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Maternal and Pediatric Oral Health Care Presentation to University of Medical Sciences of Bhutan Faculty of Nursing and Public Health March 18, 2015.

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Presentation on theme: "Maternal and Pediatric Oral Health Care Presentation to University of Medical Sciences of Bhutan Faculty of Nursing and Public Health March 18, 2015."— Presentation transcript:

1 Maternal and Pediatric Oral Health Care Presentation to University of Medical Sciences of Bhutan Faculty of Nursing and Public Health March 18, 2015

2 In the US and worldwide, dental caries (tooth decay) is the most common chronic disease of childhood. Dental caries is almost entirely preventable. Highly related to lifestyle factors (high sugar diet and protective factors like fluoride, oral hygiene). Untreated disease results in pain, nutritional problems, poor appearance, malodor, lost school days, other disruption of normal activities. Socially disadvantaged children are especially vulnerable.

3 Oral Health and Global Burden of Disease Dental caries is a major though declining disease in developed nations and a growing disease in countries with increasing consumption of sugar and inadequate exposure to fluorides. Survey of child oral health in nine countries showed 65% children had decayed, filled or missing teeth (DFMT), with untreated decay in 47% of children age 1-2 and 97% of children over age 8

4 Measures Disease prevalence: – Decayed, missing or filled permanent tooth (DMFT) – Untreated decayed teeth Access to dental care: – Number of dentists per 1,000 population Dental services utilization: – Claims for care from a dental care professional, preventive services, treatment – American Dental Association format for claims does not include diagnosis codes

5 Why Oral Health is Important for Mothers and Young Children Often neglected area of public health policy and health care delivery system In childhood, oral health has a significant effect on normal growth and development, nutrition, learning and social function. Periodontal disease may affect birth outcomes. Oral diseases and chronic diseases share common risk factors Traditional separation of medical and dental practice may limit effective health promotion

6 Oral Health in Early Childhood


8 Dental Decay is an Infectious Transmittable Disease Cariogenic bacteria: Streptococcus mutans Bacteria is transmitted from mother or caregiver. Mothers with high levels of bacteria have: – High levels of decay – Poor oral hygiene – High frequency of sugar intake

9 Early Childhood Caries (ECC) Severe rapidly developing form of tooth decay in infants and young children Affects teeth that erupt first, at about 6 months, and are least protected by saliva Formerly called Baby Bottle Tooth Decay or nursing caries

10 Impact of Severe Early Childhood Caries Extreme pain Under-nutrition, low weight & height Spread of infection Poor self-esteem Speech development problems Lost school days and difficulty learning High risk of dental decay and crooked bite in adult teeth

11 Contributing (Modifiable) Factors Feeding habits such as high sugar snacks or nighttime bottle formula or juice Beliefs about child care and teeth: “Baby teeth are not that important.” “It is cruel to deny my baby the bottle.” “The bottle and snacks keep my baby quiet.” “Decay will happen anyway.” Changing feeding practices can health prevent other conditions like childhood obesity.

12 Maternal Oral Health

13 Good Oral Health for Mothers Good oral health is important for pregnant women and for the future health of their children. A child’s oral health begins in uteroandpoor maternal oral health and malnutrition may may disrupt enamel formation. Most infants and young children acquire cariogenic bacteria from their mothers during ordinary caregiving.

14 Physiologic Changes During Pregnancy Pregnancy gingivitis: increased inflammatory response to dental plaque during pregnancy causing gingivae swell and bleed more easily. Tooth mobility: Ligaments and bone that support the teeth may loosen during pregnancy Erosion of tooth enamel: Due to exposure to gastric acid from vomiting due to morning sickness or gastric reflux Dental caries: Due to increased acidity in the mouth, increased sugar intake (cravings), decreased attention to oral health maintenance

15 Periodontal Disease During Pregnancy Untreated gingivitis can lead to periodontitis, an inflammatory response in which a film of bacteria (plaque) adheres to teeth and releases bacterial toxins that create pockets of infection in gums and bones. Studies have linked periodontal disease and preterm birth; however, subsequent studies have not shown any reduction in preterm birth or low birthweight from treating periodontal disease during pregnancy.

16 Maintaining Good Oral Health In Pregnancy: Advice for Mothers Practice good oral hygiene (brushing twice daily, flossing daily) Eat healthy foods. Get oral health care: – Oral health care is an important component of prenatal care. – Oral health care is safe throughout pregnancy. Source: Dr. Alex Rose,

17 Program and Policy Options

18 Strategies for Increasing Access to Oral Health Care Co-locate dental clinics in medical care facilities. Locate dental clinics in schools. Expand dental provider workforce. Train pediatric primary care providers (doctors and nurses) in providing oral health evaluation and hygiene instruction for patients under 3 and topical therapeutic fluoride varnish application for children at risk for dental caries.

19 Other Options for Improving Oral Health in the Community Community water fluoridation Steps to reduce craniofacial injuries from accidents and sports injuries Reducing smoking

20 Oral Health Research

21 Build on Bhutan National Health Survey Oral health indicators: – Percent who brush teeth at least once a day – Percent have never received dental care Risk factors for oral disease and other diseases: – Percent who currently smoke – Percent who use smokeless tobacco – Percent who eat doma/betel quid – Percent who use chewing tobacco Add examination survey to track DFMT prevalence Add survey questions of child health, nutrition, infant feeding practices

22 Recommendations for Oral Health Research Agenda International Association for Dental Research Global Oral Health Inequalities Task Group on Dental Caries recommends that research should: – Integrate health and oral health, using common risk factors – Respond to and influence international developments – Exploit the potential for novel funding partnerships with industry and foundations Translation of research into policy and practice should be a priority for all.

23 For further information: MaryAlice Lee, Ph.D. Lecturer Yale School of Public Health Special thanks to Joanna Douglass DDM, University of Connecticut, and Connecticut Department of Public Health for photos of children with early childhood caries.

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