Washoe County Maternal and Child Health Coalition

1. Washoe County Maternal and Child Health Coalition Laurie Nickles, RDH, MS Health Educator Nevada State Health Division Bureau of Family Health Services

2. Contact Information Oral Health Program Bureau of Family Health Services Nevada State Health Division 3427 Goni Road, Suite 108 Carson City, NV  89706 tel:  (775) 684-4285 emails:  lnickles@health.nv.gov web: http://health.nv.gov

3. Teeth, Germs and more! • Oral health and the rest of the body • Concerns during pregnancy/motherhood / • Review the basics with NEW relevance! • Oral health information for your target population • Oral Health Program highlight

4. Why is a Healthy Mouth Important? • “Oral health is essential to general health and well-being”The U.S. Surgeon General • “Infection and inflammation in the mouth have been linked to: • type 2 diabetes • heart disease • stroke” Oral and the Whole Body Health, Scientific American, 2006 • Teeth are for a lifetime!

5. The Mouth really is part of the Body! Oral Health affects: • Pregnancy • Diabetes • Heart and Lung disease • Stroke • Pancreatic Cancer • Emotional and Mental Health (self-esteem, employability) • Pocketbook – dental tx is expensive!

6. Pregnant Women & Oral HealthWhat happens in your mouth affects your whole body! • Moms with good oral health have healthier babies and children • Moms with poor oral health are up to seven times more likely to deliver premature or low birth weight babies

7. Oral Diseases Can Effect Pregnancy • How does it work? • Theories • Teeth cleaning in pregnant women with periodontitis may reduce pre-term births

8. Spontaneous preterm birth in pregnant women with gum disease Spontaneous Preterm Births Jeffcoat et al. (2003) Periodontal disease and preterm birth: results of a pilot intervention study.

9. When should I see the dentist? You could hurt yourself or your baby by NOT going to the dentist • Any time • Check-ups and cleanings • Emergency care (including x-rays with lead apron) • Second trimester or first half of third best for procedures that require: • Anesthesia • Medication • Time in the chair

10. Safe Dental Treatment • Most treatments considered safe • Acceptable drugs • Dental anesthetics • Chlorhexidine rinse • Give dentist your obstetrician’s contact information • Avoid • Aspirin or ibuprofen • Tetracyclines

11. Fetal Growth and Development • Development of infant’s mouth • 4-5 weeks – primary tooth buds • 4-7 weeks – lips • 8-12 weeks – roof of mouth • 12 weeks – primary teeth start to harden • 6 months - permanent tooth buds

12. Changes During Pregnancy that Affect Oral Health • Hormonal Affects • Increased tooth mobility • Saliva changes • Increased bacteria • Gum problems

13. Changes During Pregnancy that Affect Oral Health • Morning sickness • Difficulty with hygiene • Gum disease • Tooth decay • Vomiting • Esophogeal Reflux (heartburn) • Acid exposure • Irritation of the gums • Weakening of tooth enamel • Dental erosion

14. Treatment for Acid Exposure • Do NOT brush immediately after vomiting • Rinse • Water with baking soda • Antacid • Plain water • Eat some cheese • Ask about fluoride

15. Eating Disorders According to the National Eating Disorders Association: • Up to 89 % of bulimic patients have signs of tooth erosion, due to the effects of stomach acid. • Loss of tooth enamel can be considerable. Teeth change in color, shape and length. • Teeth can become brittle, thin, and sensitive to temperature. • Lips may become reddened, dry and cracked. • Patient may also experience dry mouth. Photos courtesy of Craig Mabrito, D.D.S.

16. Prevention: Oral Hygiene • Reduce the amount of bacteria in your mouth • Brushing and flossing • Antibacterial mouth rinses • Xylitol gum or mints • Keep routine dental visits

17. Natural, sugar-free substance – made from Birch trees. May reduce bacterial growth. May alter bacterial transmission. Increases saliva. May prevent Cavities! OK for Diabetics 70% less decay if Mom chewed xylitol 93% less cavities if child chewed before tooth came in. 40% less calories than sugar. May reduce periodontal disease/ear infections. Xylitol Research

18. Prevention:Nutrition for Oral Health • Eat well-balanced meals • B vitamins, especially folate (folic acid) • Vitamin C • Calcium, Vitamin D • Snack smart • Raw fruits and vegetables • Dairy products • Avoid starchy or high carbohydrate snacks

19. Moms and Early Childhood

20. Germs in the Mouth?¿Gérmenes en la Boca? • Babies are not born with the germ that causes cavities. • They get it from parents or caregivers. • Children are less likely to have cavities if the parents have healthy mouths. • Los bebés no nacen con el germen que causa caries. • Los obtienen de sus padres o cuidanderos. • Los niños son menos probables a tener caries si sus padres tienen bocas saludables.

