Presentation on theme: "From The First Tooth An early childhood caries prevention program"— Presentation transcript:
1From The First Tooth An early childhood caries prevention program to improve the oral health of Maine childrenFunded by the Sadie and Harry Davis FoundationA partnership of MaineHealth, MaineGeneral and Eastern Maine Health ServicesNortheast Center for Research to Evaluate and Eliminate Dental Disparities
2The purpose is to improve the oral health of Maine’s children by: From The First ToothThe purpose is to improve the oral health of Maine’s children by:Increasing children’s access to preventive oral health servicesIntegrating early oral health as the standard of care for childrenin medical practices through:Oral health screeningFluoride varnishParent/caregiver education and counselingReferral to a dentist
3Chronic Infectious Disease From The First ToothDental Caries is aChronic Infectious DiseaseTransmissibleBacterial by-products (acids)dissolve the enamel of teethLoss of tooth structure, pain,tooth loss, systemic infections
4From The First ToothDental caries is the single most common chronic disease of childhoodApproximately one third or more of Maine children has dental cariesEarly childhood caries is the best predictor of lifelong dental cariesSource: National Health and Nutrition Examination Survey,National Center for Health Statistics, CDC
5Source: National Health and Nutrition Examination Survey, 1999–2002 Source: National Health and Nutrition Examination Survey, 1999–2002. National Center for Health Statistics, CDC.Source: National Health and Nutrition Examination Survey, 1999–2002. National Center for Health Statistics, CDC.5
6What are the Consequences? Pain & infectionHospitalization,surgical intervention, deathMissed work/schoolDistraction from normal activitiesSpeech and eating dysfunctionGrowth delay
7Prevention Reduces Disease and Saves Money From The First ToothPrevention Reduces Disease and Saves MoneyLow-income children who have their first preventive dental visit by age one:Less likely to have subsequent restorative or emergency room visitsAverage dental related costs are almost 40% lower ($263 compared to $447) over a five year period than children who receive their first preventive visit after age one.
8Dental/Medical Home By Age One Recommended by:American Academy of PediatricsAmerican Dental AssociationAmerican Academy of Pediatric DentistryEndorsed by:Maine Chapter of the American Academy of PediatricsMaine Dental AssociationMaine Medical AssociationMaine Academy of Family PhysiciansMaine Osteopathic AssociationMaine Primary Care Association
9Preventive Dental Care is linked to Role of the Primary Care PhysiciansOral health is part of overall health!Patients are seen more regularly at the medical officesPart of oral health prevention strategiesScreen for disease and riskMonitor oral-systemic health interactionsInitially manage oral emergenciesReferral for dental careProvide anticipatory guidanceApply fluoride varnishPreventive Dental Care is linked toGood Overall Health!
13Factors Necessary for Dental Caries ToothAgeFluorideNutritionPit & FissuresDentalCariesToothSubstratesOral FloraFloraStrep. MutansOral HygieneFluoride in PlaqueSubstratesOral hygieneSalivaCarbohydratesFrequency of eating13
14Streptococci Mutans Transmission Bacteria are transmitted mainly from mother or primary caregiver to infant.Window of infectivity is first 2 years of life.The earlier a child is colonized, the higher the risk of caries.
15You Are What You EatCaries development is promoted by carbohydrateswhich act as substrate for bacteria to produce acidAcid causes demineralization of enamelBeware “hidden carbohydrates”
16Frequency vs. QuantityAcids produced by bacteria after carbohydrate intakepersist for minutes lowering pH
18Sucrose Content of Some Medicines Amoxicillin %Ceclor %Erythromycin %Penicillin %Bactrim 50%Benadryl %
19Oral Health Assessment of Child Position child in caregiver’s lap facing the caregiverSit with knees touching the knees of the caregiverLower the child’s head onto your lap
20What to Look For:Lift the lip, retract the cheeks and inspect the soft tissues and teeth to assess for:Presence of plaquePresence of white spot lesions or dental cariesPresence of tooth defectsPresence of dental abscess
21Dental PlaqueA biofilm that attaches to the tooth surfaces. It is composed of primarily streptococci mutans and other bacteria. Nourished by food and beverages high in sugar, they produce an acid that initiates the demineralization of the teeth.
