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The
New Era of Children's Dental Health
Children’s dental
health care has entered into a new era. It is a revolutionary time
in how dental disease is diagnosed, treated, and prevented by the
dental profession. As practitioners it seems difficult at times to
keep up with these ever changing advances, and pass on their
benefits to our patients. Yet, there are new and very fundamental
principles that are forming the framework for a different
perspective upon which will change how we practice dentistry for
children
Our understanding of
dental caries is increasingly viewed as an infectious,
transmissible disease. This disease process is complex,
dependent on the presence of bacteria, and fermentable
carbohydrates. The acquisition of the bacteria responsible for tooth
decay by an infant can occur even prior to tooth eruption. Mothers
who harbor significant amounts of the bacteria commonly are
responsible for infecting their children at a very early stage of
life. Infection by these bacteria is an important risk factor for
future development of cavities in their children. It has been shown
that a combination of good dental care and various preventive
measures can lead to the reduction in the bacteria found in the
mouths of mothers. As a result of this reduction, and to the extent
that bacterial transmission is minimized, the chances are improved
that the infant will remain free of caries. We may find that
optimizing the dental health of the mothers of infants has the
potential to be a significant preventive method to limit dental
disease in their children.
The “dental home”
is a new initiative which establishes an “ongoing relationship
between the dental practitioner and the patient, inclusive of all
aspect of oral health care delivered in a comprehensive,
continuously accessible, coordinated, and family-oriented way.” All
children should see a dental professional within six months of the
appearance of the first tooth, and at the latest the child’s first
birthday to establish that dental home. At the initial visit
prevention is the focus where counseling is given on oral hygiene,
fluoride therapy, diet, oral habits and dental injury prevention.
Pediatricians and family health physicians have a responsibility to
make certain that the dental home is established as they are the
first health provider to treat the child.
The concept of “remineralization”
and “demineralization” is having a major impact. The ability of
tooth structure to constructively incorporate mineral into it is
called “remineralization”, as opposed to the destructive process of
“demineralization” where minerals leave resulting in decay. This way
of thinking has changed how we diagnose and treat patients. Very
small cavities, if detected early enough can sometimes be left when
minerals can replace the destroyed tooth structure or prevent its
progression.
The basis for “minimally invasive dentistry” relies on the
ability of teeth to remineralize. This orientation’s goal is that of
preserving natural tooth structure with appreciation for its ability
to repair itself. Should a filling need do be done; the advances
made in bonded tooth colored filling materials helps in achieving
the objective of minimal sacrifice, and preserving the natural
teeth.
Assessing the “risk
level” of the child developing caries is an approach which is
more commonly being adopted as a means to manage dental caries. This
individualizes treatment and prevention modalities, enabling the
dentist to have an impact on the delicate balance that reduces the
factors that contribute to disease and increase those that are
protective.
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Common risk indicators that contribute to dental disease:
1.
An infant sleeping, or nursing with fluids in the mouth
2.
Past or present history of decay
3.
Significant visible plaque
4.
Frequent between meal snacking of fermentable carbohydrates
5.
Orthodontic appliances
6.
White lines (demineralized areas) around the teeth
Protective factors that can be used at home for those at higher
risk:
1.
Effective brushing with a fluoride toothpaste multiple times a day
2.
Fluoride mouth rinses and prescription toothpastes
3.
Xylitol gum or mints as a substitute for snacks or when brushing is
not possible
4.
Antibacterial Rinses
5.
Healthy diets with short, infrequent snacking of fermentable
carbohydrates
Protective factors that are used at the dental office:
1.
high fluoride concentration applications of fluoride varnish, gels,
and foams
2.
Calcium Phosphate applications
3.
Sealants
4.
Education on prevention
The American Academy
of Pediatric Dentistry created a “Caries –risk Assessment Tool (CAT)
that dental and nondental health providers can use to aid in the
determination of what risk level category a child or adolescents
falls in to for the development of cavities. This can be helpful to
the professional in formulating individualized treatment plans for
patients based on factors that are readily ascertained.
Fluoride has
been used for years as an effective means of reducing caries in
children. The administration of fluoride by topical means is the
most proven method of cavity prevention. It is used in various forms
at the dental office and home to aid in the reduction of caries. The
addition of fluoride regimens to the patient should be once again
based upon personal risk and tendencies for developing caries.
Dental Sealants are plastic materials applied to the irregular grooved
and pitted surfaces of the back teeth. This provides a barrier that
protects enamel from debris, plaque, and acids. The application is
simple, comfortable, without requiring the removal of tooth and
providing significant anticavity benefits to these very susceptible
chewing surfaces.
