Oral Health and Dental Public Health in South Carolina Timeline Prior to 2000, Dr. Waddell, SCDHEC Deputy Director of Health Services had been working to re-establish a state dental public health program at DHEC. In 2000, the US Surgeon General’s report on “Oral Health in America” not only recognized the importance of children's oral health but also identified the high incidence of dental cares in this population. In 2000, DHEC brought Dr. Ray Lala, a HRSA federal assignee to South Carolina as the director of the Oral Health Division. In 2002, SC was awarded the RWJF State Action for Oral Health Access Program funding for the More Smiling Faces project More Smiling Faces in Beautiful Places (MSF) is one of six oral health initiatives that are part of the State Action for Oral Health Access (SAOHA) Program that is funded by the Robert Wood Johnson Foundation (RWJ) and managed by the Center for Health Care Strategies. MSF is based upon partnerships under the leadership of the South Carolina Department of Health and Environmental Control (SCDHEC). Components of the program include: Creation of an integrated oral health network of dentists, physicians, nurse practitioners, dental hygienists, public and private health providers, community health centers, and churches to increase access to oral health care Provision of pediatric oral health training programs for medical and dental professionals Establishment of a system to link medical homes with oral health care providers, provide patients with resources, screen for eligibility in Medicaid or other insurance programs, and arrange patient transportation Provision of educational guidance and support to parents and families that enable them to become effective managers of their child’s oral health needs.
Significant advances in dentistry have not been equitable to all people. Dental caries is the most common chronic disease affecting children in the United States; five times more common than asthma and seven times more common than hay fever. - On August 26, 2005 the Centers for Disease Control and Prevention (CDC) released a new report in its Morbidity and Mortality Weekly Report (MMWR) surveillance summary titled, Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism, and Enamel Fluorosis—United States, 1988-1994 and 1999- 2002 (available at: http://cdhp.org/newsbytes/newsbytes.asp) . Key finding: Dental caries trends are higher among the nation’s youngest children . 28% of Pre-school children ages 2 through 5 years have experienced tooth decay. This findings suggests that over 4 million children are affected nationwide – a jump of over 600,000 additional preschoolers over a decade. South Carolina 2001 Oral Health Needs Assessment - 1 out of 3 children in SC’s kindergartens have experienced untreated tooth decay. Dental disease persists despite the fact that it is preventable.
Early childhood caries (ECC) occurs in the primary teeth of infants and young children. ECC is often associated with the use of bottles at nap time and bedtime, this is not the exclusive cause.
Oral health disparities impact poor children Low-income children have the greatest odds of having tooth decay, have the most severe experience with tooth decay, and are most likely to have untreated cavities. Children ages 2-11 in families with income under $18,0002 were nearly twice as likely to experience decay as children in families with twice that income level (55% versus 31%). Decay severity was more than twice as great for poor children as their higher income peers. Children in poverty were more than twice as likely to have untreated cavities as their higher income peers. Children of color are more likely to experience tooth decay and have their cavities untreated. Because children of color are the fastest growing subpopulation of children in the U.S., their higher caries experience CDHP Issue Brief Early Childhood Caries Trends Upward http://www.cdhp.org/CDHPPubs/IssuePolicyBriefs.asp
Opportunity for early intervention Pediatricians, family medicine physicians, nurse practitioners, physician assistants, registered nurses and other health professionals are more likely to reach new mothers and infants on a regular basis during infancy and early childhood than are dentists. Average child visits the medical provider 10 times in the first 3 years to receive both well child and sick care. Pediatric are focuses on preventive care and already has incorporated anticipatory guidance related to pediatric oral health such as diet, feeding practices, fluoride supplementation and injury prevention. Health professionals understand that oral health is part of a child’s overall health and are aware of the impact of dental diseases on a child health and well being.
Tooth decay in primary teeth predicts future tooth decay in permanent teeth as the child grows older. With the increase in tooth decay in preschool age children, we can expect and increase in tooth decay in their permanent teeth as the children get older. To keep this from happening, it is critical to identify children at greatest risk for caries as early as possible and initiate comprehensive dental treatment that is consistent with professional “age one dental visit” policies and establishment of the “dental home.” The challenge to the dental care system is significant as pre-school age children have the lowest rates of dental care of all age groups in the US and therefore currently miss an important and timely opportunity for effective prevention.
