Snapshots: Smart Mouths Smart Kids Across Ages, Stages & Demographics

Patty Braun, MD, MPHMary Kay Meintzer, LPC, CACII

Deidre Callanan, RDH, DC, MPH

Meet the presenters!

Goals for This Session

• Identify specific behavioral and physical characteristics that impact the oral health of children ages 0 to 5, 6 to 12, and 13+.

• Describe what is “normal/expected” for children in those age groups, and “red flags” for their oral health.

• Think with a “whole child” mindset.• Identify available oral health prevention

interventions.

Children Age 0 to 5

Physical Development & Overall Health

• Growth• Fine motor• Gross motor• Language (cognitive)• Adaptive (social)

Growth, Influential Factors & Problems

• Growth – Birth weight doubles by 4-5 months, triples by 12– Birth length increases by 50% by age 1, doubles

by 4 years• Influential factors– Nature: birth weight, gestational age– Nurture: nutrition, illness, medical conditions

• Problems• Medical conditions• Non-nutritive grazing• Nutritional supplements

Gross Motor

0-1 1-2 2-3 3-4 4-5

Fine Motor

0-1 1-2 2-3 3-4 4-5

Language Development

Da

Dada go

Me brush my teeth I brush my

teeth at school every

day.Why do I have to brush my teeth? I

don’t want to.

• Medical and/or environmental conditions – affect weight gain (e.g FTT)– result in daily medications (e.g. Fe+)– delay cognitive development (special needs)– delay motor development (cerebral palsy)– impact the introduction to solids (feeding

problems)– distracting caregiver to focus on other things– contributing to complacency around oral health

Cognitive Development

0-2 years: Sensorimotor• Knowledge of world is limited to child’s sensory

perceptions and motor activities. Object permanence develops.

2-7 years: Pre-operational Thought• Language development is a hallmark of this period.

Children in this stage do not yet understand concrete logic, cannot mentally manipulate information, and are unable to take the point of view of other people, which he termed egocentrism. Other important concepts for this stage: centration, animism, and artificialism.

Oral Health Development

Poor oral health: • Trouble concentrating and learning• Poor testing results• Poor school

attendance

Oral Health Development

Early Childhood Caries (ECC)First Dental Visit

Thumbs, Fingers, and Pacifiers

Early Childhood Caries (ECC)

• Severe decay in the teeth of infants or young children

• Common bacterial infection, of epidemic prevalence

• Highest rates (70%) in minority and rural populations

• Infectious and vertically transmissible

Abscess

• Causes: Trauma (chipped or broken tooth) or tooth decay

• Complications if untreated:• Tooth loss• Blood infection (sepsis)• Spread of infection to

soft tissue, bone and other areas of the body

First Dental Visit

• By age 1– Dental Home: comprehensive, ongoing,

accessible, coordinated and family-centered

• 1 + 1 = ZERO– ONE dental visit when

there’s ONE tooth can equal ZERO cavities

Thumbs, Fingers & Pacifiers

• Non-nutritive sucking for pleasure, comfort and security

• Pacifier-vs-thumb: AAPD supports pacifiers • Stop the habit:

discourage after age 3 and decrease chance for orthodontic problems

Children Age 5 to 12

• Growth: – 4-7 lbs/year – ~ 3 inches/year

• Influential factors– Nature: mid-parental height– Nurture: nutrition, illness, medical conditions

• Problems• Picky eater• Problem feeder

Growth, Influential Factors & Problems

Gross Motor

5-6 6-8 9 10 11-12

Fine Motor

5-6 6-8 9 10 11-12

• Medical and/or environmental conditions – affecting their sleep (e.g. xerostomia)– with undesirable side affects (e.g antihistamines)– result in behavior problems (e.g. refusal)– create concerns about weight gain (e.g. poor growth)– contribute to complacency around oral health (e.g.

should be old enough to do it him/herself)

Cognitive Development

6-7 years: Pre-operational Thought7-11 years: Concrete Operations• Children gain a better understanding of mental

operations. They begin thinking logically about concrete events, but have difficulty understanding abstract or hypothetical concepts. Important concepts of this stage: conservation, reversibility, and associative thought.

11+ years: Formal Operations• People develop the ability to think about abstract

concepts. Skills such as deductive reasoning and systematic planning emerge during this stage.

