Dental Facts for the Frontline

1
Dental Facts for the Frontline

• Danielle G. Dooley, MD, MPhil, FAAP
• Pediatrician
• Unity Health Care

2
Is Your Child Care, Practice or Organization
Dental-Friendly?

• Education
• Preparation
• Prevention

3
Are You Advocating for Oral Health?

• 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

4
Topics for Today

• Why early intervention matters
• Tooth development and decay
• Baby bottle tooth decay
• Teeth grinding
• Thumbsucking
• Dental emergencies

5
Good Oral Hygiene Habits Start EARLY!

• 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. http//www.aapd.org.

6
Teeth are in Jeopardy

• 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
  Childrens Oral Health Past, Present, and
  Future. Pediatrics 2004113e487-492

7
Why Are Teeth in Jeopardy?

• 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. http//www.aapd.org

8
Where do Kids Learn to Keep Their Teeth Healthy?

• Dentists
• Pediatrician
• Family
• School/Child Care

9
Dental Access is a Problem

• 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. http//www.aapd.org

10
Pediatricians Dont Have the Training or the Time

• 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
  Childrens Oral Health Past, Present, and
  Future. Pediatrics 2004113e487-492

11
There Just Isnt Time!

• 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

12
What is a Tooth?

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

13
Enamel

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

14
Dentin

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

15
Pulp

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

16
Types of Teeth

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

17
Types of Teeth

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

18
Types of Teeth

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

19
Tooth Development

• 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

20
Tooth Development
21
Why Are Baby Teeth Important?

• 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)

22
What is Tooth Decay?

• 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

23
Tooth Decay

• 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

24
Is the Bacteria that Causes Tooth Decay
Contagious?

• 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 adults mouth testing the
  temperature of a bottle with the mouth
• Caregivers need to practice good oral hygiene too!

25
Who is at Increased Risk for Tooth Decay?

• 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- Downs
  syndrome, cleft palate

26
Is There a Familial Component to Tooth Decay?

• 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 20031111113-1116

27
How to Prevent Tooth Decay?

• Proper brushing
• Proper snacking
• Fluoride
• Regular dental visits

28
Cleaning Infant Teeth

• Begin cleaning an infants 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!

29
Cleaning Toddler Teeth

• 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

30
When Can Kids Brush by Themselves?

• 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

31
Snacks that are Good for Smiles

• Avoid sticky, sugary snacks- cookies, cake,
  candy, sodas
• Fruits, vegetables, whole grain snacks are best
• Snack at regular times- dont allow all-day
  snacking!
• Offer the child plenty of water (not juice!),
  especially with snacks

32

• Fruits, grains, dairy products provide excellent
  snacks for healthy smiles!

33
What is Fluoride?

• 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

34
Why Dont Our Kids Get Enough Fluoride?

• 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

35
Is There Such a Thing as Too Much Fluoride?

• YES
• Dont 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

36
When Should Kids go to the Dentist?

• 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

37
Baby Bottle Tooth Decay

• 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

38
Baby Bottle Tooth Decay

• Milk or juice pools in the childs 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

39
What does Baby Bottle Tooth Decay Look Like?

• 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
40
What About Breastfed Babies?

• 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

41
Baby Bottle Tooth Decay is Preventable!

• 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
• Dont 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

42
What if the Baby Really Needs the Bottle to go to
Sleep?

• 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

43
Teeth Grinding

• 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

44
What Causes Teeth Grinding?

• 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

45
What are the Effects of Teeth Grinding?

• 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

46
How is Teeth Grinding Treated?

• Visit the dentist, who will examine the childs
  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
  childs life and help them relax before going to
  bed

47
Thumbsucking

• 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

48
Thumbsucking

• 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

49
Thumbsucking

• 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

50
Thumbsucking

• Upper front teeth flare out and tip upward
• Lower front teeth move inward
• Roof of mouth becomes arched or caved in

51
Tips to End a Thumbsucking Habit

• Praise children for NOT sucking their thumb or
  pacifier
• Address the childs anxiety or discomfort so they
  dont need to suck to soothe themselves
• Pick certain times during the day when kids
  cannot suck their thumb

52
Common Dental Emergencies

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

53
Cut or Bitten Tongue, Lip, Cheek

• 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

54
Knocked-Out Permanent Tooth

• 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

55
Broken Tooth

• 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

56
Bleeding after a Baby Tooth Falls Out

• 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

57
Current Legislation

• 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. www.loc.gov.
58
Is Your Child Care, Practice or Organization
Dental-Friendly?

• Education
• Preparation
• Prevention
• Advocacy

59
Acknowledgements

• 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
• www.docsfortots.org
• Dft_at_docsfortots.org

A Nationwide Network of Doctors Advocating for
Young Children