“My Pediatrician Didn’t Tell Me That. What Do You Mean?”

“My Pediatrician Didn’t Tell Me That.
What Do You Mean?”
Amanda B. Elzey, RDH,BS
Tiffany H. Yater, RDH
Pediatric Dental Hygienist
Prevention Is Better Than Treatment
 Pediatricians are not trained in identifying or
diagnosing oral diseases
 Visit a dentist 6 months after the first tooth eruption
or by age 12 months (whichever comes first)
 Children who are seen earlier and routinely have
fewer dental needs
 Dental cost over their lifetime is significantly less
than children who are not seen regularly or until the
age of four
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“My Dentist Said My Child Has
Dental Caries????”
 “Caries”-destructive lesion of the tooth structure
causing a hole in the surface therefore creating a
“cavity”
 Totally predictable
 Disease of choices and habits
 Silent epidemic
 Infectious disease
 pH disease
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2007 CDC Report On Oral Health
 Preschoolers showed an increase in cavities
 (Juice, Infectious disease from feeding/parents)
 Elementary and middle school cavity rate
stabilized
 High school showed an increase in caries rate
 (Sodas, sport/energy drinks, orthodontics)
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Saliva: Liquid Gold
 Any food that can be broken down in the mouth
may cause cavities
 Saliva’s role is to wash away the food and to
neutralize the acid caused by frequent snacking
 Sugar is not the primary cause of cavities, once
broken down the sugar is a harmful acid
 Acid dissolves calcium and phosphate minerals in
enamel
 pH of saliva is 7.4
 A tooth breaks down at a pH of 5.8
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pH of Familiar Foods
 Drinks
 Coffee 2.4-3.3
 Tea 4.2
 Soda 2.7-3.5
 Sports Drink 2.3-4.4
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 Fruits and Vegetables
 Tomatoes 3.7-4.7
 Apples 3.5-3.9
 Strawberries 3.0-4.2
 Oranges 3.2
 Lemons 2.8
DEVELOPMENT OF DENTAL CARIES
CARIOGENIC FOODSTUFF
Fermentable carbohydrate taken
into plaque
DEMINERALIZATION
Caries process
initiated
White spotincipient lesion
PLAQUE BACTERIA
DENTAL CARIES
Rapid action pH of plaque drops
ACID FORMATION
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Forms
immediately
Frequent
exposures
Children in pain do not eat well,
sleep well, learn well, or behave
well
Factors In Prevention
 Diet
 Patient’s Oral Hygiene
 Parent’s Oral Care
 Fluoride
 Xylitol
 Sealants
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Diet
 Limit high sugar intake between meals
 Sugar-free medicines is recommended if
possible
 Give dietary supplements containing sugar
at mealtimes when possible (unless
clinically directed otherwise)
 Supplemental feedings of high calorie
increase chance of dental caries
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Most Harmful Drinks
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pH Values for Sour Candy
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“My Child Still Drinks From A Bottle.”
 From six months of age infants
should be introduced to drinking from
a cup, and from age one year feeding
from a bottle should be discouraged
 Never put a child to bed with the
bottle or sippy cup
 Prolonged bottle feeding should be
diagnosed and treated; It is either a
parenting, feeding, or behavior issue
 Prolonged bottle feeding leads to
more dental caries
 Failure to thrive and feeding issues
should involve the dental team
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“My Child Won’t Let Me Brush.”
 Start as soon as the first baby tooth erupts
 Should occur twice daily – clean teeth last thing at
night before bed and at least one other time each
day
 Children need to be helped or supervised by an adult
when brushing until at least 10 years of age because
of lack fine motor skills and consistency
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“Why Is Brushing and
Flossing Important?”
 Brushing and flossing prevents plaque sticking to the
teeth allowing bacteria to convert sugars in to the acid
which attacks the enamel
 Plaque irritates the gums making them red and swollen
which in turns causes bleeding which can allow
bacteria into the bloodstream
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“Why Is It Important For Me To
Have Good Oral Hygiene, Also?”
 Dental caries is an infectious disease
 Bacteria is transferred from caregiver to child
 Things such as active decay, poor oral hygiene, or
poor diet can affect the developing baby teeth in the
fetus
 Pre-eclampsia, gestational diabetes, or stress can
also have affects
 Important for parents to maintain a good diet and
excellent oral health
 Do not share cups, toothbrushes, or pacifiers
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“What Type of Toothbrush
Should I Use?”
