peds oral health

• Pediatric Oral Healthcare


  Dental care for children
• Interprofessional Education


  Education involving multiple healthcare professions
• Early Childhood Caries


  Tooth decay in young children
• Tooth decay is the most common chronic disease of childhood
• Early childhood caries is 5x more common than asthma and 7x more common than allergies
• Effects of early childhood caries

  • Pain/infection
  • Malnutrition
  • Loss of sleep
  • Missed school days
• 2/3rds of all Canadians aged 6 to 11 have tooth decay
• 1 out of 3 kids entering grade 1 have tooth decay
• Early childhood caries is the leading cause of day surgery for children in Canada
• 85% of Canadians report that they have good oral health
• 75% of Canadians have visited the dentist within the last year
• Populations with poorer oral health in Canada

  • Seniors
  • Low-income populations
  • Children
  • Individuals with special needs
  • Indigenous populations
• Infant Oral Health

  Dental care for infants and young children
• All children should be seen by a dentist by age 1 or within 6 months of eruption of the first tooth
• Risk assessment and early intervention

  Identifying and addressing oral health risks early on
• Risk Factors for Early Childhood Caries


  • Fluoride exposure
  • Diet
  • Sleep time routine
  • Oral hygiene
  • Habits
  • Special health needs
  • Previous caries
  • Oral bacteria
  • Poor family oral health
  • Socioeconomic status
• Fluoride exposure risk factors


  • Fluoridated community?
  • Taking supplements?
  • Well water? Fluoride level?
  • Fluoride toothpaste?
  • Bottled water?
• Fluoride - Mechanisms of Action

  Topical: Inhibits demineralization, Promotes remineralization

  Antibacterial: Concentrates in plaque, Inhibits glycolysis and disrupts enzyme systems

  Systemic: Reduces enamel solubility, Improves enamel crystallinity
• Fluoride - Delivery Methods


  • Topical: Varnish, Neutral NaF, Stannous F, APF gels/rinse, Dentifrices

  Systemic: Water fluoridation, Community, School, Salt fluoridation, Milk fluoridation, Fluoride supplements

  Professional: Varnish, Neutral NaF, Stannous F, APF gels/rinse

  Self-Applied: Dentifrices, OTC/Rx, Mouth rinses, Fluoride gels
• Dietary habits


  Factors related to food and drink consumption that impact oral health
• Sleeping habits


  Factors related to sleep that impact oral health
• Oral hygiene


  Factors related to tooth brushing and oral care that impact oral health
• Poor family oral health


  Factors related to the oral health of family members that impact a child's oral health
• Socioeconomic status


  Factors related to income and access to care that impact oral health
• Special health care needs

  Factors related to medical conditions that impact oral health
• Anticipatory Guidance

  • Oral development
  • Oral hygiene
  • Diet and nutrition
  • Fluoride adequacy
  • Oral habits
  • Injury prevention
• Oral Development


  Information about the development of teeth and jaws
• Oral hygiene


  Guidance on proper tooth brushing techniques and supervision
• Fluoride


  Assessing fluoride status and determining if supplementation is required, discussing toxicity and safety
• Fluoride - Acute Toxicity


  Beneficial in small amounts, toxic in large amounts

  Probable toxic dose: 5-10 mg F/kg body weight

  Certain lethal dose: 16-32 mg F/kg body weight

  A tube of toothpaste (100 g) has up to 230 mg of F ion
• Fluoride - Acute Toxicity Symptoms


  • GI discomfort
  • Nausea/Vomiting
  • Altered CNS function
  • Convulsions
  • Coma
  • Cardiac Arrhythmias
  • Death
• Fluoride - Acute Toxicity Treatment

  Determine child's body weight

  <8 mg F/kg - give milk, observe > 6hrs, refer if progression

  >8 mg F/kg - induce vomiting, give milk, refer immediately

  Unknown dose - if asymptomatic treat as <8 mg F/kg, if symptomatic treat as >8 mg F/kg
• Fluoride Dentifrices


  Children under 3: Require assistance, use minimal amount for moderate/high risk

  Children 3 and older: Require assistance/supervision, use a small amount (pea-sized)
• Diet and nutrition


  Factors related to food and drink consumption that impact oral health
• Injury prevention


  Guidance on preventing oral injuries
• Non-Nutