PREVENTIVE PEDIATRIC DENTISTRY – THE CONTINUED CARE MODEL 1426 McPhillips Street, Winnipeg, MB PREVENTIVE PEDIATRIC DENTISTRY – THE CONTINUED CARE MODEL Dr. Charles Lekic DDM, MSc, PhD, FRCD(C)

Pediatric Preventive Dentistry Dental caries presents a major dental health problem in children Etiology of caries: tooth susceptibility, bacterial plaque, carbohydrates, time, oral sugar clearance,saliva flow & pH

Pediatric Preventive Dentistry Most important factors in caries prevention are: Oral Hygiene, Diet, Fluoride therapy and Fissure sealants

Oral Health Education Plaque removal & Diet are the most important factors in oral health education

Oral Health Education Plaque Removal Use of Disclosing Agents Caries Activity Tests Tooth brushing

Oral Health Education Plaque Removal (Cont’d) Flossing (once posterior contacts close) Oral Rinsing- removes only soft debris, recommended in patients with ortho appliances

Oral Health Education Plaque Removal (Cont’d) Chemotherapeutic agents- e.g. Chlorhexidine- short term benefits Chewing gums- Trident, CDA approved

Oral Health Education Toothbrushing Roll method Horizontal scrub- most successful for children Modified Bass

Oral Health Education Diet -Instruct Patient/Parent to write down what he/she eats or drinks for 3 consecutive days. -Analyze with the patient/parent and make recommendations: Reduce sucrose consumption Sweets are not to be eaten between meals or at bedtime Emphasize foods that require chewing, stay away from soft/sticky foods Brush teeth after meals and ALWAYS at Bedtime Discuss the danger of “hidden” sugars such as starchy foods (bread)

Fluoride Therapy Systemic Fluorides Water Fluoridation Provided by water fluoridation and by supplemental therapy Water Fluoridation Concentration of 1 ppm of fluorides in drinking water is considered optimal in reducing caries prevalence Optimal fluoride concentration reduces caries up to 50% Commonly use sodium fluoride, hydrofluosilic acid and sodium silicofluoride

Fluoride Therapy Water Fluoridation (Cont’d) Effect of systemic fluorides is greater on smooth enamel surfaces Most effective method in caries prevention Supplemental Fluoride Therapy Before prescribing supplemental fluoride, must know: The fluoride content in child’s drinking water Child’s weight Overall fluoride intake

Fluoride Therapy Topical Fluorides Delivered via gels, varnishes, mouthrinses, prophy pastes and dentifrices No need for topical fluoride in patients with low risk and/or residing in optimally fluoridated areas- use of a fluoridated toothpaste should be sufficient. Fluoridated dentifrices are not recommended in small children (<3 years)

Fluoride Therapy Topical Fluorides (Cont’d) Parents should always supervise brushing so that the toothpaste and saliva are expectorated Acidulated phosphate fluoride (0.5%) and stannous fluoride (0.4%) are most common for topical use

Fluoride Toxicity Chronic Toxicity Only a pea-sized amount of toothpaste should be used Not recommended to use fluoridated dentifrice in children younger than 3 yrs. Use the “cup test” to check if the child could rinse and spit without swallowing

Chronic Toxicity Repeated ingestion of lesser amounts of fluoride may result in chronic fluoride toxicity, the most common of which is dental fluorosis To prevent chronic fluoride toxicity, parents should: Make sure their child thoroughly expectorates toothpaste after brushing

Acute Fluoride Toxicity Acute Toxicity Results from the accidental ingestion of excessive amounts of fluoride Common symptoms include nausea and vomiting Lethal dose for a 3 yr. old child approx. 500 mg of fluoride ingested at one time In the event of accidental ingestion of excessive amounts, vomiting should be induced (2 teaspoons of Ipecac Syrup) Administer milk to slow absorption and form complexes with the fluoride Consider transporting the child to a poison control centre

Pediatric Preventive Dentistry Dental diseases are largely preventable and increased emphasis on prevention should be the goal of every dental practice

The role of Manitoba dentist’s in promoting children’s oral health It is important to increase the general awareness regarding oral health and more particularly for the economically disadvantaged portion of the child population.

The role of Manitoba dentist’s in promoting children’s oral health At a present time there are very few programs aiming at increasing the awareness regarding child’s oral health. In dental offices there is little understanding if and in what capacity private practitioners could be involved in the implementation of such programs.

The role of Manitoba dentist’s in promoting children’s oral health Therefore, it is important for every dental practice to assess if and in what capacity they could be involved in reaching out to both the children and their parents and guiding them toward improved child’s oral health.

Children’s Dental World Model of Continued Care Children’s Dental World has been specifically interested in designing a program, including a reward\motivation system that benefits the child and a somewhat of a counseling\guidance system that will frequently remind and help the caregiver maintain the child’s oral health.

Continued Care Model Every child will after booking a recall appointment be classified, in regard to the completed restorative treatment, into: 1. Low risk (0-1 rest. treat.) 2. Moderate risk (2-4 rest. treat.) 3. High risk (≥5 rest. treat.)

Continued Care Model Children’s Dental World recall patients are receiving, every 6 weeks, health promotion material related to child’s age and the risk factors involved. Parents are at the same time asked to answer two to three questions and mail them in the envelope provided.

Continued Care Model (0-1 yr)

Continued Care Model (1-3 yrs, low risk)

Continued Care Model (1-3 yrs, moderate risk)

Continued Care Model (1-3 yrs, high risk)

Continued Care Model (3-6 yrs, low risk)

Continued Care Model (6-12 yrs, moderate risk)

Continued Care Model (>12 yrs, high risk)

Continued Care Model Following the first round of preventive letters ≈25% of parents responded, answering the questions. We expect this percentage to increase following the next rounds of letters and more especially following the next recall visit.

Continued Care Model At the next recall visit if the child will present with healthy teeth he/she will earn the membership to “the No Cavity Club”. No Cavity Club

Continued Care Model The child will be able to use this card in Toys R Us stores and the cash value for the first cavity free recall visit will be $15.00 No Cavity Club

Continued Care Model At the subsequent recall visits if the child continues to have healthy teeth the cash award will increase by $5.00 and will raise up to the full amount reduced only for the actual cost of the recall visit. No Cavity Club

Continued Care Model No Cavity Club membership and the health promotion letters, that are to be sent to the parents, are designed to increase the awareness regarding oral health and to award and motivate children and parents in achieving and maintaining health.

Continued Care Model Continued Care Model is a true investment in health and is a unique model to North America. Further research will provide evidence regarding the effectiveness of the program and the dental profession will be given this information as soon as it becomes available

Continued Care Model At the end of the day what is more rewarding then a healthy smile on a pediatric dental patient?

Thanks for your attention