Overview: The health care provider explores the health behaviors and preventive measures that enhance children s oral health.

Transcription

1 Lesson 5: Prevention Overview: The health care provider explores the health behaviors and preventive measures that enhance children s oral health. Goals: The health care provider will be able to describe: Key Terms: How to prevent dental decay Appropriate dental hygiene practices for infants and toddlers Importance of fluoridation and steps to evaluate sources of fluoride Use of dental sealants The role of early intervention, injury prevention and response Use of fluoride varnishes and Chlorhexidine rinses How dietary preventive measures affect oral health Chlorhexidine: Enamel: Fluoridation: Fluoride Varnish: Sealants: Systemic Fluoride: Topical Fluoride: prescription antimicrobial mouth rinse hard surface of the teeth addition of fluoride to community water systems a fluoride lacquer that is painted on teeth to reduce dental decay a plastic coating applied to back teeth to protect them from the bacteria that causes dental decay ingested fluoride, i.e. fluoridated water or fluoride drops or tablets fluoride in contact with teeth once they have erupted in the mouth, i.e. fluoride toothpaste, fluoride mouthrinse, fluoride treatment at the dental office Prevention Maine Smiles Matter P 1

2 When should a child start visiting the dentist? Ideally, children should have an oral health exam by their first birthday. The goal of this visit is to assess the risk for dental disease, initiate a preventive program and decide when to schedule the next visit. During these early visits, the dentist and dental hygienist can also assess proper tooth development and check for other problems. By starting early, caregivers learn steps to ensure good oral hygiene for their children. For example, children will learn the importance of good oral health care and will see that the oral health visit is a very positive experience. What oral hygiene practices are indicated for infants and young children? The parent or caregiver should begin wiping the baby s gums with a damp washcloth or baby tender at least once a day from birth. This practice reduces the amount of bacteria and sugars in the baby s mouth, preventing dental decay and forming appropriate behaviors Once the first tooth erupts a small soft bristled toothbrush should be used to clean teeth after each meal and before bedtime. Remember to lift the lip in order to brush at the gum line and behind the teeth. Brushing 2-3 times a day would be ideal. Nighttime, before bed, is the most important time to brush. Remember, it is important not to eat or drink anything other than plain water after brushing at night. A small, pea sized amount of fluoride toothpaste should be used beginning at approximately age 2, unless a different recommendation is made by the child s dentist. The parent or caregiver should dispense the toothpaste and brush the child s teeth. Children need assistance with brushing until at Maine Smiles Matter P2

3 least age 7 or 8, and frequently longer. Children do not have the manual dexterity to brush well alone until this age. Assisting children with brushing helps assure proper cleaning and reinforces proper brushing technique. There are various techniques that can be used when cleaning a child s teeth. Infants and toddlers could lie with their head on the adult s lap so the adult can effectively see and clean all areas of the child s mouth. As children get older, parents/caregivers could assist with brushing by standing behind the child and in front of a mirror, reaching around the child, or by kneeling in front of the child. Daily flossing should begin as soon as two teeth have erupted next to each other. What about Fluoride? Fluoride is a mineral that strengthens the outside of teeth. Strong teeth resist decay. Tooth decay can be reduced by 40 to 49 percent in primary teeth with ingestion of proper amounts of fluoride. Fluoride is found in naturally occurring ground water and rock beds. It is also found in many large public water supplies. Who needs Fluoride? Maine Smiles Matter P3

4 Maine has one of the best public fluoridation systems in the country, but tens of thousands of families living in small towns and communities, or who get their water supply from wells, springs, or bottled water may not be getting adequate fluoride from water. Infants growing up in these communities usually need to ingest (systemic) fluoride supplements in the form of drops. Fluoride supplementation is essential for any child who is at high risk for dental decay. About 75% of Maine people on public water supplies currently receive fluoridated water; since only about 47 percent of Maine people use public water supplies, this means that overall, about 35% of Maine s total population has fluoridated water in their homes. How much Fluoride Supplement Should be Given? The physician or dentist prescribing ingested (systemic) fluoride drops should consider the following before prescribing fluoride supplements: If a child s water source is from a public water supply, it should be determined whether the system is optimally fluoridated. If the child gets his or her water from a well or spring, the water should be tested to determine the presence of adequate amounts of fluoride. Testing kits are available from the Maine Health and Environmental Testing Lab. Call (207) Bottled water often does not contain adequate amounts of fluoride and, even where fluoride is present, some water filtration systems filter out the fluoride during processing. There is a limited transfer of fluoride from human breast milk. One study shows that only about 2 percent of a high dose of fluoride given to lactating mothers was transferred to the infant during breast-feeding. If the water source is not providing the recommended amount of fluoride, parents should discuss fluoride supplements with their physician, dentist or dental hygienist. No fluoride prescription should be written for more than 120 mg of fluoride. Dietary Fluoride Supplement Schedule Maine Smiles Matter P 4

