Objectives. Oral Health Intervention Workflow. Nurses Role in Oral Health Expanding Access to Oral Health Care Nurses Make a Difference!

Transcription

1 Nurses Role in Oral Health Expanding Access to Oral Health Care Nurses Make a Difference! Health Assessment Conference August 15, 2017 Maritza Morell, DMD, MS, MPH Faculty, Pediatric Dentistry Department of Growth & Development Harvard School of Dental Medicine Associate in Dentistry Children s Hospital, Boston Objectives To help other health professionals incorporate oral health into patient care To demonstrate how oral health and general health are interconnected To discuss how health professionals could prepare to do routine oral health assessments and initially help to manage dental emergencies Oral Health Intervention Workflow Referral to Dentistry handouts Automated EMR extraction for following measures: 1. Oral Health Education 2. Fluoride Varnish applications ordered 3. Fluoride varnish applications billed Doctors FV orders Paper and electronic CaRTT Fluoride varnish? 1

2 Help Us Get A Dental Home For Children Birth to 36 Months What Happens at The Infant Oral Health Visit? 4 Current AAP Policy Points The American Academy of Pediatrics published its first policy related to oral health in 2003 Since then, AAP oral health experts have published additional policies and participate in the review of the AAP many policies on children's oral health 5 Malkin, B. (2009) The importance of patients oral health and nurses role in assessing and maintaining it. Nursing Times; 105: 17 Dolce, MC, PHD, RN (2014); Integrating oral health into professional nursing practice, an interprofessional faculty; tool kit. Journal of Professional Nursing, Vol 30, No. 1 (January/February), 2014: pp

3 Early Childhood Caries Why See Children Under the Age of 1? (a.k.a. bottle caries, nursing caries) Focus on health supervision Not disease treatment 7 Rationale for Earlier Visits Is this success? Early Childhood Caries The disease of early childhood caries (ECC)is the presence of 1 or more decayed (non cavitated or cavitated lesions) missing (due to caries) or filled tooth surfaces in any primary tooth in < 5 yrs 11 mos In children younger than 3 years of age, any sign of smooth surface caries is indicative of severe early childhood caries (S ECC) 3

4 Early Childhood Caries: Implications Impacts function and quality of life Expensive to treat In primary teeth, predicts future decay in both primary and permanent teeth Results in pain and infection Missed days from school Diminished ability to learn Early Childhood Caries: Implications Break the Cycle of Early Childhood Caries By first grade, 50% of children have had decay 20% of preschoolers suffer from ECC (NIDCR/CDC) 40% have caries by age 5 Low SES groups who frequently consume sugary foods are at 32x increased risk 80% of caries in 20% of US children The cost of treating ECC is immense: $ Data suggests ECC predisposes a child to caries throughout life 12 4

5 Do Head Start Children Have Dental Problems? 40% 35% 30% 25% 20% 15% 10% 5% 0% 20% 38% 28% 9% Needed Dental Care (PIR ) Children who ever had tooth decay (cavities or fillings) Children who have cavities Toothache more than once in past 6 months 13 Early Childhood Caries : Epidemiology Disparities in dental caries: American Indians suffer the most tooth decay, followed by Hispanics, African Americans and Caucasian children. Poor of all ages particularly children and elderly suffer the worst oral health Medically compromised individuals or those with disabilities, are at an increased risk for oral diseases Initiate a Therapeutic Alliance with Parents Prepare parents for important changes affecting oral cavity Educate parents about child s oral health needs Make them aware of the child s oral cavity 15 5

6 ORAL HEALTH COUNSELING Spread the Word Vertical Transmission from caretaker Vertical Transmission and Early Childhood Caries (ECC) The mother is the most common cariogenic bacterial donor of Streptococcus Mutans to their child DNA fingerprinting studies show genotype matches between mothersandinfantsin more than 70% of cases Reduce Vertical Transmission Control of oral diseases in pregnant women has the potential to reduce Vertical Transmission 6

7 Caries Risk Assessment Sample CRA Forms High Caries Risk (D0603) Patient has disease indicators such as demineralization, cavitation, or interproximal lesions visible on radiographs or the patient has a history of caries lesions within the past 6 months. 7

8 Low Caries Risk (D0601) Patients without active lesions who are not likely to experience any new lesions, based on risk factors. Their risk factors are balanced with protective factors. Or, a previously high or moderate risk patient, who has had disease indicators addressed, has demonstrated a reduction in risk factors and/or an increase in protective factors. Absence of new demineralization and cavitation for the past 12 months. Moderate Caries Risk (D0602) Patients who have risk factors unbalanced by protective factors. Or, patients who were previously high risk, but no longer have signs of active disease; or patients who were previously low risk with new unbalanced risk factors. Dental Caries Etiology Multifactorial Streptococcus mutans principal organism Vertical colonization from mother to child 24 8

9 Risk-Based Disease Prevention and Management of Early Childhood Caries (ECC) FLIPCHART 2 nd Edition Tooth brushing Tips for BrushingTeeth Approach child from behind Use a small,soft-bristled toothbrush Lift the Lips Brush teeth for 2 minutes Lift the lip to brush along the gum lines Concentrate on the back molars which are prone to cavities Brushing doesn t have to take place in the bathroom Help with brushing until age 7 Show that tooth brushing can be fun! 20 Flossing Tips for FlossingTeeth Waxed or unwaxed Start flossing your child's teeth once a day as soon as the teeth touch Floss from behind your child Flosssticksorpicks may be easier to use instead of regular string floss Flosser 21 9

