Oral Health for Infants Lecture 4 PDF

Health Promotion for Infants PROF. GLUSHCHENKO  Introduction This Photo by Unknown Author is licensed under CC BY-NC-ND The dental professional possesses the knowledge and technology to assist parents in raising children free of dental disease....

Health Promotion for Infants PROF. GLUSHCHENKO  Introduction This Photo by Unknown Author is licensed under CC BY-NC-ND The dental professional possesses the knowledge and technology to assist parents in raising children free of dental disease. The first dental risk assessment should occur as early as 6 months of age, and the establishment of a dental home should occur by approximately 1 year of age. The role of the pediatrician in oral health: ◦ Pediatricians recommend that the infant be evaluated five times during the first year and three times during the second year of life ◦ Dental provider should assume responsibility  Population Characteristics: Pregnant Women Women are particularly susceptible to periodontal disease, because female hormones affect the periodontal structures. ◦ Gingival enlargement, increased erythema, tissue sensitivity, and spontaneous bleeding. Toothbrushing can also be problematic if the mother is experiencing morning sickness. The placement or movement of the toothbrush in the posterior of the oral cavity may trigger an overactive gag reflex that is common in morning sickness. A relationship has been drawn between the incidence of periodontitis and low birthweight (L B W), preterm babies. This Photo by Unknown Author is licensed under CC BY Population Characteristics: Infants Other medical concerns for LBW babies include cerebral palsy, blindness, respiratory conditions, cardiovascular malformations, and other developmental disabilities. Both preterm babies (P T B) and L B W infants account for a large proportion of maternal and neonatal mortality and morbidity. Excessive stress to the fetus at any critical time in development can result in a temporary, but often irreparable, arrest in cellular growth, resulting in problems. Common Oral Manifestations: Pregnant Women Pregnant black women were more likely than pregnant white women to have periodontal disease. Periodontal health has an impact on the overall health of the child and warrants the earliest intervention. Source: Common Oral Manifestations: Infants Caries has been observed in children as young as 12 months of age. Early childhood caries (E E C s) is also referred to as “nursing caries”, nursing bottle caries, nursing bottle mouth, baby-syndrome, baby-bottle tooth decay, and bottle-mouth caries.  ◦ Proper chewing and eating ◦ Provide space for the permanent teeth and guide Importance of them into correct position ◦ Permit normal development of the jaw and bones Baby Teeth and muscles ◦ Helps build self esteem Early Childhood Caries Rampant decay initially involving the maxillary primary incisors and progressing to the first primary molars. (Source: Courtesy of Sharon Peterson.) Common Oral Manifestations: Early Childhood Caries Rampant dental caries that initially involves the maxillary primary incisors and progresses This Photo by Unknown Author is licensed under CC BY-SA to the first primary molars in later stages Decay occurs with prolonged exposure of the primary teeth to milk, infant formula, fruit juices, soft drinks, or other sugar/carbohydrate-containing fluids placed in the nursing bottle or sipping “sippy” cup. This Photo by Unknown Author is licensed under CC BY-  The cause of E C C is due to frequent bottle feeding at night, breast-feeding on demand, and excessive use of a no-spill training cup. E C C can have effects on the child's face growth. Common Oral Dental caries is an infectious disease process Manifestations: that is initiated via the transmission of Streptococcus mutans from their parents to their Early Childhood infants. Caries Lower self esteem Poor Nutrition Pain/Suffering Malocclusion  Common Oral Manifestations: S. Mutans Role in Caries S. mutans colonize the oral cavity before primary teeth erupt. Sucrose facilitates the adherence of S. mutans to the tooth surface The source of infection of the infant with S. mutans is from within the family, mostly the mother. Initial acquisition of infant caries takes place during the “window of infectivity.” This Photo by Unknown Author is licensed under CC BY Common Oral Manifestations: S. Mutans Role in Caries Transmission of S. mutans to the infant most likely occurs between 6 and 30 months of age, with the highest risk being between 18 and 30 months of age. Xylitol suppresses proliferation of S. mutans in mother and