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 Use a toothbrush with small head and
soft bristles
 Electric toothbrush with
oscillating/rotating head is great
 Change toothbrushes every 3 months
bristles wear out and do not clean as well
 Clean all 3 surfaces with toothbrush
back, front, and chewing surface
 Clean in between the teeth with floss
remember to clean on both sides of the
triangular tissue
 May benefit from special aids
“Can I Use?”
 Baking Soda
 Peroxide
 Finger Sponges
 Water-picks
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“Should I Use Toothpaste?”
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 The AAPD recommends
starting to use toothpaste at
age 2 for healthy children
 The age is based on when
they can spit
 Children who are high risk
vary from this guideline
 If child cannot spit, wipe out
excess with washcloth
 Prescription Fluoride
toothpastes are also a good
option for children who have
a history of dental caries
 Fluoride level and particle
size is regulated: LOOK
FOR THE ADA SEAL OF
APPROVAL
“What Is That You Are Painting on
Their Teeth?”
 Wait to eat or drink 20

minutes after application
 Teeth should not be brushed
until at least 12 hours after
application
A number of systematic reviews
conclude that twice-yearly
applications produce a mean caries
increment reduction of 33% in the
primary dentition and 46% in the
permanent
 The evidence also supports the view
that varnish application can arrest
existing lesions on the smooth
surfaces of primary teeth and roots
of permanent teeth
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TOPICAL FLUORIDE:
Most Important Source of Prevention
 Inhibits the metabolism of the decay producing
bacteria in plaque and stabilizes minerals in the
teeth, thus preventing or slowing down the caries
process
Fluoride
Toothpaste
Drink and eat foods
containing fluoride
Sources of
Fluoride
Fluoride
supplements
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Professionaly
applied
“Why Is It Recommended For Gum
To Contain Xylitol?”
 A low-calorie sugar substitute that reduces the
incidence of dental caries
 Decreases the transmission of “bad” bacteria
(S.mutans) from mothers or caregivers
 When used in place of other sugars, stops caries
progression by 70%
 Mostly sold as gum, mints, or candies
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“What Are Sealants?”
 Plastic coatings of the biting surface of molars and
premolars that block the deep fissures where decay
often starts by making the teeth easier to clean
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“Why Is This Important For My
Child?”
 An infection caused by bacteria can enter the
bloodstream and settle in the heart
 With cavities and inflamed gums the number
of bacteria increases
 Patient with CHD is more at risk of getting
endocarditis if they have tooth decay or gum
inflammation
 Preventing infection starts with good hygiene
which includes keeping a clean healthy mouth
as well as taking precautions such as taking
antibiotics prior to dental treatment if indicated
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Blood In Heart Is Like
Water In River
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“Does My Child Need Premedication?”
 Until 2008, antibiotic coverage was
recommended for nearly all heart defects,
whether or not it had been repaired
 The recommendation has been changed so
that antibiotics will only be offered for those
who are considered at higher risk of getting
endocarditis
 It is recommended to consult with the
cardiologist
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“What Are The Current Guidelines?”
 Single dose taken orally, one hour before
dental procedure
 Amoxicillin is preferred; If allergic, use
Clindamycin or Azithromycin
 For children smaller than 66 lbs, the dose
will vary according to your child’s weight
 High Risk patients only
 Dental procedures that involve an incision
or manipulation of the gums around a tooth
which included cleaning the teeth
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“When Are Antibiotics NOT Needed?”
 Examination
 Dental x-rays
 Placement of removable appliances or orthodontic
appliances
 Adjustment of orthodontic appliances
 Loss of baby teeth
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We have confidence, knowledge, skills, and the
understanding to serve your child’s dental needs
Children’s Healthcare of Atlanta
Pediatric Dentistry
5455 Meridian Mark Road
Suite 200
Atlanta, GA 30342
Phone: 404-785-2072
Fax: 404-785-5892
Jason Bongiovi, DMD ♥ JC Shirley, MS, DMD ♥ Jack Thomas, DDS
Amanda Elzey, RDH, BS ♥ Anna Sidel, RDH ♥ Tiffany Yater, RDH
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