Healthy Smile Connection for Young Children and Children with Special Health Care Needs

Transcription

1 Healthy Smile Connection for Young Children and Children with Special Health Care Needs Disclosure statement: I have no relevant financial relationships, conflicts of interest, or commercial support to disclose at this time. Kami A. Piscitelli, B.S.D.H., R.D.H. Dental Health Program Office of Family Health Services Virginia Department of Health Richmond, VA Introductions & Housekeeping Kami A. Piscitelli, BSDH, RDH Special Needs Oral Health Coordinator Please turn off or silence all electronic devices ASK QUESTIONS!!!! Objectives Discuss how oral health is related to overall health Discuss the process and factors needed for tooth decay Identify prevention strategies to help control the epidemic of dental disease Identify common dental problems and preventive strategies for good oral health in children with special health care needs (CSHCN) Importance of Oral Health Oral Health Affects General Health Oral health is a key element of total health and well-being Your body isn t healthy without a healthy mouth Oral health preventive measures begin prior to birth Oral disease and infection Periodontal gum disease Tooth decay systemic (whole body) infection; can threaten life; unsuccessful organ transplant; surgery delay diabetes, bacterial pneumonia, heart disease, stroke malnutrition, failure to thrive, pain, loss of concentration, emotional/psychological stress 1

2 General Health Affects Oral Health The Function of Teeth Diabetes Pregnancy Medications Chronic infections increased risk of gum disease increased risk of gum disease reduced saliva, enlarged gums, decay reduced ability to fight oral infections Chewing / digestion Speech Facial appearance Bone structure Confidence The Function of Primary (Baby) Teeth Chewing function Speech development Eruption guidance Dental Disease Tooth decay disease process also called caries cavities are the result Image courtesy of dentalcare.com Periodontal gum disease Image courtesy of dentalcare.com Images courtesy of Colgate Tooth Decay Affects children and adults 5 times more common than asthma 7 times more common than hay fever Tooth decay is preventable! The Facts About Tooth Decay Tooth decay is the most common, chronic childhood disease NHANES: Decay rates are increasing for 2- to 5-year-olds 2

3 Tooth Decay Early Childhood Caries Preventing decay in primary baby teeth reduces risk in permanent teeth Preventing decay until aged 4 reduces risk of decay through aged 18 2 years of age is too late Presence of tooth decay or fillings in child under the age of 6 Often called baby bottle tooth decay Caused by multiple factors Chronic, progressive, infectious Image courtesy of AAPD.org Four Factors Necessary for Decay Bacteria: Streptococcus mutans Food sources of carbohydrates/sugar Susceptible tooth Exposure time and frequency Bacteria Transmitted from parent to child, during the first 1-2 years of life Infectious disease process sharing of utensils testing food temperatures cleaning pacifier pre-chewing food Plaque: sticky film Oral Health of Mother/Caregiver Poor oral health of mother results in: Higher levels of bacteria Higher risk of transmission to infant Better oral health in mother results in: Lower levels of bacteria Less bacteria transmitted Primary prevention begins with mother s oral hygiene Food Sources Simple or complex carbs: sugars, starches Bacteria uses the carbohydrates to produce an acid Acid demineralizes the surface enamel, starting the disease process White spot appears normally at gumline 3

4 Food Foods low in sugar cheese fruits & vegetables Cheerios, Rice Chex, Life, Kix, Corn Flakes sugar free gum Foods high in sugar candy cookies sodas fruit drinks Sugar Smacks, Sugar Pops 4 grams of sugar = one teaspoon Susceptible Tooth Susceptibility of the tooth is directly related to fluoride exposure What is fluoride? a natural mineral found in ground water (wells) and surface water (lakes, ponds) fluoride is added to most community water supplies in Virginia for dental benefits tooth enamel absorbs fluoride before and after eruption enamel is then more resistant to decay process Fluoride Fluoride has several preventive effects increases tooth s resistance to cavities encourages healing of very early decay prevents bacteria from making acid 2 sources of fluoride needed to prevent decay systemic - ingested fluoride benefits before and after teeth come in topical - applied to the tooth after eruption into the mouth Systemic (Ingested) Fluoride Sources Fluoridated water community water supplies naturally occurring in well water bottled water (normally not fluoridated) water filters Fluoride supplements prescribed by a doctor or dentist based on results of water testing and other sources of fluoride drops, liquids, tablets (topical benefits also) Community Fluoridated Water My Water s Fluoride Decades of research confirms the safety of fluoridated water Fluoride Sources Children and adults should drink fluoridated water, ideally community fluoridated water If bottled water is used, recommend nursery water 4