child. Common Oral Manifestations: Appearance of Caries Caries begins with the appearance of white areas of demineralization around the gingival third of the teeth. Eventually, the carious lesions will encircle the cervical area and can result in the entire crown being lost. If a bottle is to be used as a pacifier, it should be filled with water only. Preventive Strategies Cross-profession training in the oral disease process and prevention strategies ensures a diverse workforce who can better serve those at risk. Preventive Strategies: Pregnant Women It is important to provide oral health counseling throughout pregnancy. Proper nutrition during pregnancy is essential. Preventive Strategies: Treatment for Pregnant Women Dental diseases left untreated during pregnancy can lead to problems for both the mother and the fetus. The collaboration of medical and dental providers can ensure that both the mother and the child are given the greatest opportunity for optimal oral health. Preventive Emphasis is placed on this for three reasons: ◦ To reduce the possible onset or progression of Strategies: caries and periodontal disease ◦ Provide a greater possibility of better care for Maternal Oral the expected child Health ◦ To reduce the number of cariogenic organisms in the mother's mouth  It is more logical to intervene before the onset Preventive of a disease whenever possible, rather than to wait and see the effects of the disease. Strategies: Physicians are not adequately trained to Infants provide a thorough dental evaluation or proper preventive dental health counseling. Table 23–1 Infant and Toddler Oral Health Anticipatory Guidance Age Appropriate Guidance Prenatal Importance of good oral health for mother‐to‐be Signs of disease Disease prevention 1 month Function of baby teeth Importance of baby teeth Process of decay 3 months Appropriate bottle use Appropriate breast feeding Comforting tips 6 months Characteristics of early childhood caries Causes of early childhood caries Effects of early childhood caries Prevention of early childhood caries Age Appropriate Guidance Table 23–1 Infant and 9 Importance of cleaning baby teeth Toddler Oral Health month Method of cleaning baby teeth Anticipatory Guidance s Teaching of “lift the lip” (Source: Nevada State Health Division Office of Oral 12 The change from breast or bottle Health, Early Childhood month to cup Caries Anticipatory Guidance. February 2005. s Importance of regular dental care Used with permission.) Resources for dental care 18 Healthy eating month s 24 Implementation of healthy month behaviors s Screening for early childhood caries Early Dental Care According to parents, the reasons they seek early dental evaluations are: ◦ Information on preventing tooth decay for child ◦ Avoid unpleasant experiences that the parents had suffered ◦ Learn their role in the child's oral health ◦ It was recommended by their pediatrician or family physician Traditionally, it is recommended that a child should visit the dental office no later than two and a half years of age. Ideally the first dental visit should occur at 6 months and no later than 1 year of age. Allow child to become familiar with the dental office before treatment is needed Early Dental Care: Advantages of Infant Oral Health Identify and modify detrimental feeding habits to reduce caries. Aid in assisting parents to establish dietary and snack patterns to reduce caries. Explain and demonstrate tooth-cleaning procedures. Early Dental Care: Advantages of Infant Oral Health Determine fluoride status or recommend a fluoride program. Introduce dentistry in a pleasant, nonthreatening manner. Prepare parents for upcoming dental events. A Protocol for Early Preventive Intervention Interview ◦ This session should be thorough and specific, yet concise due to limited attention span. The interview should begin with a discussion of the parent’s reason for seeking care and should discuss: ◦ Growth and development ◦ Feeding history ◦ Medical history ◦ Preventive assessment ◦ Fluoride supplementation ◦ Oral hygiene  A Protocol These questions should be asked within the first for Early 30 months of the child's life: ◦ Do you have any problems with your teeth? Preventive ◦ Does your family have any inherited Intervention: problems/diseases affecting the teeth? ◦ Do you know the fluoride status of your Interview drinking water? ◦ Are you brushing and flossing regularly? Questions to ◦ As your child grows up, do you think you can help your child prevent tooth decay? Ask Pregnant ◦ What kinds of things do you want to do to protect your child's teeth? Women  An adult must assume total responsibility for infant's tooth cleaning. Children are unable to Counseling: Tooth- perform adequate plaque removal until they are 6–8 years of age. Cleaning Recommendations Tooth cleaning should be done in a comfortable, pleasant environment. A dentifrice is not necessary for infants.  