CHARLIE LARSEN, D.M.D., M.S. ASSISTANT

CLINICAL PROFESSOR (Pediatric Dentistry) NEW YORK UNIVERSITY COLLEGE OF DENTISTRY

DIPLOMATE, 

AMERICAN BOARD OF PEDIATRIC DENTISTRY

ATTENDING PEDIATRIC DENTIST BELLEVUE HOSPITAL CENTER

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PEDIATRIC ORAL HEALTH Everything You Need to Know About Oral Health for Pregnant Women, Infants, Toddlers and Young Children

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Not filling teeth…should be the dentist’s work. Let him consider himself successful who can show a clientele where his patients boast that never from babyhood to the grave have they ever had a stain or hole in any tooth. That is true dentistry, not this tiresome, painful plugging of holes It is an ideal possible for the majority of holes. people… M. Evangeline Jordan, DDS – chapter 3 “Operative Dentistry for Children”, Oral Prophylaxis, Prophylaxis,

1925

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Concept #1 when working with children:

EXPECT THE UNEXPECTED

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Concept #2 when

working with children:

Consider the Following:

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Concept #3 when working with children:

THINK BEFORE YOU ACTACTKNOW YOUR LIMITATIONS

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THEMES 

“You’re not healthy without good oral health” C. Everett Koop

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“The mouth is a mirror of good health”

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“F r prim “For primary r pr prevention, ti you m mustt b begin i att th the beginning”

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Health Promotion 

Encouraging patient behaviors most likely to optimize health through information information,, preventive efforts and access to care

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ANTICIPATORY GUIDANCE – What is it?

It is the process of providing practical, developmentally appropriate health information about children to their parents in anticipation of significant physical, emotional and psychological milestones. milestones -Nowak and Casamassimo 1995

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WHY IS THIS SO IMPORTANT? Guides parents by alerting them to impending change  Teaches them their role in maximizing their children’s developmental potential  Identifies their children’s special needs 

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Video Clip – Exam / OHI

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Video Clip – Fl Varnish

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Video Clip – OHI

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ORAL MANIFESTATIONS OF S ST SYSTEMIC IC DIS DISEASE AS

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Measles - Koplik Spots

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Scarlet Fever – Strawberry Tongue

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Viral Infection – Primary Herpes

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Viral Infection – Secondary Herpes

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Chicken pox – Varicella

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Thrush - Candidiasis

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Diabetic Gingivitis

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Leukemia – Gingival Swelling

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Hypophosphatasia Premature loss of anterior primary teeth from lack of cellular cementum development in a 22--year year--old male

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Hyperparathyroidism Brown tumor of hyperparathyroidism presenting as an ulcerated palatal mass

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Crohn's Disease chronic granulomatous inflammatory disorder that primarily affects the small and large intestine

Hyperplastic fold in vestibule

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INFANT AND TODDLER SOFT TISSUE LESIONS

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Epstein’s Pearls

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Bohn’s Nodules

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Dental Lamina Cyst

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Tongue -Tie / Ankyloglossia

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“Canker Sore” – Aphthous Ulcer

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Odontogenic Infection - Parulis

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Mucocoele

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Geographic Tongue

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Eruption Cyst / Hematoma

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Traumatic Ulcer – Riga Riga--Fede Syndrome

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Traumatic Injury

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ANTICIPATORY GUIDANCE Prenatal Care, Pregnancy and Oral Health

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Oral Health Issues for Pregnant Women

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Dental treatment should not be delayed; it is perfectly safe anytime. Best in 2nd trimester

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Periodontitis may contribute to preterm and low birth weight babies

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Late term fevers from a virus or infection may affect the quality and quantity of tooth structure that is forming in the fetus

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Oral Health Issues for Pregnant Women (continued) 

Morning sickness and vomiting may result in the decalcification of mother’s teeth.

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Tetracycline, Tet acyc e, which w c causes ca ses intrinsic t s c staining sta g in teeth, teet , should not be prescribed

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Hormonal changes predispose towards severe pregnancy gingivitis i i iti and, d in i rare instances, i t a pyogenic i granuloma (pregnancy tumor)

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Pregnancy Gingivitis

Pyogenic Granuloma

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ORAL HEALTH ISSUES AND CONCERNS DURING PREGNANCY 

Good oral health in the mother reduces the likelihood of dental decay in the children (Prevention of early childhood caries [ECC])

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High Mutans Streptococci (MS) count in the mother increases chances of dental decay in the offspring (transmission)

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Education regarding oral health care for the newborn child must b i early begin l to permit i timely i l iinterventions i b before f problems bl arise. i

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ANTICIPATORY GUIDANCE PEDIATRIC ISSUES

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Tooth Formation

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4 months

Pre-natal g growth spurts p 3-4 months 6-7 months

6 months

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Full Term 40 Week Specimen

Permanent Molar

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Tooth Mineralization and Eruption