Policies: American Academy of Pediatrics, Section of Pediatric Dentistry. 2003. Oral health risk assessment timing and establishment of the dental home . Pediatrics 3(5):1113-1116. American Academy of Pediatric Dentistry. 2002. Policy on the use of a caries-risk assessment tool (CAT) for infants, children and adolescents . Pediatric Dentistry 24(7):15-17.
Caries begins as a streptococcal infection. In order to progress, Bacteria , predominately streptococcus mutans metabolize fermentable carbohydrates including sugars and starches to produce acid and therefore a low pH. Acid deminterializes or dissolves the tooth If the demineralization continues, the surface enamel is weakened with eventual cavitation or breakdown of the tooth surface As the demineralization continues, the decay spreads farther into the tooth
Exactly why an early oral assessment is so important.
The children of mothers with higher caries rate are at higher risk for dental caries Modification of mother’s oral flora at the time the infant’s colonization can significantly impact the child’s caries rate. Oral health risk assessment before 1 year of age offers an opportunity to identify high risk patients and provide timely referral and intervention for the child. Acquisition of S. mutans appears to take place through mouth-to-mouth transmission between caretaker and child. Transmission can be delayed/prevented by the initiation of a prevention program including meticulous oral hygiene, especially in caretakers who demonstrate a high-risk level of S. mutans www.dentalcare.com
Information adapted from the Policy on Use of a Caries-risk Assessment Tool (CAT) for Infants, Children and Adolescents. American Academy of Pediatric Dentistry .
The child is initially held by mother and slowly lowered into health professional’s lap. Child may cry, but that will allow you to see their teeth better. Some medical providers prefer positioning the child on the exam table and working from behind the head or have older children sit on the table. Ask mother to hold the child’s hands
For more information on Oral Development: http://www.mchoralhealth.org/PediatricOH/mod2_1.htm Common oral conditions and abnormalities: http://www.mchoralhealth.org/PediatricOH/mod3.htm
Healthy teeth are shiny and smooth. Arrows point to “white spots” or areas of demineralized enamel. Earliest signs of decay may appear as white spots or like frosted glass or flat paint. “White spots” can be remineralized with the use of fluoride varnish Brown or yellow spots or carious lesions on the teeth are more obvious signs of tooth decay The inside of the upper front teeth is where the baby bottle nipple rests. Once the disease is established and the decay goes through the enamel into the dentin, restorative care is required. Once a child has experienced tooth decay, follow ups is very important.
If you observe any signs of tooth decay, you can show them to the parent. Show parent how to lift the child’s upper lip while brushing the upper teeth and to routinely check the teeth for chalky white or brown spots, being sure to look at both the front and back of the teeth and near the gumline. White spots=early signs of decay. Child needs to see a dentist!
Slides from: www.dentalcare.com
Slides from: www.dentalcare.com
Slides from: www.dentalcare.com
Dental home: provides care of infants and children ideally that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.
Other considerations are: May not be receiving adequate home care due to competing medical needs. Most babies and young children with SHCN are considered to be at “high risk” for tooth decay. Dilantin, medication for epilepsy and medications used to prevent transplant rejection can lead to gingival overgrowth (hypertrophy) which makes hygiene difficult and increases risk for gum disease.
Sit your baby on your lap, facing to one side Support the health with your arm and hand Use the index finger or thumb of your supporting hand to open the mouth and support the lower jaw Wrap the wet cloth around the index finger of your other hand Wipe the roof of the mouth, tongue, cheeks and gums Once teeth appear, clean with cloth or small soft toothbrush Breastfeeding should be encouraged and mothers should be advises that removing their baby from the breast and wiping their baby’s gums reduces the risk of tooth decay in baby teeth.
As baby gets bigger, you can trying sitting on the floor with the baby’s head in your lap
Young children have not developed good coordination, so you will need to help them until about age 8.The caregiver will evaluate the child’s motor activity to assess the child’s capabilities to brush effectively. The care giver should brush the child’s teeth after the child has completed brushing. Note: Caregiver’s hand is over the child’s hand. This allows the caregiver to teach the child proper brushing technique. This is an important part of teaching the child how to brush properly.
