Preventive Oral Health

101: Reaching families

with an oral health

message

At the end of this session you will be able to…• identify the number one most common

childhood disease;

• describe how tooth decay happens;

• list key oral health messages for pregnant women and children 0-3 that need to be conveyed and supported;

• understand how the home visitor, childcare provider and community worker can support improved oral health; and

• use resources to support oral health prevention within targeted populations.

Section ITooth Decay and Young Children—A Big Problem!

Answer: Tooth Decay

5 times more common than asthma 7 times more common than hay fever

What is the most common childhood disease?

In South Carolina…

According to the 2002 Statewide Oral Health Screening

of all kindergarten age childrenhave untreated dental decay.

*Caries Experience- the history if a child currently has or has had at least one tooth with a cavity

in other words if a child had at least one tooth that is filled (treated) or with a cavity (untreated)

**Untreated Decay- if a child has at least one tooth with active decay (cavity)

***Tx Urgency 1- when child has dental disease that needs treatment (within several weeks)

****Tx Urgency 2- when child has dental disease that needs immediate/urgent treatment (within

24-48 hours)

SC Oral Health Needs Assessment Data

OHNA 2002 OHNA 2008 OHNA 2012

*Caries Experience 51.6% 47.1% 40.5%

**Untreated decay

(caries)

32.2% 22% 12.4%

Pregnant Women Data (2009-2010)

• 46.2 percent of the pregnant women in South Carolina reported receiving no dental care while pregnant;

• less than 48 percent had received prenatal oral health counseling; and,

• about 28 percent reported having dental problems during pregnancy.

How does tooth decay affect the child and well-being?

The Effect…

Children with early childhood decay are at risk of getting more decay

Goes beyond pain and infection…it affects

SPEECH

ABILITY TO EAT

ABILITY TO LEARN

THE WAY THEY FEEL ABOUT THEMSELVES

The Response…

• 2006: The South Carolina Oral Health Coalition identified early childhood as a priority.

• 2007: Early Childhood workgroup was convened. An ECH section established as part of the State Oral Health Plan to improve the oral health status for children aged 3 years or less.

• Childcare trainings began.

• The workgroup recognized that current research supported that some prenatal oral conditions may have adverse health consequences for the mother and young child.

• A comprehensive approach for young children had to include a component and subsequent objectives for Oral Health Care for Pregnant Women and Young Children.

• Connecting Smiles Initiative was born.

• Comprehensive integration into home visitation and medical and dental settings.

Connecting Smiles InitiativeThe Goal: to integrate oral health

information and resources into existing care coordination models including medical and dental offices and to facilitate collaborative referral relationship between dentist and primary medical providers so children in SC will have access to a dental home.

The Target: individuals and programs that directly impact families including medical and dental providers and staff, home visitation programs, childcare providers and community outreach programs such as Early Head Start.

The Approach: provide

basic oral health

information and resources

that can be utilized to

support preventive oral

health behaviors and

connect dental and medical

providers.

Section IITooth Decay—How Does it Happen?

The tooth decay process

The Connection Between Foods Eaten and Tooth Decay

Germs in Plaque

+ Sugar and Starchy Foods =

ACID ATTACK

Can tooth germs be passed from caregiver to the child?

YES…here’s how

Plaque• Once the germs take hold it is called plaque.

• The sticky film you feel on your teeth.

• Can’t be rinsed away

• Need to brush and flossto remove it

Section IIIHow can you support and promote positive oral health care with the families you serve?

Target Messages for Pregnant Women

Oral Health Before PregnancyDaily Home Care:

• Brush teeth twice a day with a fluoride toothpaste

• Floss at least once a day

Dental Visits:

• Go to the dentist every 6 months

• Seek care when you have a problem

Dietary Recommendations:

• Eat a variety of fruits and vegetables

• Limit sugary foods and drinks

• Drink fluoridated water

During Pregnancy…Daily Home Care:

• Brush teeth twice a day with a fluoride toothpaste

• Floss at least once a day

Dental Visits:

• Go to the dentist every 6 months even when pregnant

• Seek care when you have a problem

Dietary Recommendations:

• Eat a variety of fruits and vegetables

• Limit sugary foods and drinks

• Drink fluoridated water

Pregnancy Affects Your Teeth

•Pregnancy Gingivitis

•Loose Teeth

•Cavities

•Tooth Erosion

Your Dental Health Can Affect Your Unborn Child

• premature and low birth weight deliveries

• when a mother has poor oral health her child is at a greater risk to have dental problems

The Dental Visit Message

• It is SAFE to visit the dentist while you are pregnant. Going to the dentist can help you have a healthy baby.

• Tell the dental staff you are pregnant and tell them your due date.

• Tell your doctor if you need help getting dental care or if you are experiencing dental problems.

• Get treatment if needed. The dental staff will know how to provide safe treatment that will not

harm you or your baby.

