3. Congress created the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program to promote: Preventative health Prevent disease Detect treatable problems early to avoid further serious health conditions & more costly health services

4. EPSDT is a preventative component of the Medicaid Program It provides for coverage of comprehensive & periodic health and developmental screening for all Medicaid enrolled children, birth to age 20 These comprehensive screenings or checkups include an oral examination component as part of the physical exam

5. A comprehensive health & developmental history including: mental health, nutrition, chemical use Growth measurements Physical & mental health development screening Comprehensive unclothed physical exam, including oral exam (teeth, gums, tongue, soft tissue) Hearing & vision screening

6. Age appropriate immunizations & review Lab tests such as: blood lead assessment appropriate for age risk factors and hemoglobin/hematrocit Health education & anticipatory guidance appropriate for the age and health of the child and which include preventative measures for good oral health Verbal referral for regular, preventative dental health checkups at the time of the eruption of the first tooth or no later than 12 months of age

8. The mouth is part of the body A childs oral health is an integral part of overall health Appropriate evaluation, treatment, & preventative measures should be instituted at infancy and continued on a regular basis to maintain optimal health

9. Dental caries is the most common chronic disease affecting children in the U.S. It is 5 times more common than asthma It is 7 times more common than hay fever 80% of early childhood caries occurs in 20% of children

10. Dental care is the most common health need for high-risk children The incidence of need for dental care by age: 20% by age 2 30% by age 3 40% by age 4 50% by age 5

11. Low income families & ethnic minorities share a larger disease burden More than 51 million school hours are lost each year because of dental-related illness

13. Children get a healthy start when dental & medical providers, parents, & educators work together to prevent oral health problems Primary care providers often have early access to high-risk children and play a key role in helping to prevent oral diseases Children often see primary care providers first and the role these health professionals serve in providing anticipatory guidance and directing families to the services of a dentist is critical

14. Children & Teen Checkups (C&TC) providers are required to verbally refer kids at the eruption of the first tooth or by 12 months of age, or earlier if indicated, for preventative dental checkups Verbal referrals should be given at each subsequent C&TC visit

16. Tooth eruption, or teething, is a process that begins around 6 months of age Teeth usually erupt on the lower gum line, from the front to the back of the mouth Children should have all their 20 primary teeth by 5 or 6 years old Primary teeth are lost as permanent teeth erupt, a process that continues for 6 to 8 years Permanent molars erupt at age 5 or 6

17. While there may be variation in tooth development and appearances among children, notable difference may be signs of oral problems Therefore, its important for them to: Receive oral health screening Assessment & care from the time their first tooth erupts through development

19. In 2000, the Surgeon General reported that oral health is an essential component of overall health and well-being that a coordinated effort is needed to reduce environmental, social, educational, health system and financial barriers to achieving optimal oral health for everyone.

20. In 2007, the Centers for Disease Control and Preventions largest survey of the nations dental health in more than 25 years, reported tooth decay in young children has been on the rise. Cavities in children ages 2 to 5 increased to 28% in 1999-2004 from 24% in 1988-1994.

21. Children who live in poverty experience two times more tooth decay than their affluent peers, and their disease is more likely to go untreated. Dental health access barriers and drinking water primarily from private wells with insufficient fluoride levels can also lead to an increased risk of tooth decay.

22. Oral diseases affect a childs ability to eat, participate in daily activities, and their overall health and social well-being. Children with chronic oral health problems may have more difficulties eating, talking, sleeping, and playing. These children will also miss more school, activities, and are at risk of failure to thrive.

24. Since oral health plays a crucial role in the overall development, health and social well- being of children, its important to screen children early for oral health problems. Its crucial to screen children who come from disadvantaged populations. These children are: Less likely to afford adequate oral and dental care Have access to proper screening & assessment

25. Primary care providers often have access to children who are most at risk for poor oral health. This provides opportunities for providers to screen & prevent oral health problems in the primary care setting.

