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Oral Health for School Nurses

June 3, 2020

Beth Cameron – Oral Health Consultant Office of Dental

Health

With Special Thanks To

John N. Dane, DDS, FAAHD, DABSCD

Dental Director

Missouri Department of Health and Senior Services and

Missouri Department of Social Services

Objectives

Describe children’s dental health needs in Missouri

Understand the disease called tooth decay (dental caries) and how it can be prevented

Discuss oral health conditions in children and the appropriate response to each within the school setting

Present resources for school nurses

Understand fundamentals of the Preventive Services Program (PSP)

Dental health in Missouri 3rd graders

67% of students have dental decay (cavity) experience (55% US)

27% of students have untreated decay (cavities) (26.1% US)

6.4% had urgent treatment needs

11% of students had dental sealants

2014 Mo Burden Report – PSP data

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Managing Dental Caries (Cavities)

Caries is an infectious oral disease that can be arrested in its

early stages.

Primary prevention

Provided to avert the onset of caries – fluoride and Community Water

Fluoridation

Home Care

Diet Recommendations

Secondary prevention

To avert the progression of early caries to cavitation – sealants,

preventive restorations, Silver Diamine Fluoride (SDF)

Dental caries - most common chronic

disease among children

Consequences of poor oral health:

Overall health, ability to learn, eat, and speak

Children miss 51 million school-hours annually due to dental-related

issues.

Poor self-esteem

Higher Risk Children

Definition - children from low-income families (up to 200%

FPL) are at greater risk for dental caries experience and for

untreated caries than the rest of the population. They are:

less likely to have a dental visit in a year

less likely to have dental sealants

more likely to have untreated caries, greater risk in MO rural

areas.

Community Water Fluoridation helps this group the most

Sealants are most cost-effective when targeted to higher risk

Children’s teeth and an important piece of prevention

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Effects of CWF on Tooth Decay

• Tooth Decay in non - CWF counties

• 27% of students in these counties have untreated tooth

decay (8% higher than fluoridated counties).

• 11% of students in these counties have rampant tooth

decay (4% higher than fluoridated counties).

• Tooth Decay in Counties that have CWF

• 19% of students in these counties have untreated decay

• 7% of students have rampant decay

2016-17 PSP annual report subject to limitations of

sampling and data collection

Basic Oral Health Review- Bacterial

Plaque• Plaque is a sticky film of bacteria that continuously grows

in the mouth.

• An accumulation of plaque can be noticeable when

scraped off the teeth.

TEETH

DECAY

TIME PLAQUE IS ON TEETH

PLAQUE

Bacteria

What Do Cavities Need to Start?

SUGARS &

STARCHES

Repeated eating

or drinking of

sugary & starchy

foods or drinks

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An Acid Attack

• The bacteria in plaque combined with foods destroys

the tooth’s enamel, and after repeated attacks, can

create a hole, or “cavity”

What You May See:

Decay/ Dental Caries

What You May See:

White Spot lesions

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What You May See:

Abscessed tooth – External View

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What You May See:

Abscessed Tooth – Internal View

Eruption and Shedding Sequence

• This is important to note – most children do not lose their last primary tooth until around age 12. If a child has a cavity in a tooth they will need for several more years, it needs to be addressed - you should not “wait for it to fall out”.

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Other Oral Health Issues You May

Encounter: Red sore swollen gums

Cold sores

Toothache

Post Extraction Bleeding

Broken or Displaced tooth

Tooth Avulsion

Possible jaw fracture or dislocation

Orthodontic appliance problems

Objects lodged between teeth

Lacerated lip or tongue

Tooth eruption pain

Dental First Aid Kit

Hanks balanced salt solution (such as a

Save-A-Tooth Kit) cold milk will work as a

substitute

Salt

3% Hydrogen peroxide solution

Benzocaine 20% for tooth pain

Benzocaine 20% for cold sores

Docosanol 10% for cold sores

Basic Supplies:

Cotton swabs, dental floss, tongue depressor,

ice pack, soft wax, 2x2 gauze squares,

stimudents or tooth picks, tea bags,

toothbrushes, and tweezers

Inflamed Red Gums

• Common in adolescence

• Also a sign of poor oral health

• Rinse with warm saltwater if painful

• Plaque needs to be removed

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Quick Oral Health Tips -

* Tilt the brush at a 45° angle against the gum line – this is very helpful for inflamed gums, even in adults!

* Brushing only 2-3 teeth at a time, gently brush the outside, inside and chewing surfaces of all the teeth.

* Use short back-and-forth

or small circular strokes

* Floss between teeth that

touch

Displaced Tooth

• Don’t try to push it back into correct position

• Contact parent to take child to dentist ASAP

Avulsed Tooth

• DO NOT clean the tooth – could destroy

connective fibers

• Try to pick up by the crown

• Keep tooth in appropriate solution

• Many times a dentist can successfully reimplant a

tooth if child is treated immediately

• Obviously does not apply to loose baby teeth

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Orthodontic Appliances

• Use wax to cover protruding wires

Toothache

• Use tooth eruption chart to help determine if ache is from

normal tooth loss/eruption. This pain is usually more

intermittent and less painful than a decayed tooth.

