Dental Facts for the Frontline

1. Dental Facts for the Frontline Danielle G. Dooley, MD, MPhil, FAAP Pediatrician Unity Health Care www.docsfortots.org

2. Is Your Child Care, Practice or Organization Dental-Friendly? • Education • Preparation • Prevention

3. Are You Advocating for Oral Health? • Ways child care providers can advocate: • Learn about oral health issues • Teach dental hygiene to the children you serve • Ways advocacy organizations can advocate: • Educate policy makers at local, state and federal level • Organize a dental advocacy campaign •  Ways doctors can advocate: • Learn updates on oral health care • Learn to do an oral health risk assessment • Talk to patients about oral health • Work with advocacy organizations to educate policymakers and the public

4. Topics for Today • Why early intervention matters • Tooth development and decay • Baby bottle tooth decay • Teeth grinding • Thumbsucking • Dental emergencies

5. Good Oral Hygiene Habits Start EARLY! • 90% of all cavities are preventable with good oral hygiene and dental care • The younger a child is when they develop dental caries, the more likely they are to have future dental disease Poland, Charles. Promoting Oral Health in Young Children. http://www.aapd.org.

6. Teeth are in Jeopardy • There is a silent epidemic of dental disease in our country • This epidemic affects poor and minority children the most- these children are 5X as likely to have untreated tooth decay than other kids Krol, David M. Educating Pediatricians on Children’s Oral Health: Past, Present, and Future. Pediatrics 2004;113:e487-492

7. Why Are Teeth in Jeopardy? • Dental caries, or cavities, is the most common chronic disease among children in the United States (5X more common than asthma!) • 50% of kids have at least one cavity by the time they start elementary school • Teenagers have an average of 8 cavities by the time they are 17 yrs old Poland, Charles. Promoting Oral Health in Young Children. http://www.aapd.org

8. Where do Kids Learn to Keep Their Teeth Healthy? • Dentists • Pediatrician • Family • School/Child Care

9. Dental Access is a Problem • Many kids have never been to the dentist- 1 out of 10 kids between the ages of 5 and 10 have NEVER seen a dentist • There are not enough pediatric dentists in the United States to meet the health needs of children • Kids from low income families are 5X as likely to have untreated tooth decay due to poor access to dental services Poland, Charles. Promoting Oral Health in Young Children. http://www.aapd.org

10. Pediatricians Don’t Have the Training or the Time • American Academy of Pediatrics declared in May 2003 that all pediatricians should be able to perform oral health risk assessments starting at 6 months of age • 60% of pediatricians have not received any oral health training • 75% of pediatricians consider their knowledge of oral health inadequate Krol, David M. Educating Pediatricians on Children’s Oral Health: Past, Present, and Future. Pediatrics 2004;113:e487-492

11. There Just Isn’t Time! • In a standard 15 minute well child visit, pediatricians must: • Talk with the parents • Examine the child • Address other topics such as violence and injury prevention, nutrition, breastfeeding, school issues, developmental issues

12. What is a Tooth? • Crown- above the gum • Root- below the gum; makes up 2/3 of the total length of the tooth!

13. Enamel • Enamel- white covering that protects tooth from wear and tear of chewing

14. Dentin • Dentin- supports the enamel; carries the nerve fibers that sense hot/cold/pain

15. Pulp • Pulp- center of the tooth; soft tissue containing blood, nerves. Carries nutrition to the tooth.

16. Types of Teeth • Incisors- teeth in the very front; sharpest; made to cut food and shovel it into mouth

17. Types of Teeth • Canine- corners of mouth; meant for grasping and tearing food

18. Types of Teeth • Molars- last teeth towards the back of the mouth; big flat surfaces for chewing and grinding food into smaller pieces

19. Tooth Development • At birth, children have 20 primary teeth • Teeth start erupting at about 6 months of age • Children shed their baby teeth starting at about 6 years of age • By age 21, they have all 32 of their permanent teeth

20. Tooth Development

21. Why Are Baby Teeth Important? • Baby teeth are important for: • Learning to eat • Learning to speak • Saving a space for the permanent teeth (if baby teeth are lost or decay early, then there is less space for the permanent teeth and this causes crowding)

22. What is Tooth Decay? • Tooth destruction caused by interaction between teeth, food, and bacteria • Streptococcus Mutans is the main bacteria involved in tooth decay • Bacteria in the saliva sticks to teeth in a thick film called plaque

23. Tooth Decay • When kids eat starchy foods, the bacteria break down the starch to produce acids that attack the tooth enamel • Repeated acid attacks cause the tooth to decay in the form of a cavity, or pit in the tooth

24. Is the Bacteria that Causes Tooth Decay Contagious? • YES • Adults have a high concentration of S. mutans in their mouths which can be spread in saliva • Sharing forks, spoons; allowing children to put fingers into adult’s mouth; testing the temperature of a bottle with the mouth • Caregivers need to practice good oral hygiene too!