5 Fluoride Supplement 1 Fluoride ion level in drinking water (ppm) Age < 0.3 ppm Birth 6 months ppm 2 > 0.6 ppm 6 months 3 years 0.25 mg/day 3 6 years 0.50 mg/day 0.25 mg/day 6 16 years 1.0 mg/day 0.50 mg/day 0.1 part per million (ppm) = 1 milligram/liter 2.2 milligrams sodium fluoride contains 1 milligram fluoride ion. Can Fluoride be Harmful? Fluorosis of teeth may result from taking in excessively high levels of fluoride in infancy during the developmental stages of teeth. It infrequently occurs in young children with ingestion (systemic) of topical fluoride from excessive use of fluoridated toothpaste. Fluorosis usually appears as small white areas in the enamel. It is a cosmetic concern only, and a very minor problem, far outweighed by the benefits of fluoride. The safest method of delivering fluoride in the diet is by optimally fluoridated drinking water. Fluorosis Ingesting excessive amounts of fluoride, just like ingesting too much of any mineral or medicine, can have serious side effects, especially in children under 3 years of age. Serious complications from excessive fluoride ingestion by young children are very rare. Maine Smiles Matter P5

6 Problems with topical fluoride can be prevented by: not using toothpaste for children under 2 years of age unless recommended by a dentist using only a pea-sized amount of toothpaste on the toothbrush an adult supervising the child s brushing until at least three years of age. Dental Sealants A dental sealant is a thin plastic coating applied to the pits and fissures of molars to prevent decay. Most tooth decay in children occurs on the chewing surfaces of the molars. Molars have irregular chewing surfaces with pits and fissures (grooves) which tend to trap food and debris. Sealants flow into and coat these grooves so that bacteria cannot multiply in the pits and fissures and cause decay. Susceptible pits and fissures Sealed pits and fissures Other Decay Preventive Measures Fluoride varnish is a type of topical fluoride-containing lacquer that is quickly and simply painted onto the susceptible surfaces of the child s teeth. Fluoride varnish may be a suitable source of topical fluoride for Maine Smiles Matter P 6

7 infants and toddlers when professionally applied. Fluoride varnish has been used widely in Europe, for more than 30 years, with good results in preventing dental decay. In the United States, applying fluoride varnishes for decay prevention is currently an off-label use. Chlorhexidine is a prescription antimicrobial mouth rinse shown to be effective in suppressing decay-causing microorganisms and decreasing gingival inflammation. Research has shown promising uses for chlorhexidine in the prevention of decay in children. A healthy diet includes a variety of foods. Sugar-laden foods should be kept to a minimum and eaten with meals. A high frequency of snacking combined with poor snack choices can lead to increased dental decay. See Lesson 4 for additional information. Injury Prevention and Response Dental injuries can be unintentional or intentional. Education and early intervention are the best ways for health professionals and families to protect children against dental injuries. At each stage of development, children are more likely to suffer different types of injury. Toddlers are likely to fall and injure their incisors or suffer soft tissue tears while older children can suffer fracture of any incompletely formed permanent incisors. Children of all ages are at risk for child abuse and neglect. Using car safety seats, safety belts, bike helmets, and mouth guards can prevent a significant number of injuries to the head, face, mouth, teeth, oral tissues, and jaws. Children of all ages must be considered at risk for child abuse. In 65 percent of physical abuse cases, reported injuries occur to the head, neck and mouth. Education and early intervention are the best mechanisms to protect children against abuse or neglect. The essential of oral trauma management vary, depending on whether the injured tooth is primary or permanent. Primary teeth tend to get knocked out, while permanent teeth tend to fracture. Avulsed primary teeth are rarely repositioned because treatment may (or may not) save the baby tooth but might damage the permanent successor. Permanent teeth that have been knocked out from their sockets should be reinserted Maine Smiles Matter P 7

8 immediately. The longer the teeth are out of their sockets, the less likely the probability of long term healing. If teeth are not reinserted within two hours, their roots will start to resorb at some point, even if the teeth are eventually reimplanted. When injuries occur in the oral cavity, the child should be brought to the dentist as soon as possible. For soft tissue tears, tongue lacerations, and puncture wounds, treatment is aimed at stopping any bleeding and preventing infection to the affected area so it can heal. Bone injuries such as a broken jaw will require treatment by a dentist, oral surgeon, or plastic surgeon. Maine Smiles Matter P 8