ORAL HEALTH SCREENING

1. ORAL HEALTH SCREENING

2. Child & Teen Checkups

3. Congress created the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program to promote: • Preventative health • Prevent disease • Detect treatable problems early to avoid further serious health conditions & more costly health services Child & Teen Checkups

4. EPSDT is a preventative component of the Medicaid Program It provides for coverage of comprehensive & periodic health and developmental screening for all Medicaid enrolled children, birth to age 20 These comprehensive screenings or checkups include an oral examination component as part of the physical exam Child & Teen Checkups

5. A comprehensive health & developmental history including: mental health, nutrition, chemical use Growth measurements Physical & mental health development screening Comprehensive unclothed physical exam, including oral exam (teeth, gums, tongue, soft tissue) Hearing & vision screening Child & Teen Checkups

6. Age appropriate immunizations & review • Lab tests such as: • blood lead assessment appropriate for age • risk factors and hemoglobin/hematrocit • Health education & anticipatory guidance appropriate for the age and health of the child and which include preventative measures for good oral health • Verbal referral for regular, preventative dental health checkups at the time of the eruption of the first tooth or no later than 12 months of age Child & Teen Checkups

7. Oral Health

8. The mouth is part of the body A child’s oral health is an integral part of overall health Appropriate evaluation, treatment, & preventative measures should be instituted at infancy and continued on a regular basis to maintain optimal health Oral Health

9. Dental caries is the most common chronic disease affecting children in the U.S. It is 5 times more common than asthma It is 7 times more common than hay fever 80% of early childhood caries occurs in 20% of children Oral Health

10. Dental care is the most common health need for high-risk children • The incidence of need for dental care by age: • 20% by age 2 • 30% by age 3 • 40% by age 4 • 50% by age 5 Oral Health

11. Low income families & ethnic minorities share a larger disease burden More than 51 million school hours are lost each year because of dental-related illness Oral Health

12. Provider’s Role

13. Children get a healthy start when dental & medical providers, parents, & educators work together to prevent oral health problems Primary care providers often have early access to high-risk children and play a key role in helping to prevent oral diseases Children often see primary care providers first and the role these health professionals serve in providing anticipatory guidance and directing families to the services of a dentist is critical Provider’s Role

14. Children & Teen Checkups (C&TC) providers are required to verbally refer kids at the eruption of the first tooth or by 12 months of age, or earlier if indicated, for preventative dental checkups Verbal referrals should be given at each subsequent C&TC visit Provider’s role

15. Dental development

16. Tooth eruption, or teething, is a process that begins around 6 months of age Teeth usually erupt on the lower gum line, from the front to the back of the mouth Children should have all their 20 primary teeth by 5 or 6 years old Primary teeth are lost as permanent teeth erupt, a process that continues for 6 to 8 years Permanent molars erupt at age 5 or 6 Dental development

17. While there may be variation in tooth development and appearances among children, notable difference may be signs of oral problems • Therefore, it’s important for them to: • Receive oral health screening • Assessment & care from the time their first tooth erupts through development Dental development

18. Oral health trends

19. In 2000, the Surgeon General reported that “oral health is an essential component of overall health and well-being that a coordinated effort is needed to reduce environmental, social, educational, health system and financial barriers to achieving optimal oral health for everyone.” Oral health trends

20. In 2007, the Centers for Disease Control and Prevention’s largest survey of the nation’s dental health in more than 25 years, reported tooth decay in young children has been on the rise. Cavities in children ages 2 to 5 increased to 28% in 1999-2004 from 24% in 1988-1994. Oral health trends

21. Children who live in poverty experience two times more tooth decay than their affluent peers, and their disease is more likely to go untreated. Dental health access barriers and drinking water primarily from private wells with insufficient fluoride levels can also lead to an increased risk of tooth decay. Oral health trends

22. Oral diseases affect a child’s ability to eat, participate in daily activities, and their overall health and social well-being. Children with chronic oral health problems may have more difficulties eating, talking, sleeping, and playing. These children will also miss more school, activities, and are at risk of failure to thrive. Oral health trends

23. Importance of oral health screening

24. Since oral health plays a crucial role in the overall development, health and social well-being of children, it’s important to screen children early for oral health problems. • It’s crucial to screen children who come from disadvantaged populations. • These children are: • Less likely to afford adequate oral and dental care • Have access to proper screening & assessment Importance of oral health screening

25. Primary care providers often have access to children who are most at risk for poor oral health. This provides opportunities for providers to screen & prevent oral health problems in the primary care setting. Importance of oral health screening

