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New Mexico

New Mexico. Welcome. ORAL HEALTH IS INTEGRAL TO GENERAL HEALTH. New Mexico Office of Oral Health Rudy Blea, BA. Oral Health Status of New Mexico Children. CDC National Objective

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New Mexico

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  1. New Mexico Welcome

  2. ORAL HEALTH IS INTEGRAL TO GENERAL HEALTH New Mexico Office of Oral Health Rudy Blea, BA

  3. Oral Health Status of New Mexico Children CDC National Objective Healthy People Objective #21-8 is to increase the percentage of eight year olds who have received dental sealants on their molar teeth to 50%. State of New Mexico Performance Measure • Develop a continuum of oral health care for children ages 0-18 by providing them with fluoride varnish and dental sealant applications. • Develop public/private partnerships to provide oral health preventive and restorative care. • Improve access by expanding the number of dental providers in rural areas. • Improve the quality of dental care for people with disabilities.

  4. ORAL HEALTH STATUS OF NEW MEXICO 3RD GRADERS Surveillance Project • 1,136 3RD GRADE STUDENTS • 27 COUNTIES REPRESENTED • DENTAL ASSESSMENTS REVIEWED • SCHOOL YEAR 2005, 2006, 2007 • SCREENED BY STATE STAFF • SEALANTS APPLIED BY STATE STAFF

  5. Oral Health Status of New Mexico Children

  6. ORAL HEALTH STATUS OF NEW MEXICO 3RD GRADERS ANALYSIS • FEMALE 50.8% MALE 47.0% • ETHNICITY • 69% Hispanic • 13% White • 6.40 % Native American • 5% Unknown • 4% Multi-racial • OF THOSE REPORTED 41.6% THE PARENTS STATED THEY DID NOT HAVE A DENTIST (473) • 55% DID NOT REPORT ANY INFORMATION

  7. ORAL HEALTH STATUS OF NEW MEXICO 3RD GRADERS ANALYSIS CONTINUED • DENTAL SEALANTS 60% HAD DENTAL SEALANTS ON ALL FOUR MOLARS 10% HAD DENTAL SEALANTS ON THREE MOLARS 9% HAD DENTAL SEALANTS ON TWO MOLARS 5% HAD DENTAL SEALANT ON ONE MOLAR 82% ONE OR MORE SEALANT COLLECTIVELY 17% DID NOT HAVE SEALANTS ON THEIR FIRST MOLAR

  8. ORAL HEALTH STATUS OF NEW MEXICO 3RD GRADERS • SEALANTS BY ETHNICITY • NATIVE AMERICAN 75.3% • HISPANIC 81.4% • MULTIRACIAL 87.2% • UNKNOWN 86.7% • WHITE 87.1%

  9. Oral Health Status of New Mexico Children

  10. ORAL HEALTH STATUS OF NEW MEXICO 3RD GRADERS • 2010 PREVALANCE OF DECAY • 26% UNTREATED DECAY • 74% NO DECAY CLASS I DECAY 74% CLASS II DECAY 11.2% CLASS III DECAY 4.7 UNKNOWN 10%

  11. ORAL HEALTH STATUS OF NEW MEXICO 3RD GRADERS • 2010 DECAY AND ETHNICITY • 43.8% NATIVE AMERICAN • 22.2% HISPANIC • 38.3% MULTI-RACIAL • 31.7% UNKNOWN • 30.3% WHITE

  12. ORAL HEALTH STATUS OF NEW MEXICO 3RD GRADERS • BARRIERS TO ORAL HEALTH • LACK OF PROVIDERS • NO DENTAL INSURANCE • LOW INCOME • MEDICAID ELIGABILITY • TRANSPORTATION • LACK OF SCHOOL PROGRAMS

  13. 2006 3RD Grade Oral Health Surveillance System Report • In 1999-2000 Survey,2136 3rd grade children were screened • 43.2% had one or more dental sealant • 64.6 had caries experience • 37% had untreated decay • 5 Years Later (FY 2006, 2007, and 2008) • Dental Sealant Use Has Increased (84%) • Untreated tooth decay has decreased (26%)

  14. THE PERIODONTIUM Cross-section of a normal tooth and supporting structures.

  15. DECIDUOUS DENTITION • Nomenclature for primary teeth.

  16. PERMANENT DENTITION • Nomenclature for permanent teeth.

  17. AGES AT ERUPTION (AND EXFOLIATION) • Age range at eruption of primary and permanent teeth and at exfoliation of primary teeth is shown.

  18. VENN DIAGRAM OF DENTAL CARIES • Caries occurs at the intersection of a susceptible host (one with teeth), presence of microorganisms (e.g., Streptococcus mutans; Lactobacillus), and dietary substances (fermentable carbohydrates). The intensity of bacterial and dietary factors and their interplay will determine caries activity levels.

  19. DENTAL CARIES: ETIOLOGY The process of dental caries requires: • Susceptible tooth • Presence of bacteria • Fermentable carbohydrates • Bacteria metabolize fermentable carbohydrates (sugars and cooked starches) and produce acid, resulting in localized lowering of the pH. • Species of Streptococcus (initiate caries) and Lactobacillus (promote continuation of caries development) are most often implicated in the caries process. The bacteria are transmitted usually from the primary caregiver (mother), but others (e.g., other parent, day care staff) have also been implicated.