25. Who is at Increased Risk for Tooth Decay? • Children in communities without fluoridated water or where kids drink mostly bottled water • Children from low income families • Children from racial and ethnic minority groups • Children with limited or no dental insurance • Children with special health care needs- Down’s syndrome, cleft palate

26. Is There a Familial Component to Tooth Decay? • YES! • In 71% of mother-infant pairs, identical genotypes of S. mutans have been found • Children of mothers with high caries rates are at a higher risk of decay • Proper dental hygiene in mothers has been shown to decrease the rate of caries in kids Section on Pediatric Dentistry. Oral Health Risk Assessment Timing and Establishment of the Dental Home. Pediatrics 2003;111:1113-1116

27. How to Prevent Tooth Decay? • Proper brushing • Proper snacking • Fluoride • Regular dental visits

28. Cleaning Infant Teeth • Begin cleaning an infant’s teeth as soon as the first tooth erupts • Use a soft cloth to wipe the tooth down or a very soft toothbrush with plain water • No toothpaste!

29. Cleaning Toddler Teeth • Ages 2 and up • Brush with a pea sized amount of toothpaste using a soft toothbrush • Have the child spit out the toothpaste after brushing but do not rinse with water

30. When Can Kids Brush by Themselves? • It is important for young children to participate in tooth brushing by helping to hold the toothbrush • They have the fine motor skills to clean their teeth well by age 7 or 8 years

31. Snacks that are Good for Smiles • Avoid sticky, sugary snacks- cookies, cake, candy, sodas • Fruits, vegetables, whole grain snacks are best • Snack at regular times- don’t allow all-day snacking! • Offer the child plenty of water (not juice!), especially with snacks

32. Fruits, grains, dairy products provide excellent snacks for healthy smiles!

33. What is Fluoride? • Mineral that increases tooth strength • Main source of fluoride is public water systems; it is also found in toothpaste • Exposure to fluoride can reduce tooth decay by 50-70% • Most important method of preventing tooth decay

34. Why Don’t Our Kids Get Enough Fluoride? • Most bottled water contains no fluoride • Due to lead service lines in the District of Columbia, many families are opting to use bottled water for their kids

35. Is There Such a Thing as Too Much Fluoride? • YES • Don’t give fluoride toothpaste to kids under 2 years- if they swallow too much toothpaste the fluoride can cause spots on their teeth • Avoid fluoride mouth rinses in kids under 6 years- they will get more than enough fluoride from their toothpaste

36. When Should Kids go to the Dentist? • Recommendation from the ADA and AAP is that kids have their first visit to the dentist by age 1 year • Reality is that many families do not have access to dental services and there is a shortage of pediatric dentists

37. Baby Bottle Tooth Decay • Occurs when kids are put to bed with a bottle or allowed to have bottle in their mouth for long periods of time • Parents and caregivers often give a bottle to encourage sleep or quiet the child and feel it is cruel to deny food to the infant • Affects 5-10% of children

38. Baby Bottle Tooth Decay • Milk or juice pools in the child’s mouth around the teeth and remains there for long periods, allowing dental cavities to form • There is not a lot of saliva produced in the mouth during sleep, so there is nothing to wash away the milk or juice • The bacteria in the mouth interact with the sugars in the liquid to produce acid and cause tooth decay

39. What does Baby Bottle Tooth Decay Look Like? • Upper front teeth and incisors are affected most • Loss of glossy appearance to enamel- white spot lesions • Flat brown, yellow spots • Occasionally teeth are broken Very early tooth decay Tooth decay Severe tooth decay

40. What About Breastfed Babies? • Breastfeeding does not automatically protect babies from dental caries • If breastfed babies feed for extended periods of time, they develop the same pattern of caries as bottle fed babies

41. Baby Bottle Tooth Decay is Preventable! • Educate parents not to put baby to bed with a bottle- by 4 months of age, most babies do not need feedings during the night • Don’t use the bottle as a pacifier- allow kids to have it only at mealtime • Transition kids from a bottle to a cup by 1 year of age

42. What if the Baby Really Needs the Bottle to go to Sleep? • Alternatives to bottles to calm an infant or help them get to sleep: • Favorite blanket or toy • Clean pacifier • Holding, patting, rocking the infant • Reading to the infant • Softly talking or singing to the infant

43. Teeth Grinding • Also known as bruxism • Usually occurs during sleep, pattern of jaw clenching and teeth grinding • 3/10 kids have this problem, most are under 5 years of age

44. What Causes Teeth Grinding? • No one really knows • Some possible causes are: • Stress- situations at home or school that cause tension or anger • Improper alignment of top and bottom teeth • Response to pain such as earache or teething pain

45. What are the Effects of Teeth Grinding? • Usually it is more bothersome to the parents than the child • In severe cases, can wear down tooth enamel, chip teeth, cause facial pain • Most kids outgrow teeth grinding

46. How is Teeth Grinding Treated? • Visit the dentist, who will examine the child’s teeth for chipped enamel and proper alignment • If either of these exist, then the dentist may make a special mouthguard for the child to wear at night • Try to address stressful circumstances in the child’s life and help them relax before going to bed

47. Thumbsucking • Many children suck their thumbs, fingers, or a pacifier • Natural reflex for infants • Soothing • Induces sleep • Helps them to explore the world around them by sucking on their fingers or other objects

48. Thumbsucking • Most children give up this habit between the ages of 2-4 years • If kids still have a sucking habit after age 4, they should see a dentist • Most problems from sucking habits start around age 6, when the permanent front teeth come in

49. Thumbsucking • Intensity of sucking determines whether children develop problems with their teeth • Kids who rest their thumb in their mouth are less likely to develop dental problems • Problems caused include misalignment of the teeth and changes in the roof of the mouth

50. Thumbsucking • Upper front teeth flare out and tip upward • Lower front teeth move inward • Roof of mouth becomes arched or caved in