Mary Kenyon Jones, S.C. DHEC

1. Preventive Oral Health
101: Reaching families
with an oral health
message

2. At the end of this session you
will be able to…
• identify the number one most common
childhood disease;
• describe how tooth decay happens;
• list key oral health messages for pregnant women
and children 0-3 that need to be conveyed and
supported;
• understand how the home visitor, childcare
provider and community worker can support
improved oral health; and
• use resources to support oral health prevention
within targeted populations.

3. Section I
Tooth Decay and Young
Children—A Big Problem!

4. Answer: Tooth Decay
5 times more common than asthma
7 times more common than hay fever
What is the most common
childhood disease?

5. In South Carolina…
According to the 2002 Statewide Oral
Health Screening
of all kindergarten age children
have untreated dental decay.

6. *Caries Experience- the history if a child currently has or has had at least one tooth with a cavity
in other words if a child had at least one tooth that is filled (treated) or with a cavity (untreated)
**Untreated Decay- if a child has at least one tooth with active decay (cavity)
***Tx Urgency 1- when child has dental disease that needs treatment (within several weeks)
****Tx Urgency 2- when child has dental disease that needs immediate/urgent treatment (within
24-48 hours)
SC Oral Health Needs
Assessment Data
OHNA 2002 OHNA 2008 OHNA 2012
*Caries Experience 51.6% 47.1% 40.5%
**Untreated decay
(caries)
32.2% 22% 12.4%

7. Pregnant Women Data (2009-2010)
• 46.2 percent of the
pregnant women in South
Carolina reported receiving
no dental care while
pregnant;
• less than 48 percent had
received prenatal oral
health counseling; and,
• about 28 percent reported
having dental problems
during pregnancy.

8. How does tooth decay affect
the child and well-being?

9. The Effect…
Children with early childhood decay are at
risk of getting more decay
Goes beyond pain and infection…it affects
SPEECH
ABILITY TO EAT
ABILITY TO LEARN
THE WAY THEY FEEL ABOUT
THEMSELVES

10. The Response…
• 2006: The South Carolina
Oral Health Coalition
identified early childhood as
a priority.
• 2007: Early Childhood
workgroup was convened.
An ECH section established
as part of the State Oral
Health Plan to improve the
oral health status for
children aged 3 years or
less.
• Childcare trainings began.
• The workgroup recognized
that current research
supported that some
prenatal oral conditions may
have adverse health
consequences for the mother
• A comprehensive
approach for young
children had to include a
component and
subsequent objectives for
Oral Health Care for
Pregnant Women and
Young Children.
• Connecting Smiles
Initiative was born.
• Comprehensive
integration into home
visitation and medical and
dental settings.

11. Connecting Smiles Initiative
The Goal: to integrate oral health
information and resources into
existing care coordination models
including medical and dental offices
and to facilitate collaborative referral
relationship between dentist and
primary medical providers so children
in SC will have access to a dental
home.
The Target: individuals and
programs that directly impact families
including medical and dental
providers and staff, home visitation
programs, childcare providers and
community outreach programs such
as Early Head Start.
The Approach: provide
basic oral health
information and resources
that can be utilized to
support preventive oral
health behaviors and
connect dental and medical
providers.

12. Section II
Tooth Decay—How Does
it Happen?

13. The tooth decay process

14. The Connection Between Foods
Eaten and Tooth Decay
Germs in Plaque
+ Sugar and Starchy
Foods =
ACID ATTACK

15. Can tooth germs be passed
from caregiver to the child?

16. YES…here’s how

17. Plaque
• Once the germs take
hold it is called plaque.
• The sticky film you feel
on your teeth.
• Can’t be rinsed away
• Need to brush and floss
to remove it

18. Section III
How can you support and
promote positive oral health
care with the families you
serve?

19. Target Messages
for Pregnant Women

20. Oral Health Before Pregnancy
Daily Home Care:
• Brush teeth twice a day with a fluoride
toothpaste
• Floss at least once a day
Dental Visits:
• Go to the dentist every 6 months
• Seek care when you have a problem
Dietary Recommendations:
• Eat a variety of fruits and vegetables
• Limit sugary foods and drinks
• Drink fluoridated water