  20. THE CARIES PROCESS • The caries process requires a tooth, fermentable sugar and cariogenic bacteria. To reach cavitation, demineralization must exceed remineralization. Demineralization may be reversible (e.g., with fluoride applications or sound oral hygiene).

  21. DEMINERALIZATION V. CAVITATION • Since caries is a process and cavitation the end result of that process, four situations are possible.

  22. COMMON PATTERNS OF DECAY: • Four patterns of decay commonly exist.

  23. CARIES AND INFECTION Left untreated, a carious area typically will continue to enlarge. Once the caries process has exposed the pulp, which is the neurovascular bundle at the center of each tooth, a soft tissue infection can result. An untreated dental abscess (single arrow) can lead to the rapid development of cellulitis. Cavernous sinus thrombosis and Ludwig’s angina (both uncommon) pose life-threatening complications which can also result from an untreated dental abscess. Fortunately, most dental abscesses remain localized. Note: Carious central and lateral maxillary incisors (double arrows). Though the central and lateral mandibular incisors touch (triple arrow), they are protected from decay by the tongue/lip and the saliva from the sublingual salivary glands.

  24. TOOTHBRUSHING TECHNIQUE • The correct positioning of the brush is shown. A small amount of fluoride toothpaste (a thin film (less than pea-sized) should be used by children two years of age and older. For the child who is less than two years of age, the dentist/medical provider should decide whether fluoride toothpaste should be used.

  25. Pit and Fissure Caries • Caries is present in both the “biting surface” of a permanent first molar (single arrows) and in the buccal pit (a non-biting surface) (double arrow). Dental caries can readily begin on the biting surfaces of posterior teeth, in a pit or fissure (which is typically narrower than a single toothbrush bristle, making it impossible to clean with a toothbrush) or in minute defects in the enamel which, at the base of these structures, is frequently thin. Plaque collects in these areas and is not easily removed by normal oral hygiene measures (brushing). Fissures such as these can be protected with sealant. Generally, primary teeth have better coalesced, less angular and less deep fissures and are therefore often less susceptible to the caries process.

  26. DENTAL SEALANTS • The placement of sealants is a minimally invasive, preventive procedure and an integral part of a caries prevention plan. The biting surfaces of permanent teeth, with their deep, narrow pits and fissures, are susceptible to the carious process and less well protected by topical fluorides or by controlling frequent consumption of fermentable carbohydrates. • In the presence of high caries rate or risk, primary teeth may also be considered candidates for sealant application. Resin sealant material seals the pits and fissures, forming a physical barrier that prevents acid demineralization of enamel. Sealants should be applied within six months to one year of eruption of the tooth. Once applied, sealants should be regularly evaluated by a dentist; they may need to be reapplied.

  27. DENTAL SEALANTS • Note sealant application on occlusal (biting) surfaces of primary and permanent molars (arrows).

  28. DENTAL SEALANTS • Dental sealants are available in an opaque, tinted, or clear form. Tinted and opaque sealants are easier to detect at subsequent dental examinations. Eighty-five to 95% of sealants are in place after one year, 65-80% after 5 years, and 40-55% after 10 years. • Sealants are easily repaired or replaced if necessary. (Tooth before sealant applied, single arrow; after application, double arrow).

  29. ORAL HEALTH STATUS OF NEW MEXICO CHILDREN PEW REPORT FOUR APPROACHES STAND OUT TO FOR THEIR POTENTIAL TO IMPROVE BOTH DENTAL HEALTH OF CHILDREN AND THEIR ACCESS TO CARE • SCHOOL BASED DENTAL SEALANT PROGRAMS • FLUORIDATION • MEDICAID IMPROVEMENTS TO INCREASE THE NUMBER OF DENTISTS SEEING CHILDREN • INNOVATIVE WORK FORCE MODELS THAT EXPAND THE NUMBER OF QUALIFIED DENTAL PROVIDERS INCLUDING MEDICAL PROVIDERS WHEN DENTAL PROVIDERS ARE ABSENT.

  30. Oral Health Status of New Mexico Children

  31. ORAL HEALTH STATUS OF NEW MEXICO CHILDREN • SCHOOL BASED PROGRAMS • Implement Dental Sealant Program • Increased Dental Screening by School Nurse or Physician • Implement Eight Component Model • Increased permission slips from parents • Dental Case Management = Dental Providers • Data Collection • Best Practice – Increase Funding

  32. ORAL HEALTH STATUS OF NEW MEXICO CHILDREN • TOOL KIT • ASTDD Pain and Suffering Brochure • CDC Coordinated School Health Program • Medical News Alert: School Role • Medical News Alert: Oral Health and Systemic Diseases • CDC Healthy Youth and Nutrition • Dental Sealant • CDC Fluoride • Medical News Alert: Smokeless Tobacco • Resource List

  33. ORAL HEALTH IS INTEGRAL TO GENERAL HEALTH Thank you!

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