The Nutrition Message• Limit foods containing sugar to mealtimes only

• Choose water or low-fat milk as a beverage

• Choose fruit rather than fruit juice to meet the recommended daily fruit intake

• Drink fluoridated water especially between meals and after snacks

Supporting the Message

• Include an oral health message when talking with expectant mothers

• Distribute Before, During and After Pregnancy Fliers

• Give pregnant moms a toothbrush

• Encourage dental visits

Oral Health Standards and Target Messages for Ages 0-3

Standard 1

•Parents/caregivers of children age 0-3 will value and understand the role that primary teeth play in development.

Target message to parents…

• Taking care of baby/primary teeth is important!

• An unhealthy mouth will affect eating, speech development and self esteem.

• Teeth come at different rates and teething can affect your child.

Why Should I Worry about Taking Care of Baby Teeth?

Tooth Eruption Chart• Stress that children

develop differently and teeth come in at different ages and at different rates

• Encourage them to speak with their dentist or pediatrician about any concerns they may have.

Prepare parents to know what to expect when their child is teething…

Common signs of teething include:

• Discomfort, restlessness, irritability, loss of appetite, and waking during the night.

• Chewing on toys and fingers is very common.

• The amount of saliva may increase, causing your child to drool more and cough as baby tries to clear his/her throat.

Standard 2

• Children ages 0-3 should receive an oral risk assessment by 6 months of age from a medical or dental provider.

• Parents/caregivers of children age 0-3 will recognize the importance of establishing a dental home for a child by age 1.

Target Message for Parents…

Get comfortable looking in your child’s mouth. Smile check!

Ask your dental or medical provider to look inside your child’s mouth by 6 months of age.

Children should receive a dental check by their first birthday and should have a dental home.

Older children and parents should visit the dentists regularly.

Smile Check

• Gently lift the child’s upper lip

• Look at the outside and the inside of the upper front teeth

• Look at the back teeth

• White spots are early decay

White Spots

1st Birthday, 1st Dental Check

Supporting the message within the home…

• Community Outreach Workers can use the Oral Health Behavioral Assessment Tool (OHBA) to determine areas in need of intervention

• Goal Sheet

• Demonstrate a smile check

• Provide information on local dental providers

• Share resources

Oral Health Behavioral Assessment Tool (OHBA)

• The Connecting Smiles Initiative adapted assessment tools for use by non-clinicians.

• Assesses risky behaviors.

Goal Sheet• Useful tool to help

parents identify behaviors to change.

• Connecting Smilesadapted the AAP tool for use with home visitation programs.

• Added a motivational interviewing component.

Potential Risk Factors for Decay

• Medicaid participants.• Mother or primary caregiver has

cavities.• Siblings have cavities.• Premature or low birth weight. • Special health care needs.• Using a bottle after 15 months of

age.• Using a sippy cup with juice or

sweeten beverages. • Eating starchy snacks more than

3 times a day.

Sample Resources to Share…• Dual language First Birthday Card

• Parent Information Sheet: Making Dental Visits Easier

• Books on about going to the dentist

Standard 3• Parents/caregivers of children age 0-3 will have a basic understanding of how to properly care for their child’s mouth before and after teeth arrive. This includes wiping the gums before teeth arrive and using a soft bristled toothbrush after teeth erupt.

Target Message for Parents…

• Mouth care begins with infants even before teeth arrive.

• One good way to prevent tooth decay is to brush your child’s teeth twice a day.

Begin with infants…

• After feeding, an infant's teeth and gums should be wiped with a moist cloth to

remove any remaining liquid that coats

the teeth and gums

From: http://www.aboutsmiles.com/photos/mom_baby.htm

Toothbrush Use• Toothbrushes for

infants and toddlers should be soft with a small head and large handle.

• Tooth brushing should be supervised until the child is 6-7 years of age.

• Consider recommending parents use an electric toothbrush to brush their child’s teeth.

ToothpasteAs soon as teeth appear, parents & caregivers need to

begin brushing children’s teeth with fluoride toothpaste 2

times a day.

Under 3 years, use

smear

Over 3 years, use pea

sized amountAmerican Dental Association Council on Scientific Affairs (2014) Fluoride toothpaste

use for young children. Journal of the American Dental Association. 145(2): 190-191.

Toothbrushing Basics…

How to support toothbrushing in the homeDemonstrate gum

wiping and tooth brushing using mouth models or puppets

Show the right amount of toothpaste

Share songs

Provide cloths, gum cleaners and infant toothbrushes

Rinsing• The cavity-causing effect of certain foods can be reduced by offering the children rinsing water after snacks when brushing is not possible.

Flossing

• when the infant/child has two teeth that touch …introduce flossing

• it is good to establish habit early

• brushing alone does not do the job

Tips…Childcare Providers

Use tooth brushing charts to encourage good brushing habits—reward children that complete their charts.

Share songs that encourage tooth brushing and make it fun!

Use tooth timers.

Do activities that teach them about good oral health.

More Tips…Home Visitors

• Use tooth brushing charts to encourage good brushing habits—reward families that complete their charts.

• Encourage families to start early and make it fun!

• Distribute gum cleaners and infant toothbrushes.

• Share a copy of Brush, Brush, Brush!book

• Encourage parents to model toothbrushing for their child.

I Have a Little ToothbrushFor toddlers we are acquainting them with what a toothbrush is and what it is used for.

A fun rhyme to share…

I Have a Little Toothbrush

A self-help rhyme

I have a little toothbrush I hold it very tight

I brush my teeth each morning, and then again at night

(children perform the actions)

Standard 4

•Parents/caregivers of children age 0-3 will be aware of the impact of feeding habits and nutrition on their child’s oral health.

Target Message for Parents…

What a child eats and

drinks

AND

How often they eat and

drinkcan be part of the tooth

decay process

Supporting this message within the home…

Breastfeeding and Oral Health

• Natural and beneficial source of nutrition.

• Not a cavity producer alone, it may lead to cavities when combined with other carbohydrate sources.

What can parents do? • Encourage: healthy foods such as fruits and vegetables or whole grain snacks.

• Discourage: sticky foods such as raisins, fruit leather, and hard candies.

• Discourage: grazing behavior where the child is eating and drinking very frequently throughout the day.

Medicines

• Medicines such as cough syrups contain sugar that germs in the mouth use to make acids.

• Be sure to brush a child’s teeth after giving him or her medicine or at least rinse with water.

Using the Bottle and Sippy Cup

• Do not put a baby down to sleep with a bottle or a sippy cup

• Only put formula, milk (after age 1) or water in a bottle.

• Never put soda or fruit juice in a bottle.

• Most children are ready to stop using a bottle at or before age 1.

• Try not to use a sippy cup all day…use it at mealtime and snack time only. If one is used between meals, it should only contain water.

• Throw away sippy cups after 6 months of use.

• A sippy cup should not be used as a pacifier and should not be carried around by your child—injury to the mouth could occur if the child fell.

• When possible, children over 18 months of age should be encouraged to use a small plastic cup without a lid.

Sippy Cups

Potential Misuse of Sippy Cups

• Used continuously throughout the day.

• Filled with sugary beverages.

• Used a as “pacifier” to calm and appease.

• Not discarded every 6 months.

Facts about juice100 percent fruit juice can be good for your child

Fruit juice has natural sugars that can lead to decay if a child drinks too much of it

How to use juice in a healthy way…

Wait until a child is at least 6 months old before giving him juice.

Serve juice in a cup, never a bottle.

Give only 4 to 6 ounces of juice each day.

Dilute the juice by adding water.

Encourage children to EAT FRUIT rather than drink fruit juice.

Standard 5

• Parents/caregivers of children age 0-3 will understand how fluoride in water and through varnish application can help protect their child’s teeth from decay. Parent and caregivers of children ages 0-3 will be encouraged to use fluoridated water for drinking, cooking and formula preparation.

Target Message for Families

• Fluoride helps strengthen teeth.

• Families should drink fluoridated water. Fluoride in water helps protect teeth from decay.

• Fluoride varnish can help strengthen and protect their child’s teeth.

Why is it good to have fluoride in your drinking water?

• As young children’s teeth develop, drinking water that contains fluoride can help their teeth grow strong and healthy.

• Drinking water that contains fluoride will help strengthen the tooth surface and help prevent tooth decay for people of all ages.

Fluoride—the tooth protector

• Replaces the minerals from the tooth surface lost during an acid attack

• Helps make the tooth stronger

Found in

–Public water systems

that are fluoridated

–Toothpaste

–Supplements

–Varnish/Gels

Determine Water Source…

Well water OR

Public water system

Well WaterFluoride level testing of well water by DHEC

www.scdhec.gov/environment/water/

dwrwtesting.htm

If a patient is on well water, providers may consider prescribing supplements or provide fluoride varnish.

Bottled Water• Check supplier or label on bottle.

• Some water has added fluoride or comes from a public water system that is fluoridated.

• Encourage patients to not depend solely on bottled water

• as their main source of drinking water.

Drink from the tap!

Standard 6

• Parents/caregivers of children age 0-3 will understand how to help prevent injuries to the mouth and how to respond to basic injuries to the mouth and teeth.

Target Message for Parents…

Smiles need to be protected from

injury

Accidents Happen?Water Fountains?

Swings and

Playgrounds?

Bikes and Riding

Toys?

Scattered Toys?

Getting the Safety Message to Families

•Share parent informationsheets about home safety

•Inform parents about how to respond to a dental emergency if one happens

•Keep dental information on file

Emergency Response…

Spread the word…

Tooth decay is preventable!!

Prevention is the KEY…

Behavior change is possible!

Available Resources…

Questions?

Thank you!

Mary Kenyon Jones, MEdOutreach and EducationSpecialist/Consultantkenyonm@dhec.sc.gov