27Caries Risk Assessment Higher Risk: One of the belowLow income - (i.e. MaineCare)Special healthcare needsParents/siblings have decayExisting decay/fillingsLimited/no dental careFrequent sugar intakeNo access to fluoridated water or tabletsLower Risk:None of the above
28Fluoride Demineralization <------------ > Remineralization Frequent carbohydrate intakeFrequent exposure to acidsPlaque presenceDecreased salivary flowExposure to fluorideRemoval of plaqueBalanced dietLimited exposure to carbohydrates
29System and Topical Fluoride Delivery ToothpasteAnti-Cavity RinsesFluoride ApplicationsVarnish, gel or foamSYSTEMICWaterTabletsDropsIn Vitamins29
30Fluoride Varnish Inhibits the growth of cariogenic 5% sodium or 22,600 PPM fluoride resinInhibits the growth of cariogenicorganisms thus decreasing acid metabolismReduces enamel solubilityPromotes remineralization of enameland may arrest or reverse early caries
31Efficacy of Fluoride Varnish in Preschool Children StudyCountry% Caries DecreaseHolm 1979Sweden44Grodzha et al. 1982Poland10Clark et al. 1985Canada9Petersson et al. 19987Frostell et al. 199137Twetman et al. 199630Weintraub et al. 2006US50
32Application of Fluoride Varnish Using gentle finger pressure, open the child’s mouth.Gently remove excess saliva or plaque with a gauze sponge.Use your fingers and sponges to isolate the dry teeth and keep them dry.Isolate a quadrant of teeth at a time, or a few teeth at a time.Apply a thin layer of the varnish to all surfaces of the teeth.Once the varnish is applied, you need not worry about moisture (saliva) contamination. The varnish sets quickly.
33Post Application Instructions Soft diet for the rest of the day.Do not brush or floss the child's teethuntil the next morning.It is normal for the teeth to appear dulland yellow until they are brushed.Tell the parent that the teeth will not be whiteand shiny until the next day
34Efficacy on the Number of Fluoride Varnish of Applications Children stratified by number of actual fluoride-containing varnish applications receivedN= 280Weinstraub et al. J Dent Res 2006
36From The First ToothMaineCare is reimbursing medical providers for the therapeutic application of fluoride varnish for members with moderate to high caries risk. MC will cover 2 applications per calendar year. For members with high caries rates and new decay within 18 months as documented, MC will cover 3 times per year.In Maine, commercial insurers and self insured companies and beginning to pay for the varnish procedure.All three health systems (MaineHealth, Eastern Maine Health Systems, and MaineGeneral Health) now pay for the procedure for their age-eligible dependents who are covered by their health plans.
37Infant and Toddler Oral Health Anticipatory Guidance Advise to parents and caregiversThe importance of healthy teethHow to take care of their child’s teethThe importance of healthy food choices
38Infant and Toddler Oral Health Anticipatory Guidance Schedule 6 MonthsBottles are for nutrition. They shouldonly be used to feed babies who arenot breast feeding.Discuss and demonstrate brushing ofinfant teeth as soon as they erupt.Instruct the parent to conduct"Lift the Lip" procedures.9 MonthsMonitor progress in weaninginfant from bottle to cup.Offer appropriate guidancein limiting juice in sippy cup.
39Infant and Toddler Oral Health Anticipatory Guidance Schedule 12 MonthsInfants are weaned from the bottle.Infants should see the dentist by year one.Review healthy eating habits and snacking.Sippy cups at mealtimes only. Water between mealsParents continue to brush and check their teeth24 MonthsMonitor healthy behaviors and snackingDiscuss and evaluate the toddler’s abilityto begin to use fluoridated toothpaste.Parents should continue to monitor the child’sbrushing and checking their teeth
40Posters, ed materials in waiting room Parent/Child Arrivesfor Well Child Visit(or other visit)Posters, ed materials in waiting roomVitals Signs TakenMedical Assistant tells parent of the FTFT(Parent Counseling)Well Child ExamMedical Provider - Oral Screening,Orders for fluoride based on risk(Parent counseling)No Access to a Dental HomeReferral to a Dental HomeImmunizationMedical Assistant Applies FluorideDental Home
41Documentation Caries Risk Assessment – (LOWER) (HIGHER) Guidelines Higher Risk: One of the belowLow income - (i.e. MaineCare)Special healthcare needsParents/siblings have decayExisting decay/fillingsLimited/no dental careFrequent sugar intakeNo access to fluoridated water or tabletsLower Risk:None of the aboveDental Caries – Y or NOral health education – Y or NFluoride varnish applied (Code D1206) – Y or NIn Chart Notes, document urgent dental needs, such as abscessesand other clinical findings and referral to dentist