There are numerous
studies that show Xylitol to have a
protective effect and be an effective tool against tooth decay. It
seems to reduce plaque formation, inhibits demineralization, and has
an inhibitory effect on Strep Mutans. Xylitol incorporated
into mints and chewing gum together with the buffering and
remineralization capacity of saliva is becoming more accepted
as a tool in the prevention regimen.
Chlorhexidine
is currently the most effective anti-bacterial mouthrinse. Older
children who are at high risk can use it to target the bacteria
involved in the caries process, reducing their levels. Chlorhexidine
Gluconate, 0.12% can be used as a rinse for one minute at bedtime,
one week per month for up to 6 months. Under this regimen staining
is kept to a minimum, and compliance maximized
Calcium Phosphate
pastes are available to help replace minerals that have been lost
from the tooth. In the early stages of the decay process these
pastes can help remineralization which strengthens the tooth enough
at times to obviate the need for treatment. MI paste which contains
Casein Phosphopeptide and Amorphous Calcium Phosphate (CPP-ACP) is a milk
derived protein that is presently available for professional
application or home use in the hopes of replacing lost mineral and
strengthening tooth structure.
Our children are growing up in an age where they can
reap the benefits of all the knowledge and advances that are being
made in the rapidly changing world of dentistry. Parents and
communities need to educate themselves so that those benefits can be
realized. This generation will be the recipient of advances over the
last 2 decades that will result in fewer cavities and filled teeth.
As these “beneficiaries” enter into various stages of adulthood, the
knowledge gained will translate in to better dental health with less
cost and discomfort.
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Prevention
of Infective Endocarditis:
Guidelines from the American Heart Association
A guideline
from the American Heart Association Rheumatic Fever,
Endocarditis and Kawasaki Disease
Committee, Council on Cardiovascular Disease in the Young, and
the Council on Clinical Cardiology, Council on Cardiovascular
Surgery and Anesthesia, and the Quality of Care and Outcomes
Research Interdisciplinary Working Group
Walter
Wilson, MD; Kathryn A. Taubert, PhD, FAHA; Michael Gewitz, MD,
FAHA;Peter B. Lockhart, DDS; Larry M. Baddour, MD; Matthew Levison,
MD; Ann Bolger, MD, FAHA;Christopher H. Cabell, MD, MHS; Masato
Takahashi, MD, FAHA; Robert S. Baltimore, MD;Jane W. Newburger, MD,
MPH, FAHA; Brian L. Strom, MD; Lloyd Y. Tani, MD; Michael Gerber,
MD; Robert O. Bonow, MD, FAHA; Thomas Pallasch, DDS, MS; Stanford T.
Shulman, MD, FAHA;Anne H. Rowley, MD; Jane C. Burns, MD; Patricia
Ferrieri, MD; Timothy Gardner, MD, FAHA;David Goff, MD, PhD, FAHA;
David T. Durack, MD, PhD
JADA,
Vol. 138 http://jada.ada.org June 2007
The major changes in
the updated recommendations include the following. (1)The committee
concluded that only an extremely small number of cases of IE might
be prevented by antibiotic prophylaxis for dental procedures even if
such prophylactic therapy were 100 percent effective. (2) IE
prophylaxis for dental procedures should be recommended only for
patients with underlying cardiac conditions associated with the
highest risk of adverse outcome from IE. (3) For patients with these
underlying cardiac conditions, prophylaxis is recommended for all
dental procedures that involve manipulation of gingival tissue or
the periapical region of teeth or perforation of the oral mucosa.
Policy
Statement
Oral Health Risk Assessment Timing and
Establishment on the Dental Home
Section on Pediatric Dentistry
PEDIATRICS Vol. 111 No. 5 May 2003,
pp. 1113-1116
Early
childhood dental caries has been reported by the Centers
for Disease Control and Prevention to be perhaps the most prevalent
infectious disease of our nation’s children. Early childhood
dental caries occurs in all racial and socioeconomic groups;
however, it tends to be more prevalent in low-income children,
in whom it occurs in epidemic proportions. Dental caries
results from an overgrowth of specific organisms that are
a part of normally occurring human flora. Human dental
flora is site specific, and an infant is not colonized
until the eruption of the primary dentition at
approximately 6 to 30 months of age. The most likely
source of inoculation of an infant’s dental flora is the
mother or another intimate care provider, through shared utensils,
etc. Decreasing the level of cariogenic organisms in the
mother’s dental flora at the time of colonization can
significantly impact the child’s predisposition to
caries. To prevent caries in children, high-risk
individuals must be identified at an early age
(preferably high-risk mothers during prenatal care), and
aggressive strategies should be adopted, including anticipatory
guidance, behavior modifications (oral hygiene and feeding
practices), and establishment of a dental home by 1 year
of age for children deemed at risk.