26. Purpose & componentsof oral health screening

27. The purpose is to identify: • normal versus abnormal oral condition • make referrals for dental care • If no problems are found, a verbal referral should be given for regular, preventative dental care. • If abnormalities are found, referrals should be given for dental assessment & treatment. Purpose & components of oral health screening

28. Oral health screening should be included whenever general health screening is done during a C&TC visit. Oral health screening in the primary care setting is important because primary care providers often have early access to children who are most at risk for poor oral health. Purpose & components of oral health screening

29. An oral health screening is comprised of three parts: • Reviewing oral health history • Performing a physical examination of the child’s math • Referring for preventative dental care or assessment & treatment Purpose & components of oral health screening

30. Oral health history review

31. The oral health history should cover a child’s and his/her caregiver’s past & current oral health practices & experience to help discover risks for oral problems. Oral health history review

32. This review can include: • Previous oral problems • Diet & nutrition • Fluoride intake: • Primary source of drinking water • Past fluoride treatment • Supplements • Dental visit history • Drug/alcohol use • Medical conditions including diabetes, infections, etc. • Medications that affect the mouth • Baby bottle or sippy cup use Oral health history review

33. Physical examinationof child’s mouth

34. An oral health screening includes a physical examination of a child’s mouth, including: • Lips • Tongue • Teeth • Gums • Tissues Physical examination of child’s mouth

35. A common screening procedure called “Lift the lip” can be used to examine a child’s mouth. A dental chair & other dental equipment are not required to perform the screening procedure. Gloves (latex or non-latex), a tongue blade & a good light source should be adequate for the exam. Physical examination of child’s mouth

36. The screener & caregiver should sit facing each other with their knees touching. Lay the child on the screener’s lap with his/her head securely nestled against the screener’s abdomen. Physical exam of child’s mouth (less than 3 years of age)COURTESY: AAFP.ORG

37. With gloved hands, the screener should: Lift the child’s lips Feel the soft tissues Check the physical conditions of the teeth and gum Look throughout the mouth Physical exam of child’s mouth (less than 3 years of age)COURTESY: WORLD NEWS ARTICLE

38. For a child 3 years of age or older: • The child can be checked while sitting close and across from the screener. • A tongue depressor can be used to move the lips to view the teeth. Physical examination of child’s mouth

39. Things to do during the physical exam

40. The objective is to identify normal versus abnormal conditions. • During this component, the screener should: • Determine whether tooth eruption and loss are up to schedule according to tooth development guidelines. • Observe tooth abnormalities and alignment of teeth • Observe oral plaque and debris • Check for dental caries using the Caries-Risk Assessment Tool, oral injuries and other anomalies Things to do during the dental exam

41. Common oral healthproblems & abnormalities

42. Normal oral conditions include: • Primary teeth should be white & opaque with smooth surfaces on front teeth & grooved surfaces on back teeth • Permanent teeth should appear creamier in color & larger than primary teeth • Lips & tongue should be soft, pink, & moist Normal oral health conditions

43. Normal oral conditions also include: • Tissues under lip should be pink or brown (depending on child’s skin color), smooth, & moist • The palate should be soft, pink, & moist • Skins & tissues of the face should not be bruised, swollen, or tender Normal oral health conditions

44. Normal oral health conditions Courtesy: World News article

45. Normal oral health conditions Courtesy: belmontdentalcare.com

46. Many oral abnormalities & problems can occur from infancy to adolescence, including: • Dental caries are cavities or holes in the teeth caused by tooth decay and are the most common, chronic and transmissible oral infections in children and adolescence • During food consumption, cariogenic bacteria in the mouth are activated to break down simple carbs & sugar-rich foods. • They produce acids that cause demineralization of teeth • Cavities are produced when the process is prolonged & exceeds teeth remineralization Common abnormalities & problems

47. Early Childhood Caries (ECC), also called “baby bottle tooth decay”, are dental caries seen in infants & children and can appear any time after tooth eruption • ECC usually affect the primary upper/lower front teeth and are caused by: • Eating sugary and simple carb-rich foods • Prolonged bottle & breast feeding • Transmission from caregiver to child if toothbrush or other products are shared Common abnormalities & problems

48. Dull white band along gum line as a result of demineralization Yellow, brown, or black collar around the neck of the teeth which is indicative of progression to cavities Dental caries & ECC characterizationCourtesy: thefreedictionary.com

49. Teeth that are brownish, black stumps as a result of advanced cavities Dental caries & ECC characterizationcourtesy: STUDIODENTAIR.COM

50. Missing or excess teeth may be present in young children, which is a result from: • Hereditary syndromes • Can be detected & further assessed by radiography • Delayed tooth loss or eruption may be signs of missing or excess teeth Common abnormalities & problems