Oral Health Development

Mouth guardsOrthodontics

Mouth Guards

• 50-80% of dental injuries involve front teeth of the upper jaw

• Most common injures: secondary to falls, traffic accidents, violence and sports

• Protect teeth and reduce the force of blows that can cause concussions, neck injuries and jaw fractures

• Three types: preformed, mouth-formed and custom-fabricated

Dental injuries are also prevalent in non-contact activities and exercises:

gymnastics and skating

Orthodontics

• Age 6-7: permanent teeth and orthodontic problems

• Orthodontic treatment uses appliances, tooth removal, or surgery

• Functional appliances use muscle action from speaking, eating, and swallowing

• Fixed orthodontic appliances are sets of wires and brackets cemented to the teeth

Wires, brackets and bands may become dental caries hubs with poor oral hygiene

Pre-adolescents/adolesents Age 13+

• Growth – Puberty

• Girls: 9-14 years• Boys: 10-15 years• Getting earlier

• Influential factors– Nature: family size– Nurture: self-image, self-serve, nutrition, illness

• Problems• Obesity• Eating disorders

Growth, Influential Factors & Problems

Gross & Fine Motor

13 14 15 16 17

• Medical and/or environmental conditions – impact receipt of health care (e.g. stop going to

healthcare provider)– result in dental trauma (e.g. don’t use mouth guards)– result in invincibility (e.g. won’t happen to me)– produce anxiety (e.g. learning about diseases)– contribute to complacency around oral health (e.g.

who cares?)

Cognitive Development

• 11+ years: Formal Operations• Consider Ethical Development here

Oral Health Development

Gingivitis/Periodontal DiseaseTobacco, Cannabis, etc.

Oral Piercing

Gingivitis• Mildest form of periodontal disease• Inflammation of the gingiva surrounding tooth• Immunosuppression and hormonal changes lead

to an altered response to bacterial plaque• If untreated, can lead to periodontitis

Contributions by Morgan Lauer,University of Colorado, School of Medicine, MS-IV

Periodontal Disease

• Chronic exposure to bacterial plaque = chronic inflammation

• Destruction of the periodontal ligament, loss of supportive bone and tooth loss

2x as likely to suffer from heart disease.May make it more difficult for diabetics to

control their blood sugar.

Tobacco

• 1 in 4 high school students report using some type of tobacco

• If current tobacco use patterns continue in the US:– 6.4 million persons now under 18 years will die

prematurely from a tobacco-related illness

Cannabis

• 3 main forms of cannabis: marijuana, hash, and hash oil

• Delta-9-tetrahydrocannbenol (THC) • Cannabis smoke is carcinogenic• Increased risk of xerostomia (dry mouth)• Complications with adrenaline-containing

local anesthetics

E-Cigarettes/Vaporizers

• ENDS have the look and feel of tobacco:– E-cigarettes and Vaping

• Cartridge filled with liquid nicotine: flavored and varying strengths

• Upon inhalation, heat vaporizes the liquid, bringing a mist to the user

• Medical Hx– ask about tobacco and marijuana use

E-Cigarettes/Vaporizers

• Marijuana can be sold and consumed in vaporizers

• Vape pens – Can be sold pre-loaded with highly concentrated marijuana

A major public health concern

Hookahs

• Waterpipe used to smoke tobacco and marijuana• Myths:– Harmless- tobacco smoke goes through water– Less addictive/nicotine in a water pipe is less

addictive than smoking cigarettes

Oral Piercing

• Intraoral piercing as a body art has been gaining popularity

• Complications:• Infection • Prolonged bleeding• Swelling and possible nerve damage • Blood borne disease transmission

Inflammation of the heart valves or tissues is a risk of oral piercing.

Oral piercing can provide opportunity for bacteria to enter the bloodstream and

travel to the heart.

Children With Special Needs

• Inability or difficulty to brush and floss• Poor diet• Difficulty clearing food from the mouth• Medications can lead to increased risk of

dental disease

• Tooth eruption: Delayed, accelerated, or inconsistent• Malocclusion: Poor fit between the upper and lower

teeth, and crowding of teeth• Developmental defects: Pits, lines, or discoloration• Tooth anomalies: Variations in the number, size,

and shape

Prevention & Intervention

• First Dental Visit by Age One• Cavity Free at Three• Community Water Fluoridation• Fluoride Varnish• Sealants

Questions?