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Minimally Invasive Dentistry
CAROL
ANNE MURDOCH-KINCH, D.D.S., Ph.D.;
MARY ELLEN McLEAN, D.D.S.
JADA, Vol. 134, January 2003
This concept includes
early detection of lesions; individual caries risk assessment;
nonsurgical interventions; and a modified surgical approach that
includes delayed restoration, smaller tooth preparations with
modified cavity designs and adhesive dental materials and repair
rather than replacement of failing restorations. The goal is
preservation of natural tooth structure.
Caries Prevention and Reversal
Based on the Caries Balance
John D.B.
Featherstone, MSc, PhD1
Pediatric Dent 2006;28:128-132
The balance between
pathological and preventive factors can be swung in the direction of
caries intervention and prevention by the active role of the dentist
and his/her auxiliary staff
Pacifier Use and the Occurrence of
Otitis Media in the First Year of Life
John J. Warren DDS, MS Steven M. Levy DDS, MPH H. Lester Kirchner PhD
Arthur J. Nowak DMD, MA George R. Bergus MD
Pediatr
Dent 23:103-107, 2001
Multivariate
analyses found that the occurrence of otitis media was associated
with pacifier use, one of few modifiable risk factors for otitis
media.
Prevalence of Pacifier-Sucking Habits and
Successful Methods to Eliminate Them—A Preliminary Study
Viviane V. Degan,
SLP, MSc, PhD Regina M. Puppin-Rontani, DDS, MSc, PhD
(J
Dent Child.2004;71:148-151
The most efficient
method to end the pacifier sucking habit was professional
explanation
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ASSOCIATION REPORT
Oral malodor
ADA COUNCIL ON SCIENTIFIC AFFAIRS
1998-2002 American Dental
Association
For the treatment of
bad breath, improved oral hygiene, especially tongue cleaning, has
been shown to reduce the source of bad breath significantly
The Use of Sorbitol and Xylitol Sweetened
Chewing Gum in Caries Control
Brian
A. Burt, BDS, MPH, PhD
JADA 2006;137:190-6.
The evidence is
strong enough to support the regular use of xylitol-sweetened gum as
a way to prevent caries, and it can be promoted as a public-health
preventive measure
Medical
Approach to Dental Caries:
Fight the Disease, Not the Lesion
Phoebe Tsang, DMD, PhD, FRCD(C)1 Fengxia Qi, PhD2 Wenyuan Shi, PhD3
Pediatr Dent 2006;28:188-191
There
are innovative research findings and technologies are about to
revolutionize the clinical management of dental caries. Pediatric
dentists will be able to adopt a more proactive approach in
preventing dental caries
through monitoring the bacterial burden in the caregivers, thus
preventing colonization of pathogenic bacteria in an infant. For
those pediatric patients who have already harbored the pathogens,
early diagnosis will bring about early preventive measures to
reverse the disease process.
Your child's health in the
news:
May 19, 2008
For an
All-Organic Formula, Baby, That’s Sweet
NY Times Article
By JULIA MOSKIN
Parents may be buying it because they
believe that organic is healthier, but babies may have a reason of
their own for preferring Similac Organic: it is significantly
sweeter than other formulas. It is the only major brand of organic
formula that is sweetened with cane sugar, or sucrose, which is much
sweeter than sugars used in other formulas.
April 1, 2008
The
Claim: A Fever in a Baby Is a Sign of Teething
NY Times Article
By ANAHAD O'CONNOR
THE FACTS
An old wives’ tale says a feverish baby is not always
a cause for concern. Chalk it up to teething, pay little mind and go
back to sleep, the saying goes.
But experts suggest otherwise. While the emergence of new teeth in
infants under 1 year old can sometimes cause a slight increase in
body temperature, studies show it does not generally cause a
high-grade
fever. The symptoms can be a
sign of a serious problem like a viral illness.
In
2000, a Cleveland Clinic team published a study in Pediatrics that
followed 125 children from 4-month doctor visit to 1st birthday. In
that time, 475 tooth eruptions occurred, and the study found many
symptoms in the roughly eight-day periods in which the teeth emerged
like increased biting, drooling, gum rubbing, facial rash and
decreased appetite. But no
teething children had a high-grade fever, 104 degrees or above.
A
later study in Pediatrics followed children 6 to 30 months old, with
the same conclusion. There was no link between teething and body
temperature or high fever. “Before caregivers attribute any infants’
signs or symptoms of a potentially serious illness to teething,” the
first study said, “other possible causes must be ruled out.”
THE BOTTOM LINE
Studies show high fevers are generally not a teething symptom and
may be more serious.
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