21. During Pregnancy…
Daily Home Care:
• Brush teeth twice a day with a fluoride toothpaste
• Floss at least once a day
Dental Visits:
• Go to the dentist every 6 months even when
pregnant
• Seek care when you have a problem
Dietary Recommendations:
• Eat a variety of fruits and vegetables
• Limit sugary foods and drinks
• Drink fluoridated water

22. Pregnancy Affects Your Teeth
•Pregnancy Gingivitis
•Loose Teeth
•Cavities
•Tooth Erosion

23. Your Dental Health Can Affect Your
Unborn Child
• premature and low birth weight
deliveries
• when a mother has poor oral health her
child is at a greater risk to have dental
problems

24. The Dental Visit Message
• It is SAFE to visit the dentist while you are
pregnant. Going to the dentist can help you have
a healthy baby.
• Tell the dental staff you are pregnant and tell
them your due date.
• Tell your doctor if you need help getting dental
care or if you are experiencing dental problems.
• Get treatment if needed. The dental staff will
know how to provide safe treatment that will not
harm you or your baby.

25. The Nutrition Message
• Limit foods containing
sugar to mealtimes only
• Choose water or low-fat
milk as a beverage
• Choose fruit rather than
fruit juice to meet the
recommended daily fruit
intake
• Drink fluoridated water
especially between
meals and after snacks

26. Supporting the Message
• Include an oral health
message when talking with
expectant mothers
• Distribute Before, During
and After Pregnancy Fliers
• Give pregnant moms a
toothbrush
• Encourage dental visits

27. Oral Health Standards and
Target Messages for Ages 0-
3

28. Standard 1
•Parents/caregivers of
children age 0-3 will
value and understand the
role that primary teeth
play in development.

29. Target message to parents…
• Taking care of
baby/primary teeth is
important!
• An unhealthy mouth
will affect eating,
speech development
and self esteem.
• Teeth come at
different rates and
teething can affect
your child.

30. Why Should I Worry about
Taking Care of Baby Teeth?

31. Tooth Eruption Chart
• Stress that children
develop differently and
teeth come in at
different ages and at
different rates
• Encourage them to
speak with their
dentist or pediatrician
about any concerns
they may have.

32. Prepare parents to know
what to expect when their child is
teething…
Common signs of teething include:
• Discomfort, restlessness, irritability, loss of
appetite, and waking during the night.
• Chewing on toys and fingers is very common.
• The amount of saliva may increase, causing your
child to drool more and cough as baby tries to
clear his/her throat.

33. Standard 2
• Children ages 0-3 should receive an oral
risk assessment by 6 months of age from a
medical or dental provider.
• Parents/caregivers of children age 0-3 will
recognize the importance of establishing a
dental home for a child by age 1.

34. Target Message for Parents…
Get comfortable looking in your child’s mouth.
Smile check!
Ask your dental or medical provider to look
inside your child’s mouth by 6 months of age.
Children should receive a dental check by their
first birthday and should have a dental home.
Older children and parents should visit the
dentists regularly.

35. Smile Check
• Gently lift the
child’s upper lip
• Look at the outside
and the inside of
the upper front
teeth
• Look at the back
teeth
• White spots are
early decay
White Spots

36. 1st Birthday, 1st Dental Check

37. Supporting the message within
the home…
• Community Outreach Workers can use the Oral
Health Behavioral Assessment Tool (OHBA) to
determine areas in need of intervention
• Goal Sheet
• Demonstrate a smile check
• Provide information on local dental providers
• Share resources

38. Oral Health Behavioral
Assessment Tool (OHBA)
• The Connecting
Smiles Initiative
adapted
assessment tools
for use by non-
clinicians.
• Assesses risky
behaviors.

