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Protecting All Children’s Teeth

Protecting All Children’s Teeth. Oral Health Screening. Introduction. Dental caries is a multi-factorial chronic disease process. A variety of risk factors are known to contribute to the development and progression of dental caries.

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Protecting All Children’s Teeth

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  1. Protecting All Children’s Teeth Oral Health Screening http://www.aap.org/oralhealth/pact

  2. Introduction • Dental caries is a multi-factorial chronic disease process. A variety of risk • factors are known to contribute to the development and progression of • dental caries. • This presentation will review the American Academy of Pediatrics (AAP) • policy on risk assessment and screening, explain how pediatricians can • assess dental caries risk in their patients, present a tool that can be used • to assist in risk assessment, and propose referral options for patients • deemed at risk. http://www.aap.org/oralhealth/pact

  3. Learner Objectives • Upon completion of this presentation, participants will be able to: • Recall the AAP policy on the initiation of oral health risk assessment in the primary office. • Perform a complete pediatric oral examination. • Utilize the AAPD Caries Assessment Tool in clinical practice. • Recall the 6 high-risk groups listed in the AAP policy on risk assessment. • State the ideal age for establishment of a dental home. http://www.aap.org/oralhealth/pact

  4. AAP Policies on Risk Assessment • The American Academy of Pediatrics (AAP) has published 2 policy • statements about oral health risk assessment: • 1. Oral Health Risk Assessment Timing and Establishment of the Dental Home (May 2003, reaffirmed in 2009) • 2. Preventive Oral Health Intervention for Pediatricians (December 2008) • The AAP also offers endorses the child-focused modules of the Society for • Teachers of Family Medicine Smiles for Life National Oral Health Curriculum, • available online at www.smilesforlife2.org. http://www.aap.org/oralhealth/pact

  5. AAP Policies on Risk Assessment, continued • According to Oral Health Risk Assessment Timing and Establishment • of the Dental Home: • All children should begin receiving oral health risk assessments by 6 months of age by a qualified pediatrician or pediatric health care professional. • Risk assessment and clinical evaluation should be done at every well child visit to determine which infants would benefit from early, aggressive intervention. • Oral health is included in the Bright Futures/AAP Recommendations for Preventive Pediatric Health Care. http://www.aap.org/oralhealth/pact

  6. AAP Policies on Risk Assessment, continued • Preventive Oral Health Intervention • for pediatricians reviews cariology • and caries risk assessment. • This policy statement also defines • recommendations for preventive oral • health intervention by primary care • providers. http://www.aap.org/oralhealth/pact

  7. Clinical Evaluation • A complete oral examination • should be part of every • routine visit, beginning at • 6 months of age. http://www.aap.org/oralhealth/pact

  8. Clinical Evaluation, continued • For a thorough examination, you need: • A good light source • A good look at the patient's mouth • A tongue depressor can improve • visualization of mouth surfaces. http://www.aap.org/oralhealth/pact

  9. Examination Technique • A knee-to-knee examination is often • best for an infant or small child. • To perform this exam, sit down facing • the parent, knee to knee, with the child • sitting on the parent’s lap facing the • parent. Then have the child lie back • onto your lap. http://www.aap.org/oralhealth/pact

  10. The Examination • Examine both the hard and soft tissues. • This includes the lips, gums, teeth, • tongue, cheeks, and palate. • Examine closely along the gum line for • plaque and dental caries at any stage • of progression, such as white spot • lesions or cavitation. http://www.aap.org/oralhealth/pact

  11. What to Look For • A thorough examination requires lifting the upper lip and lowering the • bottom lip to check along the gum line. Look for the following: • Inflammation of the gums (gingivitis)  • Ulcers or abscesses  • Caries • Masses  • Enamel defects • Pattern of tooth eruption  • Malocclusion or misalignment • Evidence of trauma; chipped, broken, or missing teeth   http://www.aap.org/oralhealth/pact

  12. Documentation Document all findings and refer children with abnormalities to a dental provider. http://www.aap.org/oralhealth/pact

  13. AAP Risk Assessment Tool • The American Academy of Pediatrics (AAP) has developed an Oral Health Risk Assessment Tool for clinicians who care for children. This tool includes risk factors obtained via history and clinical evaluation. The risk indicators help to stratify children into low or high-risk for dental caries. http://www.aap.org/oralhealth/pact

  14. Risk Groups • These risk factors should prompt automatic • referral to a dentist by 12 months of age: • Children with special health care needs  • Children of mothers with a high caries rate  • Later-order offspring • Children in families of low socioeconomic status • Demonstrable caries, plaque, demineralization, and/or staining  • Children who continue nocturnal feeding (especially bottle-feeding) past the eruption of teeth. http://www.aap.org/oralhealth/pact

  15. Risk Groups, continued • Any child determined to be at high risk • for dental caries based on risk groups, • a formal risk assessment, or • physical exam findings should be • prioritized for referral to a dental home. • These patients should be directed to establish a dental home 6 months after • the first tooth erupts or by 1 year of age (whichever comes first).* http://www.aap.org/oralhealth/pact