5 Topical Fluoride Sources Fluoridated water Fluoride toothpastes (ADA seal) Over the counter (OTC) fluoride rinses Prescription supplements liquid or chewable Professionally applied fluoride gels, foams, rinses, varnish 4. Time & Frequency (Acid Attacks) The longer teeth are exposed to the acids produced by the combination of bacteria and food, the more likely tooth decay will occur! (20-40 minute acid attacks) Consequences of Untreated Decay (in primary dentition) Increases risk of decay in permanent teeth Destruction of tooth structure Difficulty chewing gain/failure to thrive poor weight Speech development problems Premature loss of primary teeth which do need repair unless close to natural loss Consequences of Untreated Decay (adults and children) Unnecessary pain and discomfort Unfavorable treatment experiences Life threatening infections Loss of school/work time Increased treatment expense Inability to concentrate and learn Periodontal (Gum) Disease Image courtesy of AAPD.org Caused by bacteria/plaque Stages gingivitis redness, bleeding, reversible, bleeding is not normal periodontitis loss of supporting bone, irreversible Image courtesy of Colgate Image courtesy of Colgate Images of boys: courtesy of Dr. Tegwyn Brickhouse, VCU Pediatric Dentistry Image courtesy of dentalcare.com 5

6 Periodontal (Gum) Disease Leads to tooth loss Often completely painless; only a dentist or hygienist can detect the beginning stages Can be controlled by good oral hygiene and professional dental treatment Later stages of the disease are much more difficult to treat Daily Oral Hygiene Recommendations Brushing Recommendations Pregnancy Infants Preschool with fluoride 2x/day minimal rinsing with fluoride (rice-grain amount) 2x/day use washcloth or toothbrush with fluoride (pea-size amount) 2x/day parent brushes/child helps School age with fluoride (pea-size amount) 2x/day parent supervises CSHCN with fluoride 2x/day under 2 rice-grain; over 2 pea-size modifications and positioning Basic Toothbrushing Use a soft bristled brush Image courtesy of Colgate Brush the front, back, & biting surfaces of each tooth Use same pattern each time so you don t miss teeth Angle the brush toward the gums and brush with a circular motion Include gumline and tongue Lift the Lip Encourage parent to Lift the Lip once monthly Parent becomes familiar with normal appearance versus noticeable changes If anything unusual is noticed, parent should contact dentist or doctor Dental infections can easily be missed continuing-dentaleducation/store/flip-charts/ Flossing Recommendations Pregnant women Infants Preschool School age CSHCN floss daily bleeding indicates need for more flossing not indicated done by parent once 2 teeth are touching side to side done by parent until ~3 rd grade flossers are easier for children done by parent when necessary flossers are helpful modifications and positioning 6

7 Basic Flossing Flossing Sides of Teeth Flossing begins as soon as the sides of two teeth are touching Children cannot floss on their own until approximately 8-10 years of age Work the floss back and forth gently between teeth Curve floss around the side of each tooth sliding up and down, just under the gums Floss both sides of every tooth Ask a dentist or hygienist for help Top images courtesy of Colgate Topical Fluoride Recommendations* Pregnant women Infants OTC fluoride rinses professional fluoride treatments: Rx strength fluoride varnish WIC nurses, physicians, dentists Preschool fluoride varnish WIC nurses, physicians, dentists School age CSHCN OTC fluoride rinses gels, foams, varnish at dentist OTC fluoride rinses (brushed on or swished) Rx fluoride gel brushed on gels, foams, varnish at dentist Dental Visit Recommendations Pregnant women dental visits are safe and highly recommended Infants Preschoolers School age CSHCN first dental visit by the first birthday check ups every 6 months help to avoid major problems check ups every 6 months help to avoid major problems check ups every 2-6 months Dental home: comprehensive, coordinated oral health care that is continuously accessible and family-centered *In addition to fluoride toothpaste Dental Visits Routine visits every 2-6 months depending on individual needs Dental appointment etiquette / compliance same as any other appointment for a service arrive 5-10 minutes early or at least on time call if delayed or as soon as you know you can t make appointment time give at least hours notice for cancellations Patients arriving late shorten their appointment time and the next person s time Resources for Finding a Dentist DentaQuest Smiles for Children click on Virginia VDH Dental Health Program click on Find a Dentist see handout 7