39. Goal Sheet
• Useful tool to help
parents identify
behaviors to
change.
• Connecting Smiles
adapted the AAP
tool for use with
home visitation
programs.
• Added a
motivational
interviewing
component.

40. Potential Risk Factors for Decay
• Medicaid participants.
• Mother or primary caregiver has
cavities.
• Siblings have cavities.
• Premature or low birth weight.
• Special health care needs.
• Using a bottle after 15 months of
age.
• Using a sippy cup with juice or
sweeten beverages.
• Eating starchy snacks more than
3 times a day.

41. Sample Resources to Share…
• Dual language First
Birthday Card
• Parent Information
Sheet: Making
Dental Visits Easier
• Books on about
going to the dentist

42. Standard 3
• Parents/caregivers of children age 0-3
will have a basic understanding of how
to properly care for their child’s mouth
before and after teeth arrive. This
includes wiping the gums before teeth
arrive and using a soft bristled
toothbrush after teeth erupt.

43. Target Message for Parents…
• Mouth care begins with infants even before teeth
arrive.
• One good way to prevent tooth decay is to brush
your child’s teeth twice a day.

44. Begin with infants…
• After feeding, an infant's teeth and gums should
be wiped with a moist cloth to
remove any remaining liquid that coats
the teeth and gums
From: http://www.aboutsmiles.com/photos/mom_baby.htm

45. Toothbrush Use
• Toothbrushes for
infants and toddlers
should be soft with a
small head and large
handle.
• Tooth brushing should
be supervised until the
child is 6-7 years of
age.
• Consider
recommending parents
use an electric
toothbrush to brush

46. Toothpaste
As soon as teeth appear, parents & caregivers need to
begin brushing children’s teeth with fluoride toothpaste 2
times a day.
Under 3 years, use
smear
Over 3 years, use pea
sized amount
American Dental Association Council on Scientific Affairs (2014) Fluoride toothpaste
use for young children. Journal of the American Dental Association. 145(2): 190-191.

47. Toothbrushing Basics…

48. How to support
toothbrushing in the home
Demonstrate gum
wiping and tooth
brushing using mouth
models or puppets
Show the right amount
of toothpaste
Share songs
Provide cloths, gum
cleaners and infant
toothbrushes

49. Rinsing
• The cavity-causing effect
of certain foods can be
reduced by offering the
children rinsing water
after snacks when
brushing is not possible.

50. Flossing
• when the infant/child has two teeth that
touch …introduce flossing
• it is good to establish habit early
• brushing alone does not do the job

51. Tips…Childcare Providers
Use tooth brushing charts
to encourage good
brushing habits—reward
children that complete
their charts.
Share songs that
encourage tooth brushing
and make it fun!
Use tooth timers.
Do activities that teach
them about good oral
health.

52. More Tips…Home Visitors
• Use tooth brushing charts to encourage
good brushing habits—reward families
that complete their charts.
• Encourage families to start early and
make it fun!
• Distribute gum cleaners and infant
toothbrushes.
• Share a copy of Brush, Brush, Brush!
book
• Encourage parents to model
toothbrushing for their child.

53. I Have a Little Toothbrush
For toddlers we are acquainting them
with what a toothbrush is and what it is
used for.
A fun rhyme to share…
I Have a Little Toothbrush
A self-help rhyme
I have a little toothbrush
I hold it very tight
I brush my teeth each morning,
and then again at night
(children perform the actions)

54. Standard 4
•Parents/caregivers of children
age 0-3 will be aware of the
impact of feeding habits and
nutrition on their child’s oral
health.

55. Target Message for Parents…
What a child eats and
drinks
AND
How often they eat and
drink
can be part of the tooth

56. Supporting this message within the home…

57. Breastfeeding and
Oral Health
• Natural and
beneficial
source of
nutrition.
• Not a cavity
producer alone,
it may lead to
cavities when
combined with
other
carbohydrate
sources.

58. What can parents do?
• Encourage: healthy
foods such as fruits and
vegetables or whole
grain snacks.
• Discourage: sticky foods
such as raisins, fruit
leather, and hard
candies.
• Discourage: grazing
behavior where the
child is eating and
drinking very frequently
throughout the day.

