1. You Can Make a Positive Impact on a Child’s Oral Health!
Oral Health Care for Very Young Children and Children with Special Health Care Needs
Division of Dental Health Virginia Department of Health Governor Street Richmond, Virginia 1

2. Kami A. Piscitelli, BSDH, RDH Special Needs Oral Health Coordinator
Oral Health Care For Very Young Children and Children With Special Health Care Needs (CSHCN)
For more information or to schedule an oral health presentation contact:
Kami A. Piscitelli, BSDH, RDH
Special Needs Oral Health Coordinator
Division of Dental Health
Funded by Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services

3. What can you do? You’re already doing something! You’re here!
You can make an impact by:
Increasing your awareness of the oral health needs of children
Promoting oral health to families of young children and CSHCN
Encouraging age one dental visits 3

4. Topics Why oral health is important?
What are the two most common dental diseases?
The results of untreated dental disease
Common dental problems of CSHCN
Prevention of dental disease
Visiting the Dentist

5. At what age should children start seeing the dentist?

6. Background Tooth decay is the most common chronic childhood disease.
Tooth decay is 5 times more common
than asthma; 7 times more common
than hayfever.
Approximately 28% of children ages 2-5 years old have tooth decay.
CSHCN are almost twice as likely to have unmet oral health needs than children without SHCN.

7. Why is this important?
They are only teeth!

8. The Function of Teeth Chewing / Digestion Speech Facial appearance
Bone structure
Confidence

9. Baby Teeth Are Important Too!
Guide eruption of permanent teeth
Healthy baby teeth = healthy permanent teeth

10. Baby Teeth

11. Oral Health Affects General Health
In the Mouth Overall Health
oral disease and infection
systemic infection; can threaten life; unsuccessful organ transplant; surgery delay
periodontal disease
diabetes, bacterial pneumonia, low-birth weight, heart disease, stroke
tooth decay
malnutrition, failure to thrive, pain, loss of concentration, emotional/psychological stress
malocclusion
difficulty speaking/chewing, infections due to difficult oral hygiene

12. General Health Affects Oral Health
Health Factors Oral Health
gastric reflux / vomiting
erosion of teeth, sensitivity
medications
reduced saliva, enlarged gums, decay
special diets (soft, high carb)
decay, periodontal disease
oral habits
trauma, injury
chronic infections
reduces ability to fight oral infections
antibiotic therapy
oral fungal infections
physical abuse
often seen as oral trauma
Phenytoin, calcium channel blockers, cyclosporine – can enlarge gums
Up to 50% of abused children suffer head and neck injuries, oral-lacerated frenums, scar tissue
Genetic and developmental disorders: malocclusion, micrognathia, prognathia, delayed eruption, facial asymmetry

13. Two Most Common Dental Diseases?

14. Two Most Common Dental Diseases
Tooth Decay
disease process
also called Caries
cavities are the result
Periodontal “Gum” Disease
Gingivitis
Periodontitis

15. Early Childhood Caries (ECC)
Definition: The presence of one or more decayed, missing or filled tooth surfaces in a child younger than six
Begins soon after teeth erupt and can progress to a cavity in only months
Very quick, destructive form of decay
Costly to treat
Children have trouble cooperating because of age/condition
Often requires oral sedation or general anesthesia

16. Factors Necessary for Tooth Decay
1. Bacteria: Streptococcus mutans
2. Food: fermentable carbohydrates (break down quickly)
3. Susceptible tooth
4. Exposure time
This child is 1 ½ - 2 years old.

17. 1. Bacteria Transmitted from parent to child, not born with it
Infectious disease process
Window of infectivity: highest in the first two years
Early exposure to S. mutans is one of the major risk factors for future cavities
Plaque: sticky film

18. Transmission of Bacteria
Sharing of forks, spoons, straws
Testing food temperatures
“Cleaning” pacifier
Pre-chewing food

19. 2. Food: Fermentable Carbohydrates
Simple or complex carbs: sugars, starches
Bacteria uses the food to produce an acid
Acid ‘demineralizes’ or eats away at the surface enamel, starting the disease process
‘White spot’ appears, normally at gumline

20. Snacks Foods low in sugar: Cheese Fruits Vegetables
Cheerios, Rice Chex, Life, Kix, Corn Flakes
Foods high in sugar:
Candy
Cookies
Sodas
Fruit drinks
Sugar Smacks, Sugar Pops
Approximately 4 Grams of sugar are in one teaspoon