21. Sharing GermsTransmitir Gérmenes Is your mouth clean and healthy? If not, you are giving your germs to your child by: • Hand to mouth contact. • Kissing on the lips. ¿Su boca esta limpia y sana? Si no, usted le esta trasmitiendo sus gérmenes a su niño por: • Contacto de mano a boca. • Besándo en los labios.

22. Cavities are Infectious!¡Las Caries son Infeccioso! • Tasting/sharing food and drinks. • Cleaning the pacifier in your mouth. Parents need a clean healthy mouth, too! • Probando/compartiendo comida y bebidas. • Limpiando el chupón con su boca. ¡Los padres necesitan una boca limpia y saludable, también!

23. How Do Cavities Happen?¿Cómo Suceden las Caries? • Germs (plaque) grow on teeth. • Germs + Sugar foods and drinks = Acid. • Acid + Teeth = Cavity. • Gérmenes (placa) crecen en los dientes. • Gérmenes + comida y bebidas con Azúcar = Ácido. • Ácido + Diente = Carie.

24. “The whole tooth” • Bacteria + Sugar = Acid • Acid + Tooth = Demineralization • Fluoride + Tooth = Remineralization Enamel Remineralization Enamel Demineralization

25. Anatomy of a tooth!

26. Prevent CavitiesPrevenir las Caries • Eat healthy. • Limit sugary foods and drinks. • Clean teeth twice a day. • Visit the dentist 2 times a year. • Comer Saludable. • Limite comidas y bebidas con mucho azúcar. • Cepillar los dientes dos veces al día. • Visite el dentista 2 veces por año.

27. Do you know? • A 12 oz. can of soda may have 10 to 13 teaspoons of sugar. • A teaspoon of sugar has 16 calories. • Diet soda has more acid than regular soda. • If you must drink soda, drink it with a meal, don’t sip on it for an extended period of time.

28. First Tooth!¡El Primer Diente! • Start when you see the first tooth!! • Clean the first teeth with a clean damp cloth or a small soft toothbrush. • Once a day – every day. • Clean the gums, too! • ¡¡Empiece cuando salga el primer diente!! • Límpiele el primer diente con un trapo húmedo y limpio o con un cepillo dental pequeño y suave. • Una vez al día - todos los días. • ¡También límpiele las encías!

29. Cleaning TeethLimpiar los Dientes • A grown up should brush a child’s teeth until the child can sign his first and last name (not print). • Important to brush before bedtime! • Un adulto debe cepillarle los dientes a un niño hasta que el niño pueda firmar su nombre y apellido. • ¡Es importante cepillar antes de dormir!

30. ToothpastePasta Dental • Avoid too much toothpaste! • Use a “pea” size amount. • Use fluoride toothpaste after child is two years old or can spit. • ¡Evite demasiada pasta dental! • Utilice una porción del tamaño de un “frijol”. • Utilice una pasta dental con fluoruro después de que el niño tenga dos años o pueda escupir.

31. Toothbrush CareCuidado del Cepillo Dental Rinse toothbrush. • Use your own toothbrush – no sharing! • Replace every 3 months. • After illness get a new one or sterilize it. • Enjuague el cepillo dental. • Utilice su propio cepillo de dientes – ¡no lo comparta! • Reemplázalo cada 3 meses. • Después de estar enfermo obtenga uno nuevo o esterilícelo.

32. What Else Can I Do to Prevent Cavities?¿Qué Otras Cosas Puedo Hacer para Prevenir las Caries? • By age 1, use a cup to drink. • Before bed, drink only water after teeth are clean. • Children should eat or drink at meals and snack time – not all the time. • A la edad de un año, use un baso para beber. • Antes de dormir, tome solo agua después de cepillarse los dientes. • Los niños deben de tomar líquidos cuando coman sus comidas o bocados al tiempo adecuado-no todo el día.

33. Lift the Lip!¡Levante el Labio! • Look for white or brown spots on the top front four teeth. • Look on the back of the teeth - inside the mouth. • Check once a month! • Revise si tiene manchas blancas o cafe en los cuatro dientes de arriba y enfrente. • Revise en la parte interior de los dientes – adentro de la boca. • ¡Revise una vez al mes!