  16. AAP Policy on Referral to a Dentist • Children should be referred to a • dentist who is willing and capable of • providing a dental home. • This could include a pediatric dentist • or a general dentist who is comfortable • with children. • Pediatric dentists are specially trained • and capable of treating children of • all ages. http://www.aap.org/oralhealth/pact

  17. Referrals • Referrals to a dentist should begin • with documentation of the problem • in the medical record. • Referrals to a dentist should be • treated like any other referral to • a health professional. http://www.aap.org/oralhealth/pact

  18. Referrals, continued • Ideally, referrals would involve the following: • A pre-existing pediatrician-dentist relationship • A call to the dentist’s office to set up the appointment • Ongoing communication between the pediatrician and dentist • Follow-up on the oral health issue http://www.aap.org/oralhealth/pact

  19. Question #1 • Which of the following is not a risk factor for the development of • dental caries? • A. Malnutrition.  • B. Infrequent professional dental care.   • C. Frequent exposure to fermentable carbohydrates.   • D. Inadequate exposure to fluoride.   • E. Presence of caries in immediate family members. http://www.aap.org/oralhealth/pact

  20. Answer • Which of the following is not a risk factor for the development of • dental caries? • A. Malnutrition.  • B. Infrequent professional dental care.   • C. Frequent exposure to fermentable carbohydrates.   • D. Inadequate exposure to fluoride.   • E. Presence of caries in immediate family members. http://www.aap.org/oralhealth/pact

  21. Question #2 • By what age should every child begin receiving oral health • assessments by a pediatrician or pediatric health professional? • A. When the first teeth erupt.  • B. 1 month.  • C. 3 months.  • D. 6 months.  • E. 1 year. http://www.aap.org/oralhealth/pact

  22. Answer • By what age should every child begin receiving oral health • assessments by a pediatrician or pediatric health professional? • A. When the first teeth erupt.  • B. 1 month.  • C. 3 months.  • D. 6 months.  • E. 1 year. http://www.aap.org/oralhealth/pact

  23. Question #3 • Which of the following children should be prioritized for referral to • a dentist? • A. Later-order offspring.  • B. Children with special health care needs.  • C. Children who breastfeed throughout the night.  • D. Children of mothers with a history of multiple caries.  • E. All of the above. http://www.aap.org/oralhealth/pact

  24. Answer • Which of the following children should be prioritized for referral to • a dentist? • A. Later-order offspring.  • B. Children with special health care needs.  • C. Children who breastfeed throughout the night.  • D. Children of mothers with a history of multiple caries.  • E. All of the above. http://www.aap.org/oralhealth/pact

  25. Question #4 • Which of the following tools are important when performing an oral • health examination? • A. Tongue depressor.  • B. Good source of light.  • C. Disposable mirror.  • D. Toothbrush.  • E. All of the above. http://www.aap.org/oralhealth/pact

  26. Answer • Which of the following tools are important when performing an oral • health examination? • A. Tongue depressor.  • B. Good source of light.  • C. Disposable mirror.  • D. Toothbrush.  • E. All of the above. http://www.aap.org/oralhealth/pact

  27. Question #5 • The American Academy of Pediatrics recommends referring a child • at increased risk for dental caries to the dentist ... • A. By 1 year of age.  • B. When the child is developmentally ready.  • C. By 3 years of age.  • D. When abnormalities are noted on a physician's examination.  • E. When the child or parent complains of dental problems. http://www.aap.org/oralhealth/pact

  28. Answer • The American Academy of Pediatrics recommends referring a child • at increased risk for dental caries to the dentist ... • A. By 1 year of age.  • B. When the child is developmentally ready.  • C. By 3 years of age.  • D. When abnormalities are noted on a physician's examination.  • E. When the child or parent complains of dental problems. http://www.aap.org/oralhealth/pact

  29. References • 1. American Academy of Pediatric Dentistry Council on Clinical Affairs. Policy on the Dental Home. Reaffirmed 2010: 33(6) 24-25 18-19. Available online at: http://www.aapd.org/ media/Policies_Guidelines/P_DentalHome.pdf. Accessed May 25, 2012. • 2. American Academy of Pediatrics and Bright Futures. Oral Health Risk Assessment Tool. Available online at: http://www2.aap.org/oralhealth/RiskAssessmentTool.html and http://brightfutures.aap.org/Oral_Health_Risk_Assessment_Resources.html. • 3. American Academy of Pediatrics Policy Statement. Oral Health Risk Assessment Timing and Establishment of the Dental Home. Pediatrics. 2003; 111(5): 1113-1116. Available online at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/5/1113. Accessed December 1, 2006. http://www.aap.org/oralhealth/pact

  30. References, continued • 4. Casamassimo P, Holt K, eds. 2004. Bright Futures in Practice: Oral Health Pocket Guide. Washington, DC: National Maternal and Child Oral Health Resource Center. • 5. Hale KJ. Early risk assessment can lead to better oral health. AAP News. 2003; 22(5): 202. • 6. Hale KJ. Ensuring healthy smiles: Pediatric practices should assess caries risk in young patients. AAP News. 2003; 22(6): 253. • 7. Hale KJ. Something to sink your teeth into: Pediatricians advised on how to assess patients for caries, educate families on oral health issues. AAP News. 2003; 23(1): 21. http://www.aap.org/oralhealth/pact

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