• Use dental floss to remove any lodged food

• Check for abscess

Referring for Care

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Preventive Services Program

• Free of cost to any Missouri child - infant through age 18,

no qualification necessary

• Community-based, volunteer program with four

components:

• Oral Screening

• Oral Health Education

• Prevention (fluoride varnish)

• Referral

• 2018-2019 School Year:

• 91,384 students in 750 schools and organizations

What Is A Screening?

• Not a thorough clinical exam, no x-rays are taken

• Does not involve making a clinical diagnosis that results in a treatment plan

• Does identify obvious oral lesions

• Is conducted by volunteer licensed dentists and dental hygienists

• Conducted ONCE a year

Oral Health Education Resources

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Why Use Fluoride Varnish?

• Fluoride Varnish has been proven effective in preventing tooth decay in both primary and permanent teeth.

• Fluoride varnish can reverse early decay and can arrest active decay lesions.

• Fluoride varnish promotes the remineralization of tooth enamel making it resistant to tooth decay.

• Fluoride varnish is readily adaptable requiring no special equipment and can be applied in a variety of settings (school classroom, library or gymnasium).

• Fluoride varnish sets on contact with moisture (saliva), reducing the risk of ingestion & therefore recommended for all ages.

• Fluoride varnish is a cost effective preventive measure against tooth decay.

Who Can Apply Varnish?

• Anyone over 18

• We ask that they take a short training video and

agree to be confidential - this is found on our

PSP website

What Supplies are Provided by DHSS?

These are ordered through a DHSS Oral Health Consultant

Supplies from DHSS include:• Screening Forms

• Disposable Mouth Mirrors

• Fluoride Varnish

• Toothbrushes and Toothpaste

• Dental Floss

• Educational Materials

• Other Promotional Items

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What Supplies Does the Event Coordinator Need to Obtain?

• Masks

• Gloves

• Light Source

• Eye Wear

• Tooth picks

• Gauze

• Hand Sanitizer

• You will be asked to provide masks, gloves and hand sanitizer for your community volunteers, though you may ask your dental screeners to bring their own masks and gloves. Be sure to advise your screeners to bring a lighting source such as a small flashlight.

Our Website – Find Your Consultant:

Locate Your Oral Health Consultant

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Nurses Pamphlet:

Nurses Pamphlet:

Resources

“School-based or school-linked mobile or portable dental

Services”, Association of State and Territorial Dental

Directors (ASTDD.org)

“Fluoride varnish issue brief”, Association of State and

Territorial Dental Directors (ASTDD.org)

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Resources Evidence-based Clinical Recommendation: Professionally Applied

Topical Fluoride. Report of the Council on Scientific Affairs. American Dental Association. May, 2006

Synopses of State and Territorial Dental Public Health Programs Programs. Center for Disease Control and Prevention. Feb. 6 2004. Available at: apps.nccd.cdc.gov/synposes/aboutv/asp. Accessed on : 03/12/07.

Fluoride Varnish Protocol. Iowa Department of Public Health. 4/2002. Available at: http://www.idphstate.ia.us/hpcdp/commomn/pdf/oral_health/fluoride_protocol.pdf. Accessed on: 03/07/07.

Gold-Autio,Jaana,Courts, Frank (2001). Assessing the effect of fluoride varnish on early enamel carious lesions in the primary dentition. J Am Dent Assn.132(9):1247-53.

Seppa,Lisa (2004). Fluoride varnishes in caries prevention. Medical Principles & Practice.13(6):307-11.

Vivaldi-Rodrigues, G. et al (2006). The effectiveness of a fluoride varnish in preventing the development of white spot lesions. World J of Ortho. 7(2):138-44.

Resources U.S. Department of Health and Human Services. 2000. Oral Health in America:

A Report of the Surgeon General. Rockville, MD: National Institute of Dental and Craniofacial Research. Available from: www.nidcr.nih.gov/AboutNIDCR/SurgeonGeneral/default.htm

U.S. Department of Health and Human Services. National Call to Action to Promote Oral Health. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Dental and Craniofacial Research. NIH Publication No. 03-5303, Spring 2003.

Wientraub,J.A. et al (2006). Fluoride varnish efficacy in preventing early childhood caries. J Dent Res. 85(2):172-176.

Wilkins, Esther Clinical Practice of the Dental Hygienist. Philadelphia: Lea & Febiger. 1976.

Photos: Microsoft product box shots reprinted with permission from Microsoft Corporation. All photos obtained from office.microsoft.com/clipart unless otherwise noted.

Oral Bacteria May Predict Pregnancy Outcomes. March 2005. Chicago. Available at: http://www.perio.org/. Accessed on: 05/15/06.

Kerpen, J, Fleischer, A. An Obstetrician and Periodontist Translate Periodontal-Systemic Research to Preserve the Health of Pregnant Women at Risk for Adverse Pregnancy Outcomes. Grand Rounds. November 2006; 1: 28-38

Contact Information

Beth Cameron, RDH

Oral Health Consultant

Office of Dental Health

Missouri Department of Health and Senior Services

912 Wildwood Dr.

Jefferson City, MO 65109

573-529-3889

Beth.Cameron@health.mo.gov