27. The purpose is to identify: normal versus abnormal oral condition make referrals for dental care If no problems are found, a verbal referral should be given for regular, preventative dental care. If abnormalities are found, referrals should be given for dental assessment & treatment.

28. Oral health screening should be included whenever general health screening is done during a C&TC visit. Oral health screening in the primary care setting is important because primary care providers often have early access to children who are most at risk for poor oral health.

29. An oral health screening is comprised of three parts: Reviewing oral health history Performing a physical examination of the childs math Referring for preventative dental care or assessment & treatment

31. The oral health history should cover a childs and his/her caregivers past & current oral health practices & experience to help discover risks for oral problems.

32. This review can include: Previous oral problems Diet & nutrition Fluoride intake: Primary source of drinking water Past fluoride treatment Supplements Dental visit history Drug/alcohol use Medical conditions including diabetes, infections, etc. Medications that affect the mouth Baby bottle or sippy cup use

34. An oral health screening includes a physical examination of a childs mouth, including: Lips Tongue Teeth Gums Tissues

35. A common screening procedure called Lift the lip can be used to examine a childs mouth. A dental chair & other dental equipment are not required to perform the screening procedure. Gloves (latex or non-latex), a tongue blade & a good light source should be adequate for the exam.

36. The screener & caregiver should sit facing each other with their knees touching. Lay the child on the screeners lap with his/her head securely nestled against the screeners abdomen.

37. With gloved hands, the screener should: Lift the childs lips Feel the soft tissues Check the physical conditions of the teeth and gum Look throughout the mouth

38. For a child 3 years of age or older: The child can be checked while sitting close and across from the screener. A tongue depressor can be used to move the lips to view the teeth.

40. The objective is to identify normal versus abnormal conditions. During this component, the screener should: Determine whether tooth eruption and loss are up to schedule according to tooth development guidelines. Observe tooth abnormalities and alignment of teeth Observe oral plaque and debris Check for dental caries using the Caries-Risk Assessment Tool, oral injuries and other anomalies

42. Normal oral conditions include: Primary teeth should be white & opaque with smooth surfaces on front teeth & grooved surfaces on back teeth Permanent teeth should appear creamier in color & larger than primary teeth Lips & tongue should be soft, pink, & moist

43. Normal oral conditions also include: Tissues under lip should be pink or brown (depending on childs skin color), smooth, & moist The palate should be soft, pink, & moist Skins & tissues of the face should not be bruised, swollen, or tender

44. Courtesy: World News article

45. Courtesy: belmontdentalcare.com

46. Many oral abnormalities & problems can occur from infancy to adolescence, including: Dental caries are cavities or holes in the teeth caused by tooth decay and are the most common, chronic and transmissible oral infections in children and adolescence During food consumption, cariogenic bacteria in the mouth are activated to break down simple carbs & sugar- rich foods. They produce acids that cause demineralization of teeth Cavities are produced when the process is prolonged & exceeds teeth remineralization

47. Early Childhood Caries (ECC), also called baby bottle tooth decay, are dental caries seen in infants & children and can appear any time after tooth eruption ECC usually affect the primary upper/lower front teeth and are caused by: Eating sugary and simple carb-rich foods Prolonged bottle & breast feeding Transmission from caregiver to child if toothbrush or other products are shared

48. Dull white band along gum line as a result of demineralization Yellow, brown, or black collar around the neck of the teeth which is indicative of progression to cavities

49. Teeth that are brownish, black stumps as a result of advanced cavities

50. Missing or excess teeth may be present in young children, which is a result from: Hereditary syndromes Can be detected & further assessed by radiography Delayed tooth loss or eruption may be signs of missing or excess teeth

51. Gum & tissue problems can affect infants & young children in addition to tooth infections Bacterial, viral, or fungal disease can cause: Swelling Redness Ulcers in the mouth Any abnormal or atypical conditions should be referred to dentists or other health professionals

53. Handbook of Pediatric Dentistry; Angus C Cameron & Richard P Widmer; (third edition) Mosby Dental Hygiene Handbook; Kathleen Alvarez, RDH, BS; Williams and Wilkins