1. Oral Health Prevention strategies for better living and a better life.
Jennifer Smits, RDH AAAS
September 10, 2010
University of Michigan E-Learning Program

2. Economic Downturn
Alternate economic consequences such as costly medical fees due to emergency room treatment and hospital fees occur when dental disease goes untreated.
provide treatment/prevention strategies for oral infections and disease to those with special needs= overall health care costs dramatically reduced, quality of life of these individuals will improve, needless pain and suffering can be minimized.(Glassman, mod 1 readings)
Glassman P, Folse G. Financing oral health services for those with special needs: Projecting national expenditures. CDA. 2005;33(9):

3. Educational Goal
To increase staff and parents awareness of the importance and need for efficient oral hygiene care, good oral hygiene habits, and tooth friendly nutritional choices to decrease unnecessary pain and suffering and increase prevention strategies.

4. While most Americans seek care from a dentist regularly, some individuals and families face challenges accessing dental care. These Americans, including racial and ethnic minorities, people with disabilities, and those whose families are economically disadvantaged, may also suffer a disproportionate share of dental disease. Access challenges include difficulty getting to a dental office, prioritizing dental care among other health crises, overcoming financial barriers, and navigating government assistance programs. These dental patients may need special financial arrangements, help accessing a dental office, or special oral hygiene instruction. Also, basic awareness of oral health issues for many Americans may be quite limited because of cultural or language barriers or problems with literacy. (ada.org)

5. Goal Education = PREVENTION!
Education to change parental attitudes and behaviors regarding oral health
Sealants
Fluoride
Effective brushing/flossing technique
Tooth friendly snack/food choices
Oral vs. systemic health link

6. Fatal Dental Abscess
A 7 year old Liberian boy presented with a high fever, inability to walk, bulging eyes, facial swelling, reduced level of consciousness, and the loss of vision for three days at the United Nations Mission in Liberia.
The parents informed the child was diagnosed with a dental abscess one week prior to their hospital visit. Extremely decayed permanent teeth on the upper and lower right side were present.
Extraction (removal) of the molars was performed followed by heavy doses of antibiotics and a transfer to the intensive care unit (ICU) at a local civilian hospital.
Unfortunately, cavernous sinus thrombosis had formed during this bad dental infection, causing quick deterioration of his health and ultimately death four days after hospital admission.
Cavernous sinus thrombosis is caused by severe infection of the sinus cavity, which in this case was from severe dental infection.
Although rare, dental abscess’ can potentially cause life-threatening complications.
CAVERNOUS SINUS THROMBOSIS AS A FATAL COMPLICATION OF A DENTAL ABSCESS:
A CASE REPORT
Abdelwahhab A. Alwraikat BDS, MSc*, Hussein I. Alawneh MD**
University of Michigan health science libraries-boy who died from dental abscess

7. DENTAL DECAY

8. Caries (Cavity) Development
1. Pit and fissure-can spread to dentin causing
severe damage
2. Smooth surface (interproximal caries)
3. Root surface-when gingiva recedes(widespread
problem in adults

9. Dental decay is the most prevalent, yet preventable, infectoius(dentalhealthfoundation.org)
plaque, a sticky film of bacteria, constantly forms on your teeth. When you eat or drink foods containing sugars or starches, the bacteria in plaque produce acids that attack tooth enamel. The stickiness of the plaque keeps these acids in contact with your teeth and after many such attacks, the enamel can break down and a cavity forms.(ada.org)
Eat a balanced diet and limit between-meal snacks(ada.org)

10. ECC (Early Childhood Caries)
The most common childhood disease in children
National reports and studies clearly indicate ECC is highly prevalent in children of lower socioeconomic status
-Consequences can be substantial
-Treatment of ECC often requires extensive restorative treatment or extraction of the tooth
-Previously known as “milk bottle mouth” or “baby bottle tooth decay”
-ECC is rampant caries assumed to be caused by inappropriate use of baby bottles
-We now know that ECC is multifactoral (factors include: previous caries, diet i.e. sugar consumption, plaque, lack of fluoride, low SES)
Consequences: impact of quality of life, increased cost (emergency room cost, more extensive decay=more costly to repair), pain, unable to engage in regular activities (eating, sleeping, recreational and school activities are not given any focus)
DO NOT fill bottle with sugary liquids such as juice, milk, soda
Put child to bed with WATER ONLY
Encourage teaching children sip from cup by 1 year of age to avoid prolonged use of bottle
School aged children miss more than 51 million school hours each year due to dental problems/visits (adha.org)- improving oral care for at-risk children: integrating oral health into the CDC model
Children living in poverty are twice as likely to suffer from tooth decay. (adha.org)