If dentifrice is used, only use a pea-sized amount to avoid ingestion of excess fluoride. Counseling: Tooth- Cleaning Tooth cleaning should be done with small, soft- bristled toothbrush. Recommendations Tooth cleaning should be accomplished at least once daily. Counseling: Information to Be Shared with Parents Infants should be weaned from the bottle around 12 months of age. Bottle should not be given as a pacifier nor given during bedtime or naptime. Only formula or milk should be offered in the bottle. Frequent, prolonged episodes of breast- feeding could be a caries risk. Counseling: Information to Be Shared with Parents Sleeping with the child and allowing nursing through the night should be avoided. Infants and young children generally will eat more frequently than three times a day. Between-meal snacks should consist of foods that have a low cariogenic potential. Total amount of cariogenic foods is not the issue, rather the frequency of ingestion and retentiveness of the food are the factors that contribute to the caries risk. Counseling: Information to Be Shared with Parents Habits ◦ Bottle Feeding ◦ Children should be weaned from the bottle at 12-14 months of age. ◦ Thumb sucking ◦ Normal for infants; most stop by age 2 ◦ Discourage it after age 4 ◦ Prolonged thumb sucking can create crowded crooked teeth, or bite problems. Source: www.kidschatter.com.au Counseling: Information to Be Shared with Parents Fluoride ◦ Water (Community and Bottled) ◦ Toothpastes ◦ Rinses ◦ Varnish ◦ Tablets/Drops Counseling: Information to Be Shared with Parents Homecare Routine for Infants ◦ Clean gums before teeth erupt ◦ Finger tender, gauze, clean washcloth, infant toothbrush ◦ Child’s head in lap of the person cleaning the child’s teeth ◦ Wipe ridges of jaws, and wipe teeth Source: Brilliantoralcare.com Counseling: Information to Be Shared with Parents Homecare routine for toddlers ◦ Supervised brushing twice daily ◦ Start adding fluoridated toothpaste between ages 2 and 3 ◦ Use soft nylon/appropriate sized toothbrush ◦ Musical, different colors, flashing lights, electric, battery, characters ◦ Scrub technique (based on child’s dexterity) ◦ Flossing not necessary if there are interdental spaces ◦ Tight contacts should be flossed Conducting the Examination After the interview is the examination of the infant or toddler. The examination should consist of an oral cancer screening. After the screening of the tissues, a dental cleaning is accomplished with a soft-bristled, moist child-sized toothbrush. Rarely will a rubber cup and polishing paste be required for stain removal. Conducting the Examination: Tooth Cleaning Tooth cleaning should not be an unpleasant struggle for those infants and toddlers who initially resist the procedure. Less attention can be placed on performing thorough plaque removal, while maintaining a consistent effort to establish a routine with the child. Concluding the Appointment These areas should be addressed: ◦ Provide parent with a summary of the findings. ◦ Make recommendations based on clinical findings. ◦ Answer any remaining questions. ◦ Reinforce parent's roles and responsibilities. ◦ Establish optimal fluoride program. ◦ Distribute educational pamphlets. ◦ Provide anticipatory guidance information. ◦ Establish appropriate recall schedule. Source: Smartpractice.com Knee-to-Knee Correct positioning ◦ Head of infant in lap of dentist ◦ Parent holding legs & arms down ◦ Oral cleaning with gauze and/or finger tender Source: abcd-dental.org Providing Anticipatory Guidance A process for preparing the parents for upcoming developmental changes and concerns that may arise before the next scheduled dental visit Establishing a Recall Schedule Should be scheduled for 3, 6, or 12 months depending on child's potential risk for developing disease, which is based on clinical findings, stage of dental development, and feeding or diet patterns Summary The potential exists today for dental health professionals to assist parents in raising caries- free children. The request of this service is growing. Dental hygienists must take advantage of their knowledge and technology. By doing so, dental providers can provide a pleasant and logical introduction to dentistry and promote the profession in a most positive way. Reference Video: https://www.youtube.com/watch?v=D0O9zO3NW70