MODULE 15: ORAL HEALTH ACROSS THE LIFESPAN

Oral Health Across the Oral Health Across the LifespanLifespan

MODULE 15: ORAL HEALTH ACROSS THE LIFESPAN

Part 3: Oral Health in Part 3: Oral Health in ChildhoodChildhood

Erin Hartnett DNP, APRN-BC, CPNP

Learning ObjectivesLearning Objectives

• After completing this module, learners

Learning ObjectivesLearning Objectives

will be able to: • Identify the prevalence of dental caries in children

d d land adolescents• Identify the risk factors for dental caries in

children and adolescentschildren and adolescents• Identify prevention measures for caries in

children and adolescents • Discuss access problems for children and

adolescents

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Prevalence of Dental CariesPrevalence of Dental Caries• Early Childhood Caries

• is the most common chronic disease of children under 72

Prevalence of Dental CariesPrevalence of Dental Caries

months of age• 5x more common than asthma

• 50 million school hours per year lost b/c of oral health related illness (pain, infection)

• 50% of all children have never visited a dentist (Dye 2007)• One in four children living in poverty had untreated dental caries (Dye ,2012)

Child h t t ith th i i id 13 ti i th fi t 36 • Children have contact with their primary care providers 13 times in the first 36

months (Hagan, 2008)• Application of fluoride varnish can reduce caries by Application of fluoride varnish can reduce caries by

25-45% (C Marya, V Dahiya.2006)• Less than half of children between 2 and 17 were offered advice from a health

care provider about the need for routine dental care (Soni 2011)

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care provider about the need for routine dental care. (Soni, 2011)

Prevalence of Dental CariesPrevalence of Dental CariesPrevalence of Dental CariesPrevalence of Dental Caries

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Impact of Untreated Dental CariesImpact of Untreated Dental Caries• Spread of infection

Impact of Untreated Dental CariesImpact of Untreated Dental Caries

• Tooth- lip/gum-• Sinusitis/facial

cellulitis• Periorbital cellulitis/• Brain abscess-• Airway compromise

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Prevalence of Dental SealantsPrevalence of Dental SealantsPrevalence of Dental SealantsPrevalence of Dental Sealants

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Oral health: Percentage of children ages 5Oral health: Percentage of children ages 5––17 with untreated dental 17 with untreated dental caries (cavities) by age, poverty status, and race and Hispanic caries (cavities) by age, poverty status, and race and Hispanic

origin 1988origin 1988––1994 19991994 1999––2004 20052004 2005––2008 and 2008 and 20092009––20102010origin, 1988origin, 1988 1994, 19991994, 1999 2004, 20052004, 2005 2008, and 2008, and 20092009 20102010

Ages Ages 55--1717

Black, non-Hispanic

Mexican American

White, non-Hispanic

2009–2010

100–199% poverty

200% poverty and above 2005–2008

1999–2004

1988–1994

Total

Below 100% poverty

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0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

Oral health: Percentage of children ages 5Oral health: Percentage of children ages 5––17 with untreated dental 17 with untreated dental caries (cavities) by age, poverty status, and race and Hispanic caries (cavities) by age, poverty status, and race and Hispanic

origin, 1988origin, 1988––1994, 19991994, 1999––2004, 20052004, 2005––2008, and 2008, and 20092009––20102010g ,g , ,, ,, ,,

Ages 5Ages 5--1111

Black, non-Hispanic

Mexican American

200% d b

White, non-Hispanic

2009–2010

2005 2008

100–199% poverty

200% poverty and above 2005–2008

1999–2004

1988–1994

Total

Below 100% poverty

9

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

Oral health: Percentage of children ages 5Oral health: Percentage of children ages 5––17 with untreated dental 17 with untreated dental caries (cavities) by age, poverty status, and race and Hispanic caries (cavities) by age, poverty status, and race and Hispanic

origin, 1988origin, 1988––1994, 19991994, 1999––2004, 20052004, 2005––2008, and 20092008, and 2009––20102010g ,g , ,, ,, ,,

Ages 12Ages 12--1717

Black, non-Hispanic

Mexican American

200% poverty and above

White, non-Hispanic

2009–2010

2005–2008

100–199% poverty

200% poverty and above

1999–2004

1988–1994

Total

Below 100% poverty

10

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0

Risk Factors for CariesRisk Factors for Caries• Mothers with caries history

Risk Factors for CariesRisk Factors for Caries

• Vertical transmission

• Obvious caries, staining, plaque accumulation, d i li tidemineralization• Early signs

Sl i g ith b ttl• Sleeping with bottle• Diet, nutrition, snacking

Special Health care needs• Special Health care needs• medications

• Low socio economic status11

• Low socio-economic status

Dental Caries are Preventable!!!Dental Caries are Preventable!!!

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Prevention Measures for ChildrenPrevention Measures for Children• Start Early

Transmitted mainly from mother or primary

Prevention Measures for ChildrenPrevention Measures for Children

• Transmitted mainly from mother or primary caregiver to infant

• Educate new mothers• Nutrition

• BreastfeedingBreastfeeding• Bottlefeeding• No food sharing

• Oral hygiene• Tooth eruption• Teething

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• Teething

Not Just What You Eat, But How OftenNot Just What You Eat, But How Often

• Acids produced by bacteria after sugar intake persist for

Not Just What You Eat, But How OftenNot Just What You Eat, But How Often

persist for 20 to 40 minutes.

• Frequency of sugar ingestion is more important q y g g pthan quantity.

www aap orgwww.aap.org

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You Are What You EatYou Are What You Eat• Caries is promoted by

carbohydrates, hi h b k d t id

You Are What You EatYou Are What You Eat

which break down to acid.• Acid causes demineralization

of enamel.F ki • Frequent snacking promotes acid attack.

• Foods with complex carbohydrates carbohydrates (breads, cereals, pastas) are major sources of “hidden” sugars.

• High sugar content in sodas is a source of these substrates.

www.aap.org

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Stages of Early Childhood CariesStages of Early Childhood CariesStages of Early Childhood CariesStages of Early Childhood Caries

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Prevention Measures for Prevention Measures for HCildrenHCildren• Healthy Nutrition

Frequency

Prevention Measures for Prevention Measures for HCildrenHCildren

• Frequency• Snacks and drinks

• Fluoride exposurep• Water• Supplements

h• Varnish• Toothbrushing

• Fluoridated 2x/dFluoridated 2x/d• Parental assistance

until age 7D l h b 1

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• Dental home by 1 year

Prevention Measures for AdolescentsPrevention Measures for Adolescents• Oral health is more than

healthy teeth.

Prevention Measures for AdolescentsPrevention Measures for Adolescents

• The mouth is a “mirror” of general health and disease.

• Oral diseases are associated with other health problems.health problems.

• Prevention of common oral diseases.Lif t l b h i ff t • Lifestyle behaviors affect general health and oral health.

U S Department of Health and Human Services (2000) Oral Health in America: A Report of the Surgeon General Rockville

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U.S. Department of Health and Human Services. (2000). Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutesof Health.

High Risk Behaviors = Oral Health High Risk Behaviors = Oral Health P blP bl

• STDs• HPV

ProblemsProblems

HPV• Oral Cancer• GC

• Tobacco users • Tobacco users • Lung and oral cancer • Periodontal disease

• Alcohol users • Alcohol users • Liver disease • Oral cancer

Drug abusers• Drug abusers• Blood borne infections • Poor hygiene • Gross caries (e g meth mouth)

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• Gross caries (e.g., meth mouth)

Access Problems for Children and Access Problems for Children and Ad lAd lAdolescentsAdolescents

100.0

70.0

80.0

90.0

50.0

60.0

Ages 2–4

Ages 5–17

30.0

40.0Ages 12–17

0 0

10.0

20.0

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0.01997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Role of Primary Care ClinicianRole of Primary Care Clinician• Oral Health Promotion

Role of Primary Care ClinicianRole of Primary Care Clinician

• Monitoring and Management• Collaboration & Advocacy

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