Presentation on theme: "Maternal and Pediatric Oral Health Care"— Presentation transcript:
1 Maternal and Pediatric Oral Health Care Presentation to University of Medical Sciences of BhutanFaculty of Nursing and Public HealthMarch 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.Nearly half of US children 5 to 17 have decayed, missing or filled teeth (DFMT)51 M lost school days (1989)
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 8Morocco, Cambodia, Greece, Indonesia, Kenya, Myanmar, Vietnam, India, Phillipines--baseline assessment before FDI and Unilever sponsored project
4 Measures Disease prevalence: Access to dental care: Decayed, missing or filled permanent tooth (DMFT)Untreated decayed teethAccess to dental care:Number of dentists per 1,000 populationDental services utilization:Claims for care from a dental care professional, preventive services, treatmentAmerican 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 systemIn 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 factorsTraditional separation of medical and dental practice may limit effective health promotionDiamonte DriverCardiovascular disease, cancer, chronic respiratory disease, diabetes, obesity
8 Dental Decay is an Infectious Transmittable Disease Cariogenic bacteria: Streptococcus mutansBacteria is transmitted from mother or caregiver.Mothers with high levels of bacteria have:High levels of decayPoor oral hygieneHigh frequency of sugar intake
9 Early Childhood Caries (ECC) Severe rapidly developing form of tooth decay in infants and young childrenAffects teeth that erupt first, at about 6 months, and are least protected by salivaFormerly called Baby Bottle Tooth Decay or nursing caries
10 Impact of Severe Early Childhood Caries Extreme painUnder-nutrition, low weight & heightSpread of infectionPoor self-esteemSpeech development problemsLost school days and difficulty learningHigh 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 juiceBeliefs 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.
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.Gingivitis: inflammatory condition of soft tissues surrounding a tooth or gingivaPerodontitis: destrux of supporting strux such as ligament, bone, or soft tissuesGram-negative, anaerobic bacteria mainlyResults of observational studies are mixedResults of trials with low SES mothers show reduced risk of PT birth, LBW, but non-randomizedHowever, large body of evidence links infection to adverse outcomes (non-specific role):Oral mechanical manipulation can cause bacteremiaChronic periodontal infection can produce transient bacteremiaLocal inflammatory process can activate maternal inflammatory response at cellular level and may be involved in preterm labor, etc.No universally accepted standard for periodontal disease diagnosisCausal relationship or confounded by other variables such as low SES, smoking, other infections, obesity, other maternal disorders, history of adverse pregnancy outcomes. Studies in Europ and Canada (universal HC) do not find association between disease and outcomes--effect modification?Maternal health affects infant health, risk of early childhood caries?Treat during pregnancy and early motherhood—but difficult to find willing providers
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 pregnancyErosion of tooth enamel: Due to exposure to gastric acid from vomiting due to morning sickness or gastric refluxDental 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.Theoretically, blood borne gram negative anaerobic bacteria or inflammatory mediators may be transported to the placental tissues as well as to the uterus and cervix. This results in increased inflammatory modulators that may precipitate preterm labor.
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.Oral hygiene is especially important for those with vomitting, bleeding gums,Source: Dr. Alex Rose, surgicorps.org
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.Policy development…outreach materialsEff. October 2008
19 Other Options for Improving Oral Health in the Community Community water fluoridationSteps to reduce craniofacial injuries from accidents and sports injuriesReducing smoking9% of children 3-19 had at least one sealant placed (average 4.4 per child)
21 Build on Bhutan National Health Survey Oral health indicators:Percent who brush teeth at least once a dayPercent have never received dental careRisk factors for oral disease and other diseases:Percent who currently smokePercent who use smokeless tobaccoPercent who eat doma/betel quidPercent who use chewing tobaccoAdd examination survey to track DFMT prevalenceAdd survey questions of child health, nutrition, infant feeding practicesA topic ripe for public health research!Current smokers: 53.5% smoke on a daily basisBetal nut, especially when mixed with tobacco, is RF for oral cancers
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 factorsRespond to and influence international developmentsExploit the potential for novel funding partnerships with industry and foundationsTranslation 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 HealthSpecial thanks to Joanna Douglass DDM, University of Connecticut, and Connecticut Department of Public Health for photos of children with early childhood caries.