preventive strategies in paediatric dentistry


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Preventive Dentistry
Third Year

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  • Introduced by Keys, the infectious disease model even though effective, could not solve all issues related to disease development. A small percentage of the population still remains in high risk of developing caries in spite this model. Things such as trauma (30%) in children and habits are
  • Children at 3 yrs have all their primary teeth present, they are mostly ready to cooperate, they are about to go to school and have enough communication skills.
  • Trauma, caries, periodontal disease, orthodontic problems (ENT issues).3rd molar discussion with a 5 yr old will not make sense. Sealant discussion postponed if till permanent teeth have erupted and exfoliation postponed if the child has thumb sucking habit then till the habit ceases.
  • preventive strategies in paediatric dentistry

    1. 1. Preventive Strategies in the Pediatric patient Dr. Mohamed Magdi Hassan Department of preventive Sciences Division of Pediatric Dentistry
    2. 2. Pediatric Prevention • What is Pediatric Dentistry ? ▫ an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. • What is Prevention for the pediatric patient ? ▫ To prevent is to avoid occurrence. • What to prevent in a Pediatric Patient ? ▫ Transmission of Mutans streptococci. ▫ Development of Caries. ▫ Occurrence of Trauma. ▫ Development of anomalies and malocclusion. • How to prevent all Theses from Occurring ? Anticipatory Guidance, Infant oral health Assessment, Caries Risk Assessment
    3. 3. Pediatric Prevention • Infectious Disease Model Old model Dental Caries
    4. 4. Pediatric Prevention • The old concept was to have children have their FIRST dental visit at age 3 yrs • Caries was epidemic. • Anticipatory guidance began in the medical field to educate parents on their children's growth, development and health. • Also known as the WELL-CHILD-CARE visits. • Adopted by Dentistry to help deal with all issues related to dental health
    5. 5. Pediatric Prevention • Anticipatory Guidance: is pro-active counseling of parents and patients about developmental changes that will occur in the intervals between health visits that include information about daily care taking specific to the upcoming interval. Caries Assessment Tool • Anticipatory guidance is a complement to CAT • The aim of AG is to address protective factors in effort to prevent oral health problem. • AG would include discussion on oral development, diet and nutrition, fluoride adequacy, oral habits, injury prevention and oral hygiene.
    6. 6. Pediatric Prevention • AG is age specific, which: ▫ Makes the message concise ▫ Makes the message less static • Infancy represents a clean slate, but as the child grows the risk of problem increases. • Unlike the old infectious disease model, where the Doctor gave the information and the parent listened. AG provides interaction between the dentist and the parents. • Individual plan is developed for each patient.
    7. 7. Anticipatory Guidance Oral Development Dental and Oral Milestone Eruption of the first tooth Development of occlusion Teething and tooth eruption time Anatomical landmarks Diet and Nutrition Bottle related dental caries Weaning Role of Carbohydrates Role and Identification of Plaques Fluoride Adequacy Water evaluation and supplementation Breastfeeding External source of fluoride Safety and toxicity Dentifrice and topical agents Habits Non-nutritive sucking Pacifiers Oral Hygiene Mouth cleaning Streptococcus mutans testing Tooth cleaning implements Positioning and supervision Injury Prevention Child abuse and neglect Car safety Child proofing Electric cord safety Emergency instruction
    8. 8. Pediatric Prevention
    9. 9. Anticipatory Guidance Topic 6-12 months months 12-24 months 24-36 Dental and oral development •milestones • patterns of eruption • environmental and genetic influences • teething • infant oral cavity • occlusion • spacing issues • speech and teeth • tooth calcification •last primary tooth erupted • exfoliation • future orthodontic needs • radiographs Fluoride supplementation •F mechanisms • sources of F • choice of F vehicles • F and vitamins • toxicity issues/ storage • formula and F •F dentifrice use • F in food sources • avoiding excessive ingestion •F use revisited at every interval • daily access Non-nutritive habits •pacifier use and types/safety • mouthing/oral Stimulators •digit habit issues • effect on occlusion • revisit habit issues
    10. 10. Topic 6-12 months months 12-24 months 24-36 Injury prevention • signs of trauma • child abuse oral signs • emergency access instructions • implications for permanent teeth • car seats • daycare instructions • electric cord safety • re-plantation warning Re: primary teeth • child proofing • helmet safety • seat belts • safety network Diet • nutrition and dental health • bottle use and weaning • Sippy-cup use and content • breast feeding • caries process • role of carbohydrates (juice) exposures • retention of food • review caries process • revisit Sippy-cup issues • snacks • frequency issues • review caries process • role of carbohydrates (juice) exposures • revisit Sippy-cup issues Oral hygiene • oral as part of general hygiene • acquisition of S. mutans • positioning baby for oral hygiene • special techniques • child participation • dentifrice use • Fl dentifrice for high risk • electric brushes/ toddler techniques • use of floss • continued parental Participation