34. A Single Toothbrush Bristle Next to a Pit in a Tooth

35. Sealants keep the bugs out!

36. 2007 Nevada Head Start Children’s Oral Health Compared to Healthy People 2010 Objective Caries Experience Untreated Decay

37. Regional Comparison of 2004 and 2007 Head Start BSS Screening Results Caries experience Untreated decay

38. 2006 Oral Health of Nevada’s Third Grade StudentsStratified by Region

39. Healthy Teeth and FluorideDientes Saludables y Fluoruro

40. Fluoride Fluoruro • Makes Teeth Stronger. • Prevents Cavities. • Repairs Early Cavities. • Hace los Dietes Más Fuertes. • Previene caries. • Repara caries al comenzar.

41. Fluoride Works…El Fluoruro Trabaja… • Inside Your Body. (Systemic) • On Your Teeth. (Topical) • Adentro del Cuerpo. (Sistémico) • En Sus Dientes. (Tópico)

42. Water Fluoridation Saves $$$Agua Fluorizada Ahorra Dinero $$$ • In 2005 it cost 19 cents per person to add fluoride to the water in Clark County. • The American Dental Association’s Fluoridation Facts states that every $1 spent on water fluoridation saves about $38 in dental costs. • In one year (2005), Clark County saved over $12.8 million in dental costs. • En el 2005, el costo por persona fue 19 centavos para agregarle fluoruro al agua en el Condado de Clark. • La Asociación Dental Americana’s, Fluoridation Facts informo que cada $1 gastado en agua flúor izada ahorro aproximadamente $38 en costo dental. • En un ano (2005), El Condado de Clark se ahorro mas $12.8 millones en costo dental.

43. Fluoride Prescription:(systemic)Prescripción de Fluoruro:(sistemático) • Check bottle for directions. • Take with water, NOT milk. • Take it everyday to prevent cavities. • If child drinks fluoridated water, fluoride drops/tablets are not needed. • Revise la botella para leer las instrucciones. • Tome con agua y NO con leche. • Tomelo todo los días para prevenir caries. • Si su niño(a) toma agua fluorada las gotas o tabletas de fluoruro no son necesarias.

44. At Home, Fluoride May Be In:En Su Hogar, el Fluoruro Puede Estar En:

45. Fluoridated Toothpaste (topical)Pasta Dental con Fluoruro (tópico) • Use a fluoride toothpaste when a child is two years old or can spit out. • Use earlier if doctor or dentist tells you. • Use only a pea-size amount. • Look for the ADA Seal of Approval. • Utilice una pasta dental con Fluoruro cuando su niño(a) tenga dos años de edad o pueda escupir la pasta para fuera. • Utilice la pasta antes si su doctor o dentista se lo indica. • Utilice una cantidad pequeña. • Busce el ADA Sello de aprobación.

46. Fluoride Varnish by a Health ProfessionalTratamiento de Fluoruro con Barniz en una Oficina Dental • Prevents new cavities and helps stop cavities that have already started. • Takes 30 seconds to 2 minutes to paint on. • Safely used on babies as soon as they have teeth. • Works best if painted on teeth 3-4 times a year. • Previene la formación de nuevas caries y ayuda detener las caries que ya han comenzado. • Dura de 30 segundos a 2 minutos en aplicar la pintura. • Es seguro de usar en bebes tan pronto y tengan dientes • Trabaja mejor si la pintura es aplicada en los dientes 3 a 4 veces por año.

47. Identification of Dental Neglect • Untreated, rampant caries • Untreated pain, infection, bleeding or trauma • Lack of continuity of care once informed that above conditions exist • Willful failure to seek and follow through with treatment necessary to ensure oral health American Academy of Pediatric Dentistry

48. Acknowledgements MAJ Georgia dela Cruz Dental Staff Officer Directorate of Health Promotion & Wellness US Army Center for Health Promotion & Preventive Medicine • Additional graphics or information provided by the following: • Diann Bomkamp, RDH, BSDH, Missouri • WI Dept. of Health and Family Services • University of Southern California • Phoenix College • Proctor & Gamble • Dr. Luke Shwart, Calgary Health Region

49. Tobacco & Oral Cancer Over half of people with Oral Cancer are 65 years or older

50. If you smoke, chew or drink alcohol…..make sure you get an oral cancer exam! • Any white or red lesion that does not resolve in two weeks should be reevaluated and considered for biopsy to make sure you don’t have cancer. Gruen von Behrens Photo from NSTEP