10 Topics About Fluoride Adequacy Evaluation and supplementation Breastfeeding and formula Safety and toxicity Risk assessment and topical fluoride The ADA recommends a pea size amount of fluoride toothpaste for brushing from six months 28 Fluoridated Water Fluoride Toothpaste and Rinses Fluoride Varnish 0.25mg & 0.5mg F chewable tabs Fluoride Supplements NaF 5000 ppm F >6 years of age NaF 1000 ppm F toothpaste with xylitol Stannous fluoride 1000 ppm F Calcium and phosphate +/- F- 22 Choices oftoothpaste Ạ. Ḍ.Ạ... i,(n'/t (1'9g; NO Fluoride Protection Cavity Protection 10

11 Who Gets Fluoride Varnish? Using bottle/sippy cup On demand breast feeding Presence of plaque not brushing Grazer Parent/sibling has dental caries Plaque on primary incisors at one year Incipient white spot lesions on anterior teeth Early childhood caries previously treated 31 Topics under Habits Non nutritive sucking Pacifiers Breastfeeding Identifying the effects of habits 32 Topics Under Diet and Nutrition Baby bottle use Frequency of sugar contacts Weaning Breastfeeding Safe snacking for health 33 11

12 Bottles and Sippy Cups: It s what s inside that counts Only water to bed No more than 4 oz juice once each day Breastfeeding Healthy Balanced Diet Healthy Bodies Adapted from: American Academy of Pediatrics. A Pediatric Guide to Children s Oral Health. Elk Grove Village, IL: American Academy of Pediatrics; How much sugar is in your child s favorite drink? 20 ounces 15.2 ounces 12 ounces 32 ounces 14 ounces 14 ounces 8 ounces 9 Sealants Caries Prevention 36 12

13 Common Pediatric Dental Emergencies o.f Non-traumatic Origin cc: What is this on the tongue? 38 Geographic tongue/glossitis Common benign condition Atrophy of the filiform papillae 1 3% of the population 2:1 female:males Etiology, pathogenesis unknown Tx: Usually none needed 39 13

14 cc: What s wrong with my 9month old s teeth? 40 Discolorations Extrinsic staining Intrinsic staining Caries Enamel dysplasia 41 Developmental Issues Ectopic eruption Exfoliation process Crowding Anomalies of tooth number and formation 42 14

15 Overretained Primary Teeth 43 Post Local Anesthesia Trauma Most CommonPost Anesthesia Complication in Pediatric Patients Soft Tissue Trauma 15

16 Anomalies of Tooth Number Fusion/ Gemination Gemination 46 Anomalies of Tooth Formation Amelogenesis Imperfecta 47 Dentinogenesis Imperfecta fti\ Boston Children's Hospital \IV Until every child is well" 48 16

17 Soft Tissue Pathology fti\ \IV Boston Children's Hospital 49 Until every child is well" Palliative treatment Orobase Soothe & Seal Healing Minor: 7 10 days without scarring Aphthous Ulcer 50 Intraoral Abscess vs Aphthous Ulcer 51 17

18 52 Periapical Disease acute facial cellulitis Diagnostic Terms chronic alveolar abscess/ apical periodontitis 53 cc: My child refuses to eat 54 18

19 1 o Herpes 55 Acute Herpetic Gingivostomatitis Symptoms: Fever ( F) Malaise Cervical lymphadenopathy Vesicles that progress to ulcers Occurs 6 months to 5 years of age Mild cases resolve 5 to 7 days Severe cases extend to 2 weeks Treatment Rest, antipyretics, and analgesics Dehydration is a concern Palliative mouthrinses 0.5% 1.0% dyclonine hydrchloride (Dyclone) Acyclovir suspension Antibiotics and steroids contraindicated Viscous lidocaine should be avoided 56 Mucocele Ranula 57 19

20 Eruption Cysts/Hematomas 5 Common Pediatric Dental Emergencies. of Traumatic Origin Primary Dentition 20

21 Prevention of Orofacial Trauma Common Pediatric Dental Emergencies. of Traumatic Origin Permanent Dentition 21

22 fti\ \IV Boston Children's Hospital Until every child is well" fti\ Boston Children's Hospital \IV Until every child is well" 65 Uncomplicated Fractures Segment - kept moist 66 22

23 Complicated Fractures Pulpotomy 68 Dental Trauma fti\ Boston Children's Hospital \IV 69 Untilevery child is well" 23

24 Root Fractures 70 Displacement

25 Custom vs. Boil & Bite 73 Avulsed Permanent Tooth 74 AVULSED PERMANENT TEETH Main Goal: Immediate reimplantation! Where is the tooth? How long did it happen best prognosis first 1 hour How old is the child? 75 25

26 Storage Transport Media Descending order of preference & all on ice Hank s, Viaspan low fat milk saline, saliva Gatorade, contact lens solution 76 Currently recommended Optimal Storage Media Hank s BalancedSalt Solution milk 77 Avulsions and Reimplantation 78 26

27 Passive Splint 79 How do we treat Bobby in the Dental Office? Treat on His Own Chair 81 27

28 Molt Mouth Prop Papoose Board fti\ Boston Children's Hospital \fll) 28

29 General Anesthesia for Dental Rehabilitation General Anesthesia for Dental Rehabilitation