11. Eruption of baby teeth.
Tooth type
Lower arch
Upper arch
Central incisors
6 1/2 months
7 1/2 months
Lateral incisors
7 months
8 months
First molars
12 to 16 months
Cuspids
16 to 20 months
Second molars
20 to 30 months
20 to 20 months

17. PREVENTION

18. Sealants -plastic coating that covers the deep pits/grooves on chewing
surfaces of teeth
-this coating acts as a physical barrier
that deflects food debris/bacteria
out of these hard to clean areas,
decreasing risk of forming decay
-approximately 80% of all dental caries
in children occur on the chewing surfaces
of teeth
-cost effective for those at high risk
-Dimensions f dental hygiene: Assessing risk factors: tools for prevention and early intervention May 2010, Vol 8 #5

19. Fluoride WHAT IS FLUORIDE?
A protective coating that helps prevent decay from forming and reverses incipient (early) dental cavities
WHY APPLY FLUORIDE?
Simple, inexpensive, easy prevention method
Low cost of fluoride prevention can avoid the high cost and pain related to cavity restoration.
Most children do not lose all their deciduous (baby) teeth until 11 or 12 years of age
IS IT SAFE?
Fluoride varnish is safe to use as soon as teeth begin to erupt
The American Dental Association and FDA approved
WHEN TO APPLY?
2-4 times a year
Community water fluoridation is an effective, safe, and inexpensive way to prevent tooth decay. Fluoridation benefits Americans of all ages and socioeconomic status. (adha.org)
Adjusting the level of fluoride in drinking water first used fluoride as a preventative for tooth decay in Grand Rapids, Michigan. Fluoridation of drinking water has been used successfully in the United States for more than 50 years.(adha.org)

20. NUTRITION

21. Oral Health Nutrition To tell the tooth; begin with a grin
High frequency sugar intake is common in those with lower SES
Frequency of meals/snacking increases risk for decay
Bottles with milk/sweetened fluids
Sugary foods with sticky consistency develop environment for decay
Snacking before bedtime (saliva flow lowered during sleep, can not buffer acidic environment)
At any age, a complete oral health home program includes sound nutritional habits. Many of the foods that help your body build strong muscles and bones also help build strong, healthy teeth and gums.(adha.org)
-snacking more than three times a day between meals can increase children’s risk for dental decay (dimensions: caries interrupted pg. 40)
(dimensions of dental hygiene: intervention in Early Childhood Caries)

22. Oral Health Nutrition Cont…
Decay causing bacteria can be transmitted from parent/caregiver to child via saliva
Sweets are often used as rewards, but should be limited to mealtimes
Eating patterns have changed over time to calorically dense, nutrient poor food choices (convenience)
Poor eating can lead to poor tooth development/formation, eruption, and increase risk to decay
Bacteria transmission (commonly by mother) can occur by sharing utensils/food, exposing child to more advanced bacteria they had not yet developed (dimensions-ecc article)

23. Infant Oral Health
Parents need to be made aware of importance of primary (baby) teeth
Regular dental examinations, cleanings, fluoride are essential to optimal health
Initial dental exams for infants should be done 6 mo-1yr after eruption of first tooth according to ADA
Parents should be assisting tooth brushing from time when first tooth erupts to age 8
Fluoride toothpaste should only be used if child is expectorating (spitting) it out and not ingesting
Primary teeth are space maintainers for permanent teeth. If these teeth are prematurely lost/extracted, over crowding and discomfort can occur when adult teeth are erupting. Also, infection from primary teeth can travel through gingival tissues to permanent teeth still developing. (dimensions, caries interrupted pg 40)
-a recent study found that on average parents do not begin brushing their children’s teeth until 1.8 years of age (dimensions, caries interrupted)
-a young child does not yet have the dexterity and ability to perform simple task such as brushing teeth effectively/independently (caries interrupted)

