child orh management -malaysia 0415

8/17/2019 Child ORH Management -Malaysia 0415

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Caries management in young childrenPrathip Phantumvanit

Thammasat University, Thailand

Former Vice-Chair, Public Health Committee, FDI


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Dental caries status in primary teeth Caries classifcation mana!ement matri"

Caries control a#ter frst tooth eruption $%mo&

Caries control at 'ell-baby clinic Caries control in child care center Caries mana!ement at all prevention levels

Overview

Child caries mana!ement ()*+alaysia (+.*%


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country Age (yrs)

prevalence(%)

Year

Japan 3 244 2!!"

#epal "$ "&" 2!!4

'alaysia " &2 2!!"

Thailand 3 (5) 51.7 (78.5) 2012

'ongolia 3$" & 2!!&

ietnam $ *22 2!!&

Cam+odia *3, 2!,,

-aos " *, 2!,!

.hilippine

s

*&, 2!!

Caries prevalence in primaryteeth

Child caries mana!ement ()*+alaysia /+.*%


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Country Year dm/t

0ingapore 2!!" 2!3

#epal 2!!4 2&

1orea 2!,2 2

0ri -ana 2!,, 3"'alaysia 2!!& 3&

Thailand (5 yr) 2012 4.4

ietnam 2!!& 3

-ao . 2!,! 3

.hilippines 2!! 4

Cam+odia 2!,, *!

ar es n pr mary ee ayr

Child caries mana!ement ()*+alaysia 0+.*%


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!!"

)12/

(120

.

*(

*3

a!e $months&

no1 o# teeth

'ean no o/ carious teeth +y age(month) in 0outhern part o/ 5hailand

Tithisommakul S et al. 2003Child caries mana!ement ()*+

alaysia ++.*%


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Prevalence o# 4CC rose sharply #rom(1)5 at . months to %31*5 at *3months1 $Thitasomakul et al., 2006)

In *+-*.month-old children, the

prevalence o# 4CC 6as 3(135 $0(1)5

noncavitated 7 0)135 cavitated lesions&$Vachirarojpisan et al. 2003)

.revalence o/ primary teethcaries

Child caries mana!ement ()*+alaysia %+.*%


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3"3.2

0.050.03

0.07

0.03

#

m

d

2001 2012

dm/t o/ 3 yr olds 5hai

Thailand National Oral Health Sure!,

/1% (12



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%caries

dm/t dt mt /t

8apan 0(1* *130 )13. ) !*"

alaysia 201+ /12 /1+ ) !2Thailand"#)

$%.# &.3$ 3.'% 0.(3 0.26

yanmar 3. 01/0 01*% ) !,

Vietnam 301. +10 +1)2 )1/* !!2

9ao PD: 331% 2,.+ 21.( )1)/ !

Cambodia ./1* .1) 31. )1* !

+.*%Child caries mana!ement ()*+

alaysia 3

ental Caries 0tatus in yr$old


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;orea urvey $()*(&

◦

+ years old, d#t 6as (12. but *13/ flled $%+1%5& 8apan $>urvey o# CH ()**&

◦ + years old, d#t 6as *130 6ith )1.+ flled $+*1%5& 4n!land =ral health >urvey $())3&

◦ + years old, dm#t 6as /10+ and Care Inde" *05$restoration carious teeth&

'alaysia #O600 (2!!&)

◦ years old7 d/t was 3& and !" 8lled (,3"%) Thailand National Oral Health Sure! "20(2)

◦ at # !ears old, dmt *as &.& and onl! 0.26 +lled "6.%) Vietnam $Hanoi, ())2&

◦ %-3 years old, dm#t 6as +12 and only )1** flled $*1.5&

9ntreated caries

Child caries mana!ement ()*+alaysia +.*% .


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9ess important due to e"pected e"#oliation o#primary teeth

>everity o# carious lesions due to non-earlydetection and care

Dental #ear in children due to sound and 6ater

#rom aeroter drillin! machine in?ection

Child mana!ement problem in !eneral dentists

9ntreated caries in children: ;hy<

Child caries mana!ement ()*+alaysia *)+.*%


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ental caries in primary teeth

o/ 3 yr olds 5hai children

5 4 3 2 1 1 2 3 4 5

0

5

10

15

20

25

30

35

40

LOWER UPPER

% children

Child caries mana!ement ()*+ alaysia **+.*%


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0evere =arly childhoodcaries (s=CC)

Defnition@◦ :ampant caries in

primary dentitionespecially in theupper anterior teeth,

as early as intoddlers andyoung children,

mostly in the under-privile!ed #amily1

Child caries mana!ement ()*+ alaysia *(+.*%


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Caries control a#ter frst tooth eruption $%mo&

Caries control at 'ell-baby clinic Caries control in child care center

Caries mana!ement at all prevention levels

Overview

Child caries mana!ement ()*+alaysia */+.*%


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Caries Classi8cation and'anagement 'atri> ? FDI 2012

Child caries mana!ement ()*+alaysia *0+.*%


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>core%

EXTENSIVE

CAVITY

>core+

DISTINCT

CAVITY

>core0

UNDERLYING

GREY

SHADOW

SURFACE

INTEGRITY

LOSS

>core/

OPACITY

without air-

drying:

WHITE,

BROWN

>cores(

SOUND

>core)

OPACITY

with air-

drying:

WHITE,

BROWN

>cores*

Detection system@ 4ach o#the 2 scores are illustrated6ith an e"ample

*'

*A

*'

('

(A

>ound-kstrand et al., "(''$) modi+ed ! /1S "nn ror), 2002 and aain in 200&

"4altimore)

Child caries mana!ement ()*+alaysia *++.*%


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@CA0 score ,$2 or @CC'0 score a(non$cavitated enamel) Bluoridated toothpaste

>core ( or a@ O.AC@5Y 6ithout air-

dryin!@ ;6@5=7 O;#

5itts N, 200$

>core * or a@ O.AC@5Y 6ith air-dryin!@ ;6@5=7 O;#



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@CA0 score 3 or

@CC'0 score + (cavitated enamel)Bluoride varnish or silver diamine Duoride

>core / or b@ 09BAC=@#5=E@5Y -O00



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@CA0 score 4 or@CC'0 score c (non$cavitated dentine)

sealant with E@C

5itts N, 200$

>core 0 or c@ 9#=-Y@#EE=Y 06AO;

Child caries mana!ement ()*+alaysia *.+.*%

@CA0 "F @CC'0 d


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@CA0 score "F or @CC'0 score d(/ran open cavity).artial caries removal and E@C

restoration

>core + @05@#C5CA@5Y

>core % =G5=#0@=CA@5Y

5itts, 200$

Child caries mana!ement ()*+alaysia ()+.*%


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Caries control a#ter frst tooth eruption $%mo& Caries control at 'ell-baby clinic Caries control in child care center


Overview

Child caries mana!ement ()*+alaysia (*+.*%


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Oral health start at 8rstprimary tooth eruption Home visit Tooth cleanin!routinely ri!ht a#ter

the frst primary tootheruption

Tooth-brushin! 6ithsmear amount o/Duoride toothpaste,t6ice daily a#ter %month old

Child caries mana!ement ()*+ alaysia ((+.*%

Cl t ddl th d


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Clean toddles mouth andteeth

Child caries mana!ement ()*+alaysia (/+.*%

ec ve uor e oo pas e


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Concentration: range ,!!! ? ,"!! ppm Duoride(minimum o/ !! ppm B +ioavaila+le)rushing BreHuency ? At least twice per dayAmount o/ B toothpaste:◦ mo ? 2 yr: thin smear7 hal/ a pea (!!" $ !, g)

◦2 ? yr: pea siIe or width o/ tooth+rush (!2" g)

◦ and older: /ull length o/ tooth+rush (, ? ," g)rushing 5ime ? 'inimum o/ two minutes.ost +rushing +ehaviors ? 0pit out the toothpasteand minimiIe rinsing +ehaviors with water5iming ? @deally a/ter meals in the morning and

immediately +e/ore +edBluoride toothpaste is sa/e to use irrespective o/ low7normal7 or high Duoride e>posure /rom othersources7 i/ used as recommended

ec ve uor e oo pas e9se(Zero DT, Marinho V ! "han#$%&ani# " 2012' D 24*16+21)

Child caries mana!ement ()*+alaysia (0+.*%


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confrm the benefts o# usin! Euoridetoothpaste in preventin! caries in children

and adolescents only si!nifcantly #or Euoride

concentrations o# *))) ppm and above caries preventive eects o# Euoride

toothpastes o# dierent concentrationsincrease 6ith hi!her Euorideconcentration

Cochrane ata+ase o/ 0ystematicreviews: (;alsh 5 et al 2!,!)

Child caries mana!ement ()*+alaysia (++.*%

i / l h d


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Thai children a!e .-*3 months, * year#ollo6-up study

>tudy !roup 6ith instruction to parentalhand-on tooth$+rushing with Bluoridetoothpaste sho6ed caries incrementdm#sdm#t as /1/*1/

Control !roup demonstrated cariesincrement dm#sdm#t as *31.210"Thanakanjanaphakdee ; Triratorakul 20(0, < 1ent ssoc Thai 609%3='3)

=ectiveness o/ parental hand$ontooth+rushing with Duoridetoothpaste

Child caries mana!ement ()*+alaysia (%+.*%


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Overview

Child caries mana!ement ()*+alaysia (2+.*%


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Appropriate oral healthcare

4arly oral healthe"amination, 6hite

spot lesion caries inprimary dentition

Fluoride varnish inhi!h risG !roup

Child caries mana!ement ()*+ alaysia (.+.*%


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4arly caries detection $care#ul& Continuin! tooth-brushin! 6ith Euoride

toothpaste under parents close supervision

Fluoride varnish as primary andor seondaryprevention in in#ant #rom . months old#ollo6ed at *(, *+, *3, (0 and /% durin!vaccination period $Thailand 'ell-Aaby

Clinic&

Caries control duringvaccination

Child caries mana!ement ()*+alaysia /)+.*%


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Deciduouseruptiontimes

Permanenteruptiontimes

9i#espan

Central incisor )1+ 2 %1+

9ateral incisor )12+ 3 21(+

Canine *1+ .*(a 21+*)1+a

First

molarpremolar

* *) .

>econdmolarpremolar

( ** .

=ruption times and li/espan o/deciduous teeth (in years)K

a Upperlo6er arch >idd, an meronen, an meronen8 200%

Child caries mana!ement ()*+alaysia /*+.*%


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Overview

Child caries mana!ement ()*+alaysia /(+.*%


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Bluoride toothpaste use inyoung children

Tooth-brushin! 6ithpea siIe or width o/

tooth$+rush amounto/ Duoridetoothpaste, *,)))ppmF, t6ice daily ater

ull primar! teetheruption "2 !r old)

Child caries mana!ement ()*+ alaysia //+.*%

= ti Bl id 5 th t


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Concentration: range ,!!! ? ,"!! ppm Duoride(minimum o/ !! ppm B +ioavaila+le)rushing BreHuency ? At least twice per dayAmount o/ B toothpaste:◦ mo ? 2 yr: thin smear7 hal/ a pea (!!" $ !, g)

◦

2 ? yr: pea siIe or width o/ tooth+rush (!2" g)◦ and older: /ull length o/ tooth+rush (, ? ," g)rushing 5ime ? 'inimum o/ two minutes.ost +rushing +ehaviors ? 0pit out the toothpaste andminimiIe rinsing +ehaviors with water5iming ? @deally a/ter meals in the morning and

immediately +e/ore +edBluoride toothpaste is sa/e to use irrespective o/ low7normal7 or high Duoride e>posure /rom other sources7 i/used as recommended

=ective Bluoride 5oothpaste9se(Zero DT, Marinho V ! "han#$%&ani# " 2012' D 24*16+

21)

Child caries mana!ement ()*+alaysia /0+.*%


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*1B#ter lunch

toothbrushin!6ith Euoridetoothpaste

(1 Provide nutritioussnacG

/1=ral health

e"amination

=ral health promotion activities

in Day Care Center

Child caries mana!ement ()*+alaysia /++.*%


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Jlass ionomer cements and resin-based e"hibitedsi!nifcant caries preventive eects "?enopal V etal 200')

:ecommendations a6ay #rom resin and to6ard !lassionomer #or sealant pro!rams "Niederman 7 20(0)

◦ !lass ionomer is moisture-#or!ivin!

◦ !lass ionomer contains and slo6ly releases Euoride

◦ !lass ionomer Eo6s more deeply into pits andfssures, providin! protection even as abrasion6ears a6ay the occlusal sur#aces

Elass ionomer sealants

Child caries mana!ement ()*+alaysia /2+.*%


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Child caries mana!ement ()*+alaysia +.*%


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'hen the disease is beyondprimary prevention, the secondary

prevention and tertiary preventionor care are reuired accordin!ly1

Ho6ever, the secondary prevention and

the tertiary prevention or care cannot berendered merelyK they must be per#ormedto!ether 6ith the primary prevention inorder to stop recurrent disease1

#=G5

Child caries mana!ement ()*+alaysia /.+.*%


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Fluoride and non-operative therapy#or initial enamel caries

>ealants 6ith Jlass Ionomer Cement#or non-cavitated caries lesioninvolvin! dentine

Conservative D48 caries removal andJIC restorations #or deep cariouscavities L>B:TM

Caries management /or primary teeth

Child caries mana!ement ()*+alaysia 0)+.*%


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B *-yr evaluation o# the success rate o# l /; // restorations o the primar! molarsrestored *ith hih+&i-o-i#y /I *as '& $Nilma N et al ())%&

B#ter * yr, the overall surial restorationso @/ *as '# or l / and %2 or l //restorations : i%lied, Modied T or

MT "5honhan!udh et al 20(2)

E@ in primary teethrestorations

Child caries mana!ement ()*+alaysia 0*+.*%


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Fluoride toothpaste, non-operative therapy, #or non$cavitated7 initial7 enamel caries

Fluoride varnish #or cavitated enamel caries

>ealants 6ith Jlass Ionomer Cement #or non$cavitateddentine caries

Conservative, $partial&, caries removal and JICMT restorations #or /ran open cavitateddentine caries

.ractical Caries management /or primary teeth

Child caries mana!ement ()*+alaysia 0(+.*%


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Overview

Child caries mana!ement ()*+alaysia 0/+.*%


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Primary prevention◦oral hy!iene instruction

◦dietary control

◦Euoride toothpaste

◦Euoride mouth-rinse>econdary prevention

◦early detection

◦Euoride varnish

◦!lass ionomer sealant

◦silver Euoride application

◦hi!h-Euoride toothpaste Tertiary prevention

◦minimum intervention dentistry $B:T&

◦>B:T preventive restoration $partial caries removal 7capsulated JIC&

Comprehensive caries management



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ynamic .rocess o/ ental Caries.laHue=namel @nter/ace

$Oero ()**&

3H7 7 Ca*)$P=0&%=H( %$HP=0&- - 7 *)Ca77 7 (H(=

demineraliationUndersaturatedconditions in oral Euids

F-

remineraliation>upersaturatedconditions in oralEuids

Child caries mana!ement ()*+alaysia +.*%


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Child caries mana!ement ()*+alaysia 0%+.*%


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.aradigms in Cariology

Old paradigm◦ In#ectious disease

$mono-in#ectiousconcept&

◦ Fluoride createLenamel resistanceM

◦ =perative treatment

◦

Drill and fll restoration◦ :emovin! bacteria in

cavity

#ew paradigm◦ Dynamic process

leadin! to mineralloss

◦

Fluoride inhibitsdemineraliation andenhancesremineraliation

◦

Preventive treatment◦ inimum intervention

◦ Pulp and reparativedentine



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>evere untreated caries is very common in manycountries

Children 6ith untreated 4CC have si!nifcantly

poorer oral health-related uality o# li#e Follo6in! treatment o# aected caries there is more

rapid 6ei!ht !ain and !ro6th velocity in the treatedchildren

Comprehensive care maGes si!nifcant dierence tothe psycholo!ical and social aspects o# the childsli#e

4ritish 1ental


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Deliverable treatment philosophy◦ leadin! children into adulthood 6ith cavity-#ree

permanent teeth

◦ responsibility and ability to care o# their mouth and

teeth 6ithout #ear o# dental treatment


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>pecialists in pediatric dentistry◦ limited number

Jeneral dental practitioners◦ busy schedule 6orG plan, child mana!ement

Public health dentists, dental therapists or

dental nurses◦ preventive restoration approach

◦ less invasive dental treatment

◦ chan!in! attitudes and priorities

Approaches to treating carious

primary teeth

Child caries mana!ement ()*+alaysia +)+.*%


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4arly caries detection #or prevention

=ral health pro!ram 7 preventiverestoration with partial caries

removal (0'A5) as an inte!ral part o#the e"istin! national health care delivery

system1 >ervice covera!e to rural areas - an

euitable distribution o# oral health services Ase o auBiliaries and other health personnel esides dentists.

"oliy and na#ional

rora%

+.*%Child caries mana!ement ()*+

alaysia +*


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=ral disease $dental caries& need to betreated or prevented as to control painand discom#ort and enhance the uality o#li#e1

I%ro&ed oral heal#h and

enhaned $ali#y o lie

Child caries mana!ement ()*+alaysia +(+.*%

O l h lth i


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=ral pain and !eneral health Jood mastication and body 6ei!ht

astication and brain !ro6th Tooth esthetics and personality Healthy mouth and body =ral health and uality o# li#e o# the child,

parents, #amily and community

Oral health in youngchildren

Child caries mana!ement ()*+alaysia +/+.*%


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hank You

prathipphanCmail.com

56A#1 YO9 BO YO9 1@#A55=#5@O#

child orh management -malaysia 0415

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