Any liquid except water — even milk and juice — can cause cavities. Some other ways to calm baby: Favorite blanket or toy Pacifier Holding, patting, rocking Softly singing or talking to baby
With obesity and diabetes on the rise in SC’ children, we have a responsibility to counsel families to limit both sugar intake and the frequency of exposures per day to enhance both general overall health as well as oral health.
The bacteria in the mouth use the sugar to make acids that can demineralize the tooth surface.
Children should receive supplements based on this table only after a determination of the FL content of their primary water source.
ADA approved FL containing toothpaste is recommended for children age two and over. Very small amount (pea sized) should be smeared on brush for use with very young children.
Fluoride varnish helps reverse early demineralization that has already started.
White spots are areas of demineralization and considered early decay—Indication for fluoride varnish applications.
Child is examined in a knee-to-knee position with parent.
Remember to clean and dry the teeth. It is critical to dry the teeth with a gauze before applying the varnish.
When fluoride varnish is used to remineralize white spot lesions these are the results. Acknowledgement: The fluoride varnish section was adapted wit permission from the work of Dr. Michael Kanellis, Department of Pediatric Dentistry, University of Iowa.
Oral Health Risk Assessment Training for Pediatricians and Other Child Health Professionals Developed by American Academy of Pediatrics Pediatrics Collaborative Care (PedCare) Program Supported by the Maternal and Child Health Bureau, Health Resources and Services Administration Department of Health and Human Services U93MC0
Fluoride prevents tooth decay by inhibiting the demineralization of the tooth surface-enamel, enhancing remineralization and inhibiting the bacteria in plaque. Water fluoridation is considered to one of the greatest public health advances of the 20 th century.
Fluoride toothpaste is effective at preventing dental caries.
It is important to address the limiting the frequency of simple carbohydrates including sugary foods and drinks, and foods like potato chips. It is the frequency of fermentable carbohydrate intake that contributes to tooth decay. For more information: http://ohioline.osu.edu/mob-fact/0001.html Nutritional information for pregnancy and for the child up to age three. Into the Mouths of Babes: A Nutritional Guide to Age Three Nutritional Needs of Pregnancy
Serious gum disease has been linked to premature and low birth weight babies. This visit gives the dental team the opportunity to assess the mother’s caries risk and subsequently the caries risk for her child.
Xylitol is a naturally occurring sugar. An over the counter brand is Carefreee Koolerz (1.6 grams piece). When purchasing over the counter xylitol products, one should look to see if xylitol is listed as the first ingredient. A therapeutic dose is 5-10 grams per day.
Get regular dental care because cavity germs in your mouth can be passed to your baby by sharing spoons, forks and cups. Learn how to do a Smile Check to check for white spots or stains on the teeth by lifting the baby’s upper lip. Learn how to clean your baby’s teeth by wiping the baby’s mouth and teeth with a clean, soft cloth or a baby toothbrush. To prevent baby bottle tooth decay do not put your baby in bed with a bottle at night or naptime. If you do use a bottle at night or naptime, fill it with water only. Teach you child how to use a cup around age one. Ask you doctor or dentist to check your child’s teeth by age one. Fluoride drops are important for babies starting at 6 months of age. Talk to your doctor or dentist about fluoride.
Pediatric Oral Health Risk Assessment Training for Medical Professionals More Smiling Faces in a SCDHEC led oral health initiative funded by the Robert Wood Johnson Foundation and managed by the Center for Health Care Strategies SCDHEC Oral Health Division 2006
Needs treatment within 1 month Special Note : an infant or child with any positive caries risk factors should be referred to a dentist within one month even though there are no observable dental problems.
If the baby goes to bed with a bottle, only use water.
Baby should begin using a cup by 6 months
Wean from bottle to cup by age 1
Avoid letting baby walk around with a bottle or sippy cup with milk, juice or sweet liquid
Parent Information Booklet: The Bottle and Your Infant’s Dental Health Sippy Cups, page 19
Encourage Good Food Choices Parent Information Booklet: Healthy Eating Habits for Good Dental Health, page 16 Juice, page 17 Facts About Milk, page 18 Nutrition and Your Child’s Dental Health, page 30