24. Infant Oral Health Continued…
-Prior to tooth eruption, the parent/primary care giver should use soft wipes on the child’s gingival tissues to clean off debris/bacteria (this allows the child to get used to daily oral hygiene tasks)
-After the first tooth erupts, teeth should be cleaned twice daily with an appropriate sized toothbrush and a very small amount of toothpaste
Dimensions of Dental Hygiene: Assessing Risk Factors: tools for prevention and early intervention May 2010: Vol 8:5
Infant Oral Health Continued…
-A young child’s daily oral care should be provided by the parent
-children lack the manual dexterity to perform simple tasks of personal hygiene

25. PREGNANCY

26. Maternal Oral Health
Studies indicate that maternal oral health can affect the infants future oral health and/or systemic health
Pregnant women need to be encouraged to seek routine dental care
Periodontal disease linked with premature birth/low birth weight babies
Breast feeding provides the best sources of nutrients for infants and lowers risk of decay found in bottle usage that contain sweetened beverages and feeding at will
Periodontal disease in pregnant women has been associated with an increased risk for premature birth (dimensions: caries interrupted pg 40)
Bacteria from disease release toxins, the same toxins which can cause contractions, which in turn can cause this premature birth.

27. It is common for those pregnant to be nauseous and vomit
It is common for those pregnant to be nauseous and vomit. Vomiting puts stomach acid directly on the teeth. It is advised to wait at least 30 minutes to brush your teeth after vomiting so the top layer of the tooth, the enamel, is not brushed away. To freshen breath using a fluoride rinse is sufficient in the mean time.
Information from:

28. GENERAL HEALTH LINK

29. Oral health & General health
ADA states there is a link between periodontal disease and diabetes, heart disease, adverse pregnancy outcomes
Diabetes: difficult to control glycemic levels with periodontal disease
Heart disease: atherosclerosis, cardiovascular disease, and stroke are all an increased risk for those with the chronic inflammation of periodontal disease.
Adverse pregnancy outcomes: premature birth, low birth weight babies (the same enzyme released by bacteria in mouth are those used to trigger contractions, which in turn can result in premature birth.

30. What is periodontal disease?
A disease that affects the tissues that support your teeth (gingiva, bone)
There is a v shaped sulcus between the tooth and gum called a pocket, this is where disease begins
As disease progresses, pocket deepens and tooth attachment is weakened with destruction of supporting tissues
The more severe the disease, the greater the pocket
2 stages: gingivitis (this is milder, reversible stage but without treatment can progress into the later stage), periodontal disease
It is common to have periodontal disease with no warning signs
Signs if present: oral malodor/persistent bad taste in mouth, tender/red/bleeding gums, loose teeth, shifting teeth
Bacterial plaque adheres to the tooth surface and can spread into the pocket, releasing toxins which causes this disease to progress and worsen. Ada.org

32. Oral Health & Diabetes

33. Diabetes
WHAT IS IT?
Pancreas is unable to control blood glucose levels properly
High blood glucose levels can allow bacteria in mouth to thrive
Oral Concerns:
Increased risk for periodontal disease
Poor healing (surgical sites, periodontal disease, gingivitis, oral infections)
Lower resistance to infection
Xerostomia (dry mouth)
Dental decay
Xerostomia: saliva helps to rinse away food particles and debris from teeth, with out saliva bacteria can thrive and cause damage to gingival tissues and teeth. Saliva substitutes can be useful along with fluoride rinses/toothpastes, chewing sugarless gum, sugarless mints, etc to promote saliva flow. Avoiding alcohol and caffeine are recommend as these beverages dry mouth. Information taken from: (

35. Closing Statement
Today we have discussed various efforts on how to protect our teeth, which in turn will better our overall dental health and well-being. With knowledge on prevention, dental decay and cost can be greatly reduced and quality of life at its best!
If you have any other questions feel free to stay after and I would be happy to help you!

36. Great Resources American Dental Association: ada.org
American Dental Hygienists Association: adha.org
Action for Healthy Kids:
Children’s nutrition center: