and swelling (in extreme cases, a severely swollen tongue can close off the airway and restrict breathing);

    • Chipped or cracked teeth;

    • Injury to the gums, possibly resulting in bone loss and root decay;

    • Problems with chewing, swallowing, and pronouncing words properly;

    • Blood-borne diseases including various strains of hepatitis; and

    • Endocarditis, an inflammation of the heart valves or tissues.

Adolescent oral health oral piercing1
Adolescent Oral Health: count of cavity-causing germsOral Piercing

  • Because of the risks involved even after an initial oral piercing wound has healed, the ADA recommends that both teens and adults avoid oral piercing.

Adolescent oral health grills
Adolescent Oral Health: count of cavity-causing germsGrills

  • Made from gold, silver, or jewel-encrusted precious metals

  • Use of permanent cement not intended for internal use

  • Do-it-yourself kits and unlicensed jewelers

Adolescent oral health grills1
Adolescent Oral Health: count of cavity-causing germsGrills

  • Grills can wear away the enamel on the opposing teeth and inflame the gums; cement can damage teeth and gum tissues

  • Food collects  tooth decay

  • ADA recommends that youth avoid wearing grills, but if they are considering it, youth should:

    • talk to their dentists first

    • find out what materials the grills are made of

    • limit the time the grills are worn

    • remove the grills when eating

    • practice good oral hygiene

Prevention of dental decay
Prevention of Dental Decay count of cavity-causing germs

  • Regular dental visits starting at age 1

    • Referral by medical providers

  • Oral hygiene

  • Fluoride

  • Dental Sealants

  • Healthy feeding practices

  • Modifying caregiver’s oral health: Xylitol

Oral hygiene infants
Oral Hygiene: Infants count of cavity-causing germs

  • Before teeth come in, wipe gums clean with gauze or washcloth, before or after last feeding at night

Oral hygiene lift the lip
Oral Hygiene: “Lift the Lip” count of cavity-causing germs

  • When teeth are in, “lift the lip” monthly to check for chalky white spots or brown spots

Oral hygiene brushing
Oral Hygiene: Brushing count of cavity-causing germs

  • Begins when first tooth erupts

  • An adult should help brush a child’s teeth until child is around 8 years old

Fluoride toothpaste
Fluoride Toothpaste count of cavity-causing germs

  • Encourage daily use in the morning and before bed

  • A small smear is the appropriate amount

  • Apply toothpaste across width, not length of toothbrush

Fluoride varnish
Fluoride Varnish count of cavity-causing germs

  • Brown resin that sets on contact with moisture in the mouth

  • Prevents ECC

  • Easy application

  • Contains 5% of NaF

Community water fluoridation
Community Water Fluoridation count of cavity-causing germs

  • Only about 30% of Californians have fluoridated drinking water (vs. 67% nationwide)

  • San Francisco Public Utilities Commission areas all fluoridated

  • All of Contra Costa is fluoridated except Bay Point, Byron, Knightsen, and Brentwood

Dental sealants
Dental Sealants count of cavity-causing germs

  • Plastic coatings that dentists apply to the chewing surfaces of the molars

  • Make it difficult for plaque to adhere to the grooves of these teeth, reducing the risk of developing cavities

  • Most effective in children who have newly developed molars (ages six and 12)

  • Last for several years

Dental sealant placement
Dental Sealant Placement count of cavity-causing germs

Healthy feeding practices
Healthy Feeding Practices count of cavity-causing germs

  • Eat healthy foods and avoid sticky, starchy foods between meals

  • Don’t let infants and toddlers go to bed with a bottle or sipper cup or carry one around during the day, unless it contains only water

Caregiver s oral health
Caregiver’s Oral Health count of cavity-causing germs

  • Modify caregiver’s dental flora during the period from birth until the child is 2 years old

  • Use anti-bacterials like xylitol

Xylitol count of cavity-causing germs

  • An antibacterial, non-cariogenic sweetener

  • Used in some foods, chewing gum, candies; available over-the-counter and online

  • Caries-causing bacteria cannot feed on xylitol (it does not produce acid)

  • Increases saliva flow

  • Studies show that when used by mothers, there is a 30 to 60% reduction in tooth decay in their children

Prevention of periodontal disease
Prevention of count of cavity-causing germsPeriodontal Disease

  • Regular brushing and flossing

  • Regular dental exams and professional cleanings

  • Eliminating tobacco use

  • Reducing stress

Access to oral health care
Access to Oral Health Care count of cavity-causing germs

  • 21% of children (0-17) and 35% of adults (18+) in CA do not have dental insurance (’05 & ’03 CHIS)

  • Many employers do not cover dental insurance

  • Lack of dentists and specialists accepting Medi-Cal

  • County and community clinics overburdened

  • Need more dentists to see young children and pregnant women

  • Lack of dental specialists

  • Regular threats by state to cut or eliminate Medi-Cal dental benefits for pregnant women & children

Take home messages
Take-home Messages count of cavity-causing germs

  • Oral health is integral part of total health

  • Dental disease is very common

  • Dental disease is infectious and transmissible, but it is preventable in many ways

  • Dental visit by age one

  • Access to care barriers can be very significant, especially for low-income families