1. Oral Health for MCAH Populations
Presentation for Peds
March 25, 2017
Oral Health for MCAH Populations
Children’s Oral Health Program
Contra Costa Health Services
November 2008

2. Presentation Outline Overview Early childhood caries
Periodontal disease and perinatal health
Adolescent oral health: Oral piercing and grills
Prevention of dental decay
Access to oral health care
Take-home messages

3. Presentation for Peds
March 25, 2017
A Silent Epidemic
Dental disease is the most common chronic and infectious disease affecting children in the U.S.
Five times more common than asthma
7% of Contra Costa children miss school because of a dental problem

4. Presentation for Peds
March 25, 2017
National Policy
All children should see a dentist by age one or six months after the eruption of the first tooth
American Academy of Pediatrics
American Academy of Pediatric Dentistry

5. What are Early Childhood Caries (ECC)?
Presentation for Peds
March 25, 2017
What are Early Childhood Caries (ECC)?
ECC is an infectious and transmissible disease; however, it is preventable
Previously known as Baby Bottle Tooth Decay (BBTD) or Nursing Caries
Can appear as soon as the first tooth erupts (around 6 months of age)

6. ECC is an infectious, transmissible disease
Presentation for Peds
March 25, 2017
ECC is an infectious, transmissible disease
Mutans streptococci, lactobacilli, and other acid- producing bacteria
Transmission is both vertical and horizontal

7. Colonization Can begin even before the eruption of teeth
Presentation for Peds
March 25, 2017
Colonization
Can begin even before the eruption of teeth

8. Cariogenic Bacteria (S. mutans, lactobacilli)
Presentation for Peds
March 25, 2017
The Chain of Decay
Cariogenic Bacteria (S. mutans, lactobacilli)
Sucrose, Glucose, Fructose, Starch
Acids dissolve tooth mineral
Fluoride
Caries No Caries

9. White Spot Lesions The first visible sign of tooth decay
Presentation for Peds
March 25, 2017
White Spot Lesions
The first visible sign of tooth decay
Reversible with fluoride varnish

10. Presentation for Peds
March 25, 2017
White Spot Lesions

11. Presentation for Peds
March 25, 2017
Mild/Moderate ECC

12. Presentation for Peds
March 25, 2017
Severe ECC

13. Risk Factors for Caries
Presentation for Peds
March 25, 2017
Risk Factors for Caries
Having a mother with a high caries rate or a high bacterial count of cavity-causing germs
Demonstrable caries, plaque, demineralization, and/or staining
Being a later-order offspring
Sleeping with a bottle or breastfeeding throughout the night
Low socioeconomic status
Lack of access to dental care

14. Children with Disabilities and Other Special Needs
Presentation for Peds
March 25, 2017
Children with Disabilities and Other Special Needs
Reduced saliva flow
Sweetened medications
Competing medical needs

15. The Effects of ECC Loss of primary teeth Pain Infection Self-esteem
Presentation for Peds
March 25, 2017
The Effects of ECC
Loss of primary teeth
Pain
Infection
Self-esteem

16. Loss of Primary Teeth Primary teeth are important for:
Nutrition
Speech development
Holding spaces for permanent teeth
Untreated decay in primary teeth can lead to decay in permanent teeth, or permanent teeth may not erupt at all

17. Primary and Permanent Teeth

18. Pain Children learn to live with the pain
Presentation for Peds
March 25, 2017
Pain
Children learn to live with the pain
Missed preschool and school days
Inability to concentrate; impairs school readiness
Can affect sleep and overall health and well-being

19. Infection Failure to thrive and delayed growth patterns
Presentation for Peds
March 25, 2017
Infection
Failure to thrive and delayed growth patterns

20. Self-esteem Stainless steel crowns Unattractive smiles
Presentation for Peds
March 25, 2017
Self-esteem
Stainless steel crowns
Unattractive smiles

21. Importance of Oral Health for Pregnant Women
Presentation for Peds
March 25, 2017
Importance of Oral Health for Pregnant Women
Periodontal disease in a pregnant woman has been linked to increased risk for preterm delivery and having a low birth weight baby
For mom: pain, infection, poor nutrition, sleep deprivation, inability to concentrate, work or take care of children

22. Possible Biological Pathway Between PD and PTB/LBW
Presentation for Peds
March 25, 2017
Possible Biological Pathway Between PD and PTB/LBW
Bacteria in PD
Blood
Placenta
Inflammation
Cervical Dilation and Uterine Contractions

23. Periodontal Disease
Gingivitis
Periodontal Disease

24. Gingivitis Early stage of gum disease – only gums are infected
Presentation for Peds
March 25, 2017
Gingivitis
Early stage of gum disease – only gums are infected
Caused by bacterial plaque and host risk factors: smoking, diabetes, stress, genetics
Bacteria in plaque create toxins that irritate the gums and cause redness, swelling, bleeding
Reversible with good oral hygiene

25. Presentation for Peds
March 25, 2017
Pregnancy Gingivitis
Infection that is more superficial and brought on by hormonal changes during pregnancy

26. Presentation for Peds
March 25, 2017
Periodontitis
An inflammation and degeneration below the gum line (bone and tissues surrounding the teeth)
Multi-factorial and episodic in nature
Prevalence in women of childbearing age is 5-40%
Destruction of the bone is not reversible
If left untreated can cause tooth loss

