PREVENTIVE PEDIATRIC DENTISTRY THE CONTINUED CARE MODEL

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PREVENTIVE PEDIATRIC DENTISTRY THE CONTINUED
CARE MODEL
1426 McPhillips Street, Winnipeg, MB
Dr. Charles Lekic DDM, MSc, PhD, FRCD(C)
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Pediatric Preventive Dentistry

• Dental caries presents a major dental health
  problem in children
• Etiology of caries
• tooth susceptibility, bacterial plaque,
  carbohydrates, time, oral sugar clearance,saliva
  flow pH

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Pediatric Preventive Dentistry

• Most important factors in caries prevention are
• Oral Hygiene, Diet, Fluoride therapy and Fissure
  sealants

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Oral Health Education

• Plaque removal Diet are the most important
  factors in oral health education

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Oral Health Education

• Plaque Removal
• Use of Disclosing Agents
• Caries Activity Tests
• Tooth brushing

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Oral Health Education

• Plaque Removal (Contd)
• Flossing (once posterior contacts close)
• Oral Rinsing- removes only soft debris,
  recommended in patients with ortho appliances

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Oral Health Education

• Plaque Removal (Contd)
• Chemotherapeutic agents- e.g. Chlorhexidine-
  short term benefits
• Chewing gums- Trident, CDA approved

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Oral Health Education

• Toothbrushing
• Roll method
• Horizontal scrub- most successful for children
• Modified Bass

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Oral Health Education

• Diet
• -Instruct Patient/Parent to write down what
  he/she eats or drinks for 3 consecutive days.
• -Analyze with the patient/parent and make
  recommendations
• Reduce sucrose consumption
• Sweets are not to be eaten between meals or at
  bedtime
• Emphasize foods that require chewing, stay away
  from soft/sticky foods
• Brush teeth after meals and ALWAYS at Bedtime
• Discuss the danger of hidden sugars such as
  starchy foods (bread)

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Fluoride Therapy

• Systemic Fluorides
• Provided by water fluoridation and by
  supplemental therapy
• Water Fluoridation
• Concentration of 1 ppm of fluorides in drinking
  water is considered optimal in reducing caries
  prevalence
• Optimal fluoride concentration reduces caries up
  to 50
• Commonly use sodium fluoride, hydrofluosilic acid
  and sodium silicofluoride

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Fluoride Therapy

• Water Fluoridation (Contd)
• Effect of systemic fluorides is greater on smooth
  enamel surfaces
• Most effective method in caries prevention
• Supplemental Fluoride Therapy
• Before prescribing supplemental fluoride, must
  know
• The fluoride content in childs drinking water
• Childs weight
• Overall fluoride intake

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Fluoride Therapy

• Topical Fluorides
• Delivered via gels, varnishes, mouthrinses,
  prophy pastes and dentifrices
• No need for topical fluoride in patients with low
  risk and/or residing in optimally fluoridated
  areas- use of a fluoridated toothpaste should be
  sufficient.
• Fluoridated dentifrices are not recommended in
  small children (lt3 years)

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Fluoride Therapy

• Topical Fluorides (Contd)
• Parents should always supervise brushing so that
  the toothpaste and saliva are expectorated
• Acidulated phosphate fluoride (0.5) and stannous
  fluoride (0.4) are most common for topical use

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Fluoride Toxicity

• Chronic Toxicity
• Only a pea-sized amount of toothpaste should be
  used
• Not recommended to use fluoridated dentifrice in
  children younger than 3 yrs.
• Use the cup test to check if the child could
  rinse and spit without swallowing

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Chronic Toxicity

• Repeated ingestion of lesser amounts of fluoride
  may result in chronic fluoride toxicity, the most
  common of which is dental fluorosis
• To prevent chronic fluoride toxicity, parents
  should Make sure their child thoroughly
  expectorates toothpaste after brushing

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Acute Fluoride Toxicity

• Acute Toxicity
• Results from the accidental ingestion of
  excessive amounts of fluoride
• Common symptoms include nausea and vomiting
• Lethal dose for a 3 yr. old child approx. 500 mg
  of fluoride ingested at one time
• In the event of accidental ingestion of excessive
  amounts, vomiting should be induced (2 teaspoons
  of Ipecac Syrup)
• Administer milk to slow absorption and form
  complexes with the fluoride
• Consider transporting the child to a poison
  control centre

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Pediatric Preventive Dentistry

• Dental diseases are largely preventable and
  increased emphasis on prevention should be the
  goal of every dental practice

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The role of Manitoba dentists in promoting
childrens oral health

• It is important to increase the general awareness
  regarding oral health and more particularly for
  the economically disadvantaged portion of the
  child population.

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The role of Manitoba dentists in promoting
childrens oral health

• At a present time there are very few programs
  aiming at increasing the awareness regarding
  childs oral health.

• In dental offices there is little understanding
  if and in what capacity private practitioners
  could be involved in the implementation of such
  programs.

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The role of Manitoba dentists in promoting
childrens oral health

• Therefore, it is important for every dental
  practice to assess if and in what capacity they
  could be involved in reaching out to both the
  children and their parents and guiding them
  toward improved childs oral health.

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Childrens Dental World Model of Continued Care

• Childrens Dental World has been specifically
  interested in designing a program, including a
  reward\motivation system that benefits the child
  and a somewhat of a counseling\guidance system
  that will frequently remind and help the
  caregiver maintain the childs oral health.

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Continued Care Model

• Every child will after booking a recall
  appointment be classified, in regard to the
  completed restorative treatment, into
• 1. Low risk (0-1 rest. treat.)
• 2. Moderate risk (2-4 rest. treat.)
• 3. High risk (5 rest. treat.)

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Continued Care Model

• Childrens Dental World recall patients are
  receiving, every 6 weeks, health promotion
  material related to childs age and the risk
  factors involved.
• Parents are at the same time asked to answer two
  to three questions and mail them in the envelope
  provided.

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Continued Care Model (0-1 yr)
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Continued Care Model (1-3 yrs, low risk)
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Continued Care Model (1-3 yrs, moderate risk)
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Continued Care Model (1-3 yrs, high risk)
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Continued Care Model (3-6 yrs, low risk)
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Continued Care Model (6-12 yrs, moderate risk)
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Continued Care Model (gt12 yrs, high risk)
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Continued Care Model

• Following the first round of preventive letters
  25 of parents responded, answering the
  questions.
• We expect this percentage to increase following
  the next rounds of letters and more especially
  following the next recall visit.

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Continued Care Model

• At the next recall visit if the child will
  present with healthy teeth he/she will earn the
  membership to the No Cavity Club.

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Continued Care Model

• The child will be able to use this card in Toys R
  Us stores and the cash value for the first cavity
  free recall visit will be 15.00

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Continued Care Model

• At the subsequent recall visits if the child
  continues to have healthy teeth the cash award
  will increase by 5.00 and will raise up to the
  full amount reduced only for the actual cost of
  the recall visit.

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Continued Care Model

• No Cavity Club membership and the health
  promotion letters, that are to be sent to the
  parents, are designed to increase the awareness
  regarding oral health and to award and motivate
  children and parents in achieving and maintaining
  health.

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Continued Care Model

• Continued Care Model is a true investment in
  health and is a unique model to North America.
• Further research will provide evidence regarding
  the effectiveness of the program and the dental
  profession will be given this information as soon
  as it becomes available

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Continued Care Model

• At the end of the day what is more rewarding then
  a healthy smile on a pediatric dental patient?

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• Thanks for your attention