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Chronology of Eruption

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Development and Importance of Primary Teeth

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A Healthy Primary Dentition

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Teething Child With ihC Corall T Teething hi Ri Ring – Joseph Whiting Scott 1845

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The best remedies for teething are “COLD” and “PRESSURE” Avoid commercial preparations

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Initial Oral Examination 

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Sh ld occur b Should by 12 months of age, preferably upon eruption of the first tooth American Academy of Pediatric Dentistry American Academy of Pediatrics

Purpose is not so much to examine child, but to counsel and educate parents specifically ifi ll about b their child’s oral health

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Early Childhood Caries (ECC) 

A di disease off excess andd neglect l

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An “overload” of the oral clearance system

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Totally preventable

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Caretaker ignorance a major factor

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Ineffective strategies by the dental profession have resulted in no reduction in prevalence

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Sequella of ECC, Pain and Early Tooth Loss *Oral Health and Learning Newsletter, Oral Health Resource Center, HRSA, HHS, 2001       

Failure l to thrive h Impaired speech development Absence from and ability to concentrate in school decreased school performance school, Reduced selfself-esteem Poor social relationships Anxiety, y, fatigue g Irritability, depression, withdrawal

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Onset of ECC - Early Demineralization

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Cavitation

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Early ECC/demineralization /d

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Progressive ECC/cavitation /

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Loss of tooth structure

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Extensive ECC

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Loss of structurestructure-chronic/acute / pulp necrosis/abscesses

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ECC is Difficult to Treat

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3 Strategies g to Prevent Earlyy Childhood Caries 

Remove the plaque matrix 

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Lower bacterial count 

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Wipe teeth w/gauze or washcloth washcloth, toothbrushing Fluorides, therapeutic rinses

Control exposures to nutrients 

Diet counseling and modification

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Venn Diagram Caries as a Multi Multi--factorial Disease

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Interventions to Eradicate ECC 

Di Disrupt t plaque l matrix t i on a regular l b basis i ((gauze, wipe i or b brush h tteeth th att least l t 2X daily)

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Lower bacterial counts (S.mutans, (S.mutans, S. sobrinus, lactobacillus) lactobacillus)

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Chlorhexidine therapy – 0.12% gluconate rinse

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Fl Fluoride id therapy h – optimally i ll fl fluoridated id d water, supplements, l rinses, i varnishes ih

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Parental education prepre- and neonatally

Nutritional guidance  

Quantity vs. quality of foods O l clearance Oral l

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Therapeutic Remineralization 7/07

1/08

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Knee – to – Knee Position

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Technique for properly positioning pos t o g infant a t or o toddler for oral exam, tooth cleaning or dental procedure

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Acquisition of the Oral Flora 

M tans Streptococci (MS) are strongly Mutans associated with dental caries

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Infants do not acquire MS until sometime after teeth emerge

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Caufield et al showed “window of infectivity” from 1919-28 months

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Berkowitz & Jordan – MS in children genetically matches MS of the mother

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Children exhibiting dental caries have MS count >10,000cfu

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Transmission occurs through utensils, utensils tasting food, licking pacifiers, kissing and ??

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Early Development of Sound Dietary Habits

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Nursing bottle vs. breastfeeding Advantages – emotional, immunologic, oral musculature Not so much what you eat as how often you eat it -Quality vs. quantity -Frequency of exposures to food

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The Role of Fluoride in Prevention

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Fluorides 

Mechanism of Action A

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Systemic Fluoride d Protocol

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Fluoride Varnish • Tested in Europe since 1964 • Particularly recommended for preschool and younger children – ease of application and equal efficacyy to APF g gels Stookey, 1998 • No need for prophylaxis before application • Sets under moisture/saliva • Minimizes ingestion – very little gets swallowed • Best material for remineralization or arresting caries

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FLUORIDE VARNISH

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Oral Injuries During First Two Years

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Oral Injury Prevention - Mouthguards

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Nutritive/Non--nutritive Sucking Nutritive/Non Effects of Oral Habits – Thumb sucking, pacifiers

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Tongue--thrust / Anterior Open Bite Tongue

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REVIEW – Oral Hygiene Practices

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Begin Early **upon p eruption p of first tooth or sooner

**use washcloth, gauze or fingertender

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It would never occur to a parent to neglect the hygiene and cleanliness of their infant’s “bottom”. So, to avoid problems… clean the mouth as frequently and religiously as you do the other end.

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Introduce toothbrush and fluoridated toothpaste by 18 – 30 months

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Fluoridated Toothpaste

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Use peapea-size portion to minimize amount swallowed

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Thank You For Your Time and Attention 

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If I can be of assistance or you need further information, I may be contacted at NYU College of Dentistry by at 212212-998998-9641 OR

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at [email protected]

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