27. Progression of Periodontitis
Presentation for Peds
March 25, 2017
Progression of Periodontitis

28. Severe Periodontitis - Gingival Recession in Incisors
Presentation for Peds
March 25, 2017
Severe Periodontitis - Gingival Recession in Incisors

29. Treatment of Periodontal Disease
Presentation for Peds
March 25, 2017
Treatment of Periodontal Disease
Professional deep scaling and root planing
Anti-microbial mouth rinse (chlorhexidine)
Systemic and/or site-specific antibiotics
Gum surgery

30. Adolescent Oral Health: Oral Piercing
Potential consequences of oral piercing include:
Infection;
Prolonged or uncontrolled bleeding;
pain and swelling (in extreme cases, a severely swollen tongue can close off the airway and restrict breathing);
Chipped or cracked teeth;
Injury to the gums, possibly resulting in bone loss and root decay;
Problems with chewing, swallowing, and pronouncing words properly;
Blood-borne diseases including various strains of hepatitis; and
Endocarditis, an inflammation of the heart valves or tissues.

31. Adolescent Oral Health: Oral Piercing
Because of the risks involved even after an initial oral piercing wound has healed, the ADA recommends that both teens and adults avoid oral piercing.

32. Adolescent Oral Health: Grills
Made from gold, silver, or jewel- encrusted precious metals
Use of permanent cement not intended for internal use
Do-it-yourself kits and unlicensed jewelers

33. Adolescent Oral Health: Grills
Grills can wear away the enamel on the opposing teeth and inflame the gums; cement can damage teeth and gum tissues
Food collects  tooth decay
ADA recommends that youth avoid wearing grills, but if they are considering it, youth should:
talk to their dentists first
find out what materials the grills are made of
limit the time the grills are worn
remove the grills when eating
practice good oral hygiene

34. Prevention of Dental Decay
Presentation for Peds
March 25, 2017
Prevention of Dental Decay
Regular dental visits starting at age 1
Referral by medical providers
Oral hygiene
Fluoride
Dental Sealants
Healthy feeding practices
Modifying caregiver’s oral health: Xylitol

35. Presentation for Peds
March 25, 2017
Oral Hygiene: Infants
Before teeth come in, wipe gums clean with gauze or washcloth, before or after last feeding at night

36. Oral Hygiene: “Lift the Lip”
Presentation for Peds
March 25, 2017
Oral Hygiene: “Lift the Lip”
When teeth are in, “lift the lip” monthly to check for chalky white spots or brown spots

37. Oral Hygiene: Brushing
Presentation for Peds
March 25, 2017
Oral Hygiene: Brushing
Begins when first tooth erupts
An adult should help brush a child’s teeth until child is around 8 years old

38. Fluoride Toothpaste Encourage daily use in the morning and before bed
Presentation for Peds
March 25, 2017
Fluoride Toothpaste
Encourage daily use in the morning and before bed
A small smear is the appropriate amount
Apply toothpaste across width, not length of toothbrush

39. Presentation for Peds
March 25, 2017
Fluoride Varnish
Brown resin that sets on contact with moisture in the mouth
Prevents ECC
Easy application
Contains 5% of NaF

40. Community Water Fluoridation
Presentation for Peds
March 25, 2017
Community Water Fluoridation
Only about 30% of Californians have fluoridated drinking water (vs. 67% nationwide)
San Francisco Public Utilities Commission areas all fluoridated
All of Contra Costa is fluoridated except Bay Point, Byron, Knightsen, and Brentwood

41. Dental Sealants
Plastic coatings that dentists apply to the chewing surfaces of the molars
Make it difficult for plaque to adhere to the grooves of these teeth, reducing the risk of developing cavities
Most effective in children who have newly developed molars (ages six and 12)
Last for several years

42. Dental Sealant Placement

43. Healthy Feeding Practices
Presentation for Peds
March 25, 2017
Healthy Feeding Practices
Eat healthy foods and avoid sticky, starchy foods between meals
Don’t let infants and toddlers go to bed with a bottle or sipper cup or carry one around during the day, unless it contains only water

44. Caregiver’s Oral Health
Presentation for Peds
March 25, 2017
Caregiver’s Oral Health
Modify caregiver’s dental flora during the period from birth until the child is 2 years old
Use anti- bacterials like xylitol

45. Xylitol An antibacterial, non-cariogenic sweetener
Presentation for Peds
March 25, 2017
Xylitol
An antibacterial, non-cariogenic sweetener
Used in some foods, chewing gum, candies; available over-the-counter and online
Caries-causing bacteria cannot feed on xylitol (it does not produce acid)
Increases saliva flow
Studies show that when used by mothers, there is a 30 to 60% reduction in tooth decay in their children

46. Prevention of Periodontal Disease
Presentation for Peds
March 25, 2017
Prevention of Periodontal Disease
Regular brushing and flossing
Regular dental exams and professional cleanings
Eliminating tobacco use
Reducing stress

47. Access to Oral Health Care
21% of children (0-17) and 35% of adults (18+) in CA do not have dental insurance (’05 & ’03 CHIS)
Many employers do not cover dental insurance
Lack of dentists and specialists accepting Medi-Cal
County and community clinics overburdened
Need more dentists to see young children and pregnant women
Lack of dental specialists
Regular threats by state to cut or eliminate Medi-Cal dental benefits for pregnant women & children

48. Take-home Messages Oral health is integral part of total health
Dental disease is very common
Dental disease is infectious and transmissible, but it is preventable in many ways
Dental visit by age one
Access to care barriers can be very significant, especially for low-income families