    11. 11. Pediatric Prevention Increase in irritability Loss of appetite Change in eating habits Difficulty sleeping Diarrhea Fever Vomiting Discomfort – pain Drooling
    12. 12. Pediatric Prevention • Oral Health Risk Assessment: • Systemic evaluation of presence and intensity of etiological and contributory caries risk factors (and other diseases) to provide disease risk estimation. • Helps in providing preventive measures in a customized fashion.
    13. 13. What to Address What to Ask Medical history: pre-/perinatal history (hypoplasia), general health (healthy vs. special needs), medications (some high in sucrose) Nutritional deficiencies in pregnancy Prematurity (~ < 36 weeks gestational period) Birth weight (~ < 2.5 kg) Medical problems/special health care needs (i.e. compromised salivary flow, compromised oral hygiene due to behavior problems, high caloric diets, etc.). History of hospitalization and past/current medications Oral hygiène: visible plaque on maxillary anterior teeth is one of the best predictors of future caries Age brushing began? Are the child’s teeth brushed daily, once in while or not yet? Who brushes the child’s teeth? When are the child’s teeth brushed: morning, before bedtime, morning and before bedtime and/or after meals? Any problems with positioning, child’s cooperation, etc.?
    14. 14. What to Address What to Ask Infant Feeding: only formulas, Breast milk or water in infant bottles; milk is not cariogenic, but a vehicle for cariogenic substances (i.e. chocolate powder); breast milk alone is not cariogenic, prolonged on-demand nighttime feeding associated with increased risk for caries; weaning from the bottle/sippy-cup at age 1 and from the breast as long as the mother and the child desires; breastfeeding in the 1st year of life found to be protective of future Obesity Breastfed/Bottle-fed? Breastfed/Bottle-fed to sleep and/or in the middle of the night? If yes, duration and frequency for each If bottle-fed, content of bottle: formula, milk, milk and sugary substances, juice/sugary drinks and/or water? Dietary Habits: early introduction of unhealthy foods (i.e. sugary drinks and snacks) can alter taste preferences for foods and beverages and predispose to obesity; high frequency of sugary drinks and snacks between meals (≥ 3 times) increases caries risk; limit juice and sugary drinks daily intake to 4-6 oz and best given in open cups; best to limit sweet foods/drinks at mealtimes Does the child regularly eat sweets more than 2 a day? What does the child like to snack on and how frequently? What type of container does the child usually use for drinks? Daily amount in oz during meals and/or throughout the day for the following drinks: 100% juice, juice drinks, regular/diet soda and sugary drinks (i.e. Kool-Aid)
    15. 15. What to Address What to Ask Fluoride Adequacy: daily fluoride exposure through water or supplementation, and monitored use of fluoridated toothpaste (no more than a lateral smear) can be effective primary preventive procedures Main water source from which the child is drinking: city water (unfiltered, Brita/Pur filter), city water (filtered, reverse osmosis), well water or bottle water? Fluoride level in the child’s drinking water? Does the child take fluoride supplements? If yes, dosage and frequency Does the child use fluoridated toothpaste daily, once in a while or not yet? If yes, amount placed on toothbrush Bacteria Transmission:Mutans streptococci (MS) transmission can be direct or indirect, vertical (usually from mother) or horizontal (within or outside of the family Does the child’s mother (intimate caregiver) have any untreated decay? Does the child and mother (intimate caregiver) share the same utensils, foods and cups? Does the mother (intimate caregiver) pre-chew the child’s food or kiss the child on the mouth?
    16. 16. What to Address What to Ask Demographic data: low SES, low maternal educational level, and minority groups are at higher risk for ECC Teeth characteristics: white spot lesions considered severe ECC in children younger than 3 years of age; inspect for enamel hypoplasia, enamel defects, retentive pits/fissures; stained pits/fissures not common in primary dentition (possible higher risk for future cavitation?) Iatrogenic factors: use of braces or orthodontic/oral appliances provide hard, non-desquamating surfaces and serve as plaque traps Salivary assays for MS: IvoclarVivadent CRT system (, MSKB agar plates
    17. 17. Pediatric Prevention • Summery: The old infectious disease model was deficient Anticipatory Guidance replaced the old infectious disease model Anticipatory Guidance is more concise, less static, more interactive and helps develop an individual preventive plan for each patient Starting with an infant represents a clean slate to prevent the development of many oral diseases and conditions To be effective, Anticipatory Guidance should be coupled with Infant Oral Health Risk Assessment and Caries Risk Tool
    18. 18. Thank you