59. Medicines
• Medicines such as cough
syrups contain sugar that
germs in the mouth use
to make acids.
• Be sure to brush a child’s
teeth after giving him or
her medicine or at least
rinse with water.

60. Using the Bottle and
Sippy Cup
• Do not put a baby down to sleep with a bottle or a sippy cup
• Only put formula, milk (after age 1) or water in a bottle.
• Never put soda or fruit juice in a bottle.
• Most children are ready to stop using a bottle at or before age 1.
• Try not to use a sippy cup all day…use it at mealtime and snack time only.
If one is used between meals, it should only contain water.
• Throw away sippy cups after 6 months of use.
• A sippy cup should not be used as a pacifier and should not be carried
around by your child—injury to the mouth could occur if the child fell.
• When possible, children over 18 months of age should be encouraged to
use a small plastic cup without a lid.

61. Sippy Cups
Potential
Misuse of
Sippy Cups
• Used continuously
throughout the day.
• Filled with sugary
beverages.
• Used a as “pacifier”
to calm and appease.
• Not discarded every
6 months.

62. Facts about juice
100 percent fruit juice can be good for your
child
Fruit juice has natural sugars that can lead to
decay if a child drinks too much of it
How to use juice in a healthy way…
Wait until a child is at least 6 months old before
giving him juice.
Serve juice in a cup, never a bottle.
Give only 4 to 6 ounces of juice each day.
Dilute the juice by adding water.
Encourage children to EAT FRUIT rather than drink
fruit juice.

63. Standard 5
• Parents/caregivers of children age 0-3
will understand how fluoride in water
and through varnish application can help
protect their child’s teeth from decay.
Parent and caregivers of children ages
0-3 will be encouraged to use
fluoridated water for drinking, cooking
and formula preparation.

64. Target Message for Families
• Fluoride helps strengthen teeth.
• Families should drink fluoridated water.
Fluoride in water helps protect teeth
from decay.
• Fluoride varnish can help strengthen and
protect their child’s teeth.

65. Why is it good to have fluoride
in your drinking water?
• As young children’s teeth develop, drinking
water that contains fluoride can help their teeth
grow strong and healthy.
• Drinking water that contains fluoride will help
strengthen the tooth surface and help prevent
tooth decay for people of all ages.

66. Fluoride—the tooth protector
• Replaces the
minerals from the
tooth surface lost
during an acid
attack
• Helps make the
tooth stronger
Found in
–Public water systems
that are fluoridated
–Toothpaste
–Supplements
–Varnish/Gels

67. Determine Water Source…
Well water
OR
Public water
system

68. Well Water
Fluoride level testing of well
water by DHEC
www.scdhec.gov/environment/water/
dwrwtesting.htm
If a patient is on well water,
providers may consider
prescribing supplements or
provide fluoride varnish.

69. Bottled Water
• Check supplier or label on bottle.
• Some water has added fluoride or
comes from a public water system
that is fluoridated.
• Encourage patients to not depend
solely on bottled water
• as their main source of drinking
water.
Drink from the tap!

70. Standard 6
• Parents/caregivers of children
age 0-3 will understand how to
help prevent injuries to the
mouth and how to respond to
basic injuries to the mouth and
teeth.

71. Target Message for Parents…
Smiles need to be
protected from
injury

72. Accidents Happen?
Water Fountains?
Swings and
Playgrounds?
Bikes and Riding
Toys?
Scattered Toys?

73. Getting the Safety Message
to Families
•Share parent information
sheets about home safety
•Inform parents about how to
respond to a dental
emergency if one happens
•Keep dental information on
file

74. Emergency Response…

75. Spread the word…
Tooth decay is preventable!!
Prevention is the KEY…
Behavior change is possible!

76. Available Resources…

77. Questions?

78. Thank you!
Mary Kenyon Jones, MEd
Outreach and Education
Specialist/Consultant
kenyonm@dhec.sc.gov