8 Questions??? Specific Characteristics or Guidance Preschool School age CSHCN FreeDigitalPhotos.net Preschoolers Complete eruption of primary teeth More food options More mobility More independence School Age Mixed dentition shedding primary teeth erupting permanent teeth More active/injury risks Exposure to tobacco products Eruption of Permanent Teeth Children With Special Health Care Needs (CSHCN) Chart courtesy of ADA at 8

9 Background CSHCN are almost twice as likely to have unmet oral health needs than children without SHCN CSHCN have: higher rates of dental diseases more barriers to dental care sunrisemedical.com CSHCN Common Dental Problems Excessive drool Pica: chewing on foreign objects Reflux/vomiting: baking soda rinse(1/4-1/2 tsp soda to 1 cup water) Rumination: chew food, swallow, regurgitate, chew again Pouching: holding food in the folds of the cheeks Picking or poking at gums/teeth (source?) Oral Hygiene Positioning Positioning CSHCN depends on each individual family and child head in your lap you stand behind child, supporting head bean bag or pillows for support child sitting on floor and you sit in chair right behind knee to knee when two adults available Be careful tilting head too far back if there is difficulty swallowing or gagging; neck unstable? Brushing Tips If unable to rinse use wet gauze or cloth Doesn t tolerate toothpaste: dip brush in an over-the-counter fluoride mouth rinse, like ACT or Phos-Flur, then brush Let them be as independent as possible, use the toothbrush themselves, then you brush as well Gently brush the tongue, careful of gag reflex Always use same pattern Oral Hygiene Tool Modifications Battery operated toothbrushes Modified toothbrush handles tennis ball or bicycle grip taped handles lengthen by taping to ruler bend toothbrush handle by heating handle under hot water secure toothbrush to the hand with Velcro strip, rubber tubing use larger or textured grips three-sided toothbrush heads Floss holders Other Oral Hygiene Modifications Mouth props to gain better caregiver access wrap tape around several tongue depressors sterilized door stop (be aware of potential latex allergy) mouth props purchased from dental companies 9

10 Nutrition for CSHCN Oral Health Same as other children: encourage a well balanced diet; limit sweet snacks & drinks between meals Use of bottle and training cup may last longer If frequent soft meals or diets high in sugars/starches are needed rinse or wipe out mouth after every meal more frequent brushing Talk to physician or pharmacist about sugar free medications Dental Visits CSHCN may need to visit dentist every 2-6 months Tell dentist what works and doesn t work at home Bring a favorite blanket, toy, music, etc. Encourage communication between physician and dentist Additional Resources See handouts on the resource table financial assistance for dental care for children with disabilities under aged 18 with cerebral palsy, muscular dystrophy (and related neuromuscular disorders), intellectual disabilities, and organ transplant recipients. Summary Tooth decay is a serious problem. It is preventable!!! Your body isn t healthy without a healthy mouth. You can educate children and their families about good oral health. Early prevention of tooth decay can have a significant impact on the health of children! Speaker Contact Information Kami A. Piscitelli, R.D.H. Office of Family Health Services, Dental Health Program Virginia Department of Health 109 Governor Street Madison Bldg., 8 th Floor Richmond, Virginia Office (804) Dental Health Program(804) Fax (804) kami.piscitelli@vdh.virginia.gov 10