“My Pediatrician Didn’t Tell Me That. What Do You Mean?” Amanda B. Elzey, RDH,BS Tiffany H. Yater, RDH Pediatric Dental Hygienist Prevention Is Better Than Treatment  Pediatricians are not trained in identifying or diagnosing oral diseases  Visit a dentist 6 months after the first tooth eruption or by age 12 months (whichever comes first)  Children who are seen earlier and routinely have fewer dental needs  Dental cost over their lifetime is significantly less than children who are not seen regularly or until the age of four 2 “My Dentist Said My Child Has Dental Caries????”  “Caries”-destructive lesion of the tooth structure causing a hole in the surface therefore creating a “cavity”  Totally predictable  Disease of choices and habits  Silent epidemic  Infectious disease  pH disease 3 2007 CDC Report On Oral Health  Preschoolers showed an increase in cavities  (Juice, Infectious disease from feeding/parents)  Elementary and middle school cavity rate stabilized  High school showed an increase in caries rate  (Sodas, sport/energy drinks, orthodontics) 4 Saliva: Liquid Gold  Any food that can be broken down in the mouth may cause cavities  Saliva’s role is to wash away the food and to neutralize the acid caused by frequent snacking  Sugar is not the primary cause of cavities, once broken down the sugar is a harmful acid  Acid dissolves calcium and phosphate minerals in enamel  pH of saliva is 7.4  A tooth breaks down at a pH of 5.8 5 pH of Familiar Foods  Drinks  Coffee 2.4-3.3  Tea 4.2  Soda 2.7-3.5  Sports Drink 2.3-4.4 6  Fruits and Vegetables  Tomatoes 3.7-4.7  Apples 3.5-3.9  Strawberries 3.0-4.2  Oranges 3.2  Lemons 2.8 DEVELOPMENT OF DENTAL CARIES CARIOGENIC FOODSTUFF Fermentable carbohydrate taken into plaque DEMINERALIZATION Caries process initiated White spotincipient lesion PLAQUE BACTERIA DENTAL CARIES Rapid action pH of plaque drops ACID FORMATION 7 Forms immediately Frequent exposures Children in pain do not eat well, sleep well, learn well, or behave well Factors In Prevention  Diet  Patient’s Oral Hygiene  Parent’s Oral Care  Fluoride  Xylitol  Sealants 8 Diet  Limit high sugar intake between meals  Sugar-free medicines is recommended if possible  Give dietary supplements containing sugar at mealtimes when possible (unless clinically directed otherwise)  Supplemental feedings of high calorie increase chance of dental caries 9 Most Harmful Drinks 10 pH Values for Sour Candy 11 “My Child Still Drinks From A Bottle.”  From six months of age infants should be introduced to drinking from a cup, and from age one year feeding from a bottle should be discouraged  Never put a child to bed with the bottle or sippy cup  Prolonged bottle feeding should be diagnosed and treated; It is either a parenting, feeding, or behavior issue  Prolonged bottle feeding leads to more dental caries  Failure to thrive and feeding issues should involve the dental team 12 “My Child Won’t Let Me Brush.”  Start as soon as the first baby tooth erupts  Should occur twice daily – clean teeth last thing at night before bed and at least one other time each day  Children need to be helped or supervised by an adult when brushing until at least 10 years of age because of lack fine motor skills and consistency 13 “Why Is Brushing and Flossing Important?”  Brushing and flossing prevents plaque sticking to the teeth allowing bacteria to convert sugars in to the acid which attacks the enamel  Plaque irritates the gums making them red and swollen which in turns causes bleeding which can allow bacteria into the bloodstream 14 “Why Is It Important For Me To Have Good Oral Hygiene, Also?”  Dental caries is an infectious disease  Bacteria is transferred from caregiver to child  Things such as active decay, poor oral hygiene, or poor diet can affect the developing baby teeth in the fetus  Pre-eclampsia, gestational diabetes, or stress can also have affects  Important for parents to maintain a good diet and excellent oral health  Do not share cups, toothbrushes, or pacifiers 15 “What Type of Toothbrush Should I Use?” 16  Use a toothbrush with small head and soft bristles  Electric toothbrush with oscillating/rotating head is great  Change toothbrushes every 3 months bristles wear out and do not clean as well  Clean all 3 surfaces with toothbrush back, front, and chewing surface  Clean in between the teeth with floss remember to clean on both sides of the triangular tissue  May benefit from special aids “Can I Use?”  Baking Soda  Peroxide  Finger Sponges  Water-picks 17 “Should I Use Toothpaste?” 18  The AAPD recommends starting to use toothpaste at age 2 for healthy children  The age is based on when they can spit  Children who are high risk vary from this guideline  If child cannot spit, wipe out excess with washcloth  Prescription Fluoride toothpastes are also a good option for children who have a history of dental caries  Fluoride level and particle size is regulated: LOOK FOR THE ADA SEAL OF APPROVAL “What Is That You Are Painting on Their Teeth?”  Wait to eat or drink 20  minutes after application  Teeth should not be brushed until at least 12 hours after application A number of systematic reviews conclude that twice-yearly applications produce a mean caries increment reduction of 33% in the primary dentition and 46% in the permanent  The evidence also supports the view that varnish application can arrest existing lesions on the smooth surfaces of primary teeth and roots of permanent teeth 19 TOPICAL FLUORIDE: Most Important Source of Prevention  Inhibits the metabolism of the decay producing bacteria in plaque and stabilizes minerals in the teeth, thus preventing or slowing down the caries process Fluoride Toothpaste Drink and eat foods containing fluoride Sources of Fluoride Fluoride supplements 20 Professionaly applied “Why Is It Recommended For Gum To Contain Xylitol?”  A low-calorie sugar substitute that reduces the incidence of dental caries  Decreases the transmission of “bad” bacteria (S.mutans) from mothers or caregivers  When used in place of other sugars, stops caries progression by 70%  Mostly sold as gum, mints, or candies 21 “What Are Sealants?”  Plastic coatings of the biting surface of molars and premolars that block the deep fissures where decay often starts by making the teeth easier to clean 22 “Why Is This Important For My Child?”  An infection caused by bacteria can enter the bloodstream and settle in the heart  With cavities and inflamed gums the number of bacteria increases  Patient with CHD is more at risk of getting endocarditis if they have tooth decay or gum inflammation  Preventing infection starts with good hygiene which includes keeping a clean healthy mouth as well as taking precautions such as taking antibiotics prior to dental treatment if indicated 23 Blood In Heart Is Like Water In River 24 “Does My Child Need Premedication?”  Until 2008, antibiotic coverage was recommended for nearly all heart defects, whether or not it had been repaired  The recommendation has been changed so that antibiotics will only be offered for those who are considered at higher risk of getting endocarditis  It is recommended to consult with the cardiologist 25 “What Are The Current Guidelines?”  Single dose taken orally, one hour before dental procedure  Amoxicillin is preferred; If allergic, use Clindamycin or Azithromycin  For children smaller than 66 lbs, the dose will vary according to your child’s weight  High Risk patients only  Dental procedures that involve an incision or manipulation of the gums around a tooth which included cleaning the teeth 26 “When Are Antibiotics NOT Needed?”  Examination  Dental x-rays  Placement of removable appliances or orthodontic appliances  Adjustment of orthodontic appliances  Loss of baby teeth 27 We have confidence, knowledge, skills, and the understanding to serve your child’s dental needs Children’s Healthcare of Atlanta Pediatric Dentistry 5455 Meridian Mark Road Suite 200 Atlanta, GA 30342 Phone: 404-785-2072 Fax: 404-785-5892 Jason Bongiovi, DMD ♥ JC Shirley, MS, DMD ♥ Jack Thomas, DDS Amanda Elzey, RDH, BS ♥ Anna Sidel, RDH ♥ Tiffany Yater, RDH 28