21. 3. Susceptible Tooth
Susceptibility of the tooth is directly related to fluoride exposure
What is Fluoride?
a natural mineral
found in ground water (wells) and surface water (lakes, ponds)
fluoride is added to most community water supplies in Virginia for dental benefits
tooth enamel ‘absorbs’ fluoride before and after eruption
enamel is then more resistant to decay process

22. Fluoride Fluoride has several preventive effects
Increases tooth’s resistance to cavities
Encourages healing of new small cavities
Prevents bacteria from making acid
2 categories of fluoride exposure
Systemic (swallowed) – benefits teeth before and after they come in
Topical – benefits teeth after they come in

23. Topical vs. Systemic Topical: outside the tooth / enamel
Systemic: through bloodstream

24. Systemic (Swallowed) Fluoride Sources
Water with fluoride (fluoridated water)
Community water supplies
Naturally occurring in well water
Bottled water normally not fluoridated
Water filters
Fluoride prescription
Prescribed based on results of water testing and other fluoride sources
Drops, liquids, tablets (also topical benefits)

25. Topical Fluoride Sources
Fluoridated water
Fluoride toothpastes (ADA seal)
Over the counter fluoride rinses
Prescription supplements
When chewed or liquid
Professionally applied fluoride
Gels, foams, rinses
Varnish

26. Fluoride Varnish Safe and effective, 40-60% decrease in tooth decay
Easy to apply
Applied by nurses, doctors, dentists, and dental hygienists

27. 4. Time (Acid Attacks)
The more time teeth are exposed to the acids produced by the combination of bacteria and food, the more likely tooth decay will occur! (20-40 min acid attacks)

28. Results of Untreated Tooth Decay
Unnecessary pain and discomfort
Unfavorable treatment experiences
Systemic (whole body) infections
Premature loss of primary teeth
Increased risk for permanent tooth decay
Loss of school/work time
Increased treatment expense

30. Periodontal (Gum) Disease Process
1. Plaque (bacteria) left on teeth and around gums
2. Gingivitis
3. Periodontal Disease

31. Gingivitis Irritation and inflammation of the gums
Puffy, red gums that bleed easily
Bleeding is not normal
Signal to brush better
Can be completely reversed and controlled with good oral hygiene

32. Periodontal (Gum) Disease
Causes irreversible bone loss in the bone surrounding the teeth
Leads to tooth loss
Often completely painless, only a dentist or hygienist can detect the beginning stages
Early stage treatment can stop or control the disease
Later stages of the disease are much more difficult to treat

33. Periodontal Disease

34. Conditions Linked to Gum Disease
Heart disease
Stroke
Diabetes
Pre-term low birth weight babies
Lung infections

35. CSHCN Common Dental Problems
Bruxism: grinding/gritting teeth
Wear/damage of teeth, TMJ disorders
Older children may need a night guard
Excessive drool
Skin chaffing/rash, cracked/bleeding lips
Use lotion, creams, lip balm
Reflux/vomiting
Erosion of teeth, increased cavities
Use baking soda rinses
¼ - ½ tsp soda to 1 cup water

36. CSHCN Common Dental Problems
Pouching: holding food in the folds of the cheeks
Increased decay, periodontal disease, bad breath
Frequent oral hygiene care
Picking or poking at gums/teeth (source?)
Trauma to teeth and gums
Oral exam and behavior modification
Xerostomia (Dry Mouth)
Increased decay and mouth sores
Saliva substitutes, sugar-free candy/gum – age?

37. Prevention Facts
Preventing decay in primary teeth reduces risk in permanent teeth
Preventing decay until age 4 reduces risk of decay through age 18

38. How can you prevent dental diseases?
Positioning
Lift the lip/ identify disease
Oral hygiene
Brush/floss
Modifications
Fluoride
Nutrition
Injury prevention
Dental visits

39. Positioning at Home
Positioning depends on each individual family and child
Head in your lap
Standing with you behind supporting
head
Bean bag or pillows
Child sitting on floor and you sit in chair right behind
Knee to knee when two adults available
Be careful of tilting head too far back if there is difficulty swallowing or gagging or neck injury concern

40. Lift the Lip Get to know your child’s mouth
Early decay is most commonly found on the lingual (back) surfaces of the front teeth.
Abscesses (infections) can hide from you

41. Disease Identification
Identify “White Spot” Pre-decay and active decay

42. Disease Identification

43. Disease Identification

44. Disease Identification

45. Disease Identification

46. Disease Identification

47. Disease Identification
Periodontal (Gum) Disease
Gingival overgrowth
Fungal/Viral Infection

48. Brushing the Teeth Infants (less than 2 years old)
Gums should be wiped twice daily
When teeth erupt, brushed twice daily
Use a rice grain sized amount of fluoride toothpaste
Toddlers and Preschool (older than 2 years)
Brush teeth at least twice daily
Use pea sized (or a kernel of corn sized) amount of fluoride toothpaste
Parent supervision and help with brushing until age 7-10 years
Depends on skill level of the individual child

49. How To Brush Use clean hands Use a soft bristled brush
Brush the front, back, & biting surfaces of each tooth
Use same pattern each time so you don’t miss teeth
Angle the brush toward the gums and brush with a circular motion
Include gumline and tongue

50. Brushing Tips If unable to spit, wipe with damp or dry clean cloth
Change toothbrush every 3 months or when bristles look out of shape
If child doesn’t tolerate toothpaste, try dipping brush in an over-the-counter fluoride mouth rinse (like ACT) then brush
Let the child be as independent as possible, use the toothbrush themselves, then you brush as well

51. How To Floss
Flossing begins as soon as the sides of two teeth are touching
Most children cannot floss on their own until 8-10 years, some CSHCN may need flossing done for them
Work the floss back and forth gently between teeth
Curve floss around the side of each tooth sliding up and down, just under the gums
Floss both sides of every tooth
Ask a dentist or hygienist for help

52. Flossing

53. Oral Hygiene Modifications
Toothbrushes and floss may need modification for CSHCN
Battery operated toothbrushes
Modified toothbrush handles
Tennis ball or bicycle grip
Taped handles
Lengthen by taping to ruler
Bend toothbrush handle by heating handle under hot water
Secure toothbrush to the hand with Velcro strip
Use bigger or textured grips
Three sided toothbrush heads
Floss holders
Mouth Props

54. Fluoride Recommendations
Use fluoride toothpaste for all ages
Talk to the dentist about increasing topical fluoride
Fluoride mouth rinse – brushed on or swished if they can spit out the excess
Prescription fluoride gel brushed on
Professional fluoride treatments more often

55. Feeding / Nutrition
Begin use of training cup by six months if developmentally able
Use training cups carefully and temporarily
Mealtime only if milk, juice, or sweet drink
Not walking around with cup
Between meals – offer water only
Talk to physician or pharmacist about sugar free medicines
Well balanced diet

56. Dental Injury Prevention
Things to avoid:
Sharp edges on furniture – cover if possible
Walking or running with hard or sharp objects in mouth (sippy cup, toothbrush, crayons, etc.)
Chewing on electrical cords
Chewing on ice, hard candy, any hard objects
Riding in the car without a car seat
Mouth guards and helmets as needed

57. Dental Visits: “Home by One!”
Dental appointment by the first birthday
CSHCN may need to visit dentist every 2-6 months
Tell dentist what works and doesn’t work at home
Bring a favorite blanket, toy, music, etc.
Encourage a consultation between your physician and dentist

58. Finding A Dentist DentaQuest (formerly DORAL): Smiles for Children
Some listings will specify special needs: yes/no
Phone book, word of mouth, parent organizations
When you call, ask if the dentist will see children with the particular condition the child has

59. Finding A Dentist VA Department of Health, Division of Dental Health
Virginia dentist directory – click on “Find A Dentist”

60. Click here to find a dentist
Click here to find more oral health information on CSHCN

61. Click Advanced Search for the most options

63. Click here when you have made your selections

64. Click on the dentist’s name for more information then call the dentist’s office to describe your needs and ask questions

65. Resources for More Information
American Academy of Pediatric Dentistry
American Academy of Pediatrics
– type in ‘oral health’
American Dental Association
The Center for CSHCN, Washington State
– type in ‘oral health’

66. Additional Resource http://hfgrotto.org/
Financial assistance for dental care for children with disabilities under age 18 with Cerebral Palsy, Muscular Dystrophy (and related neuromuscular disorders), mental retardation, and organ transplant recipients.

67. Key Points Oral health is directly related to overall health
Preventing decay in primary teeth reduces risk in permanent teeth
The more time teeth are exposed to acids the more likely tooth decay will occur!
Dental home by age one
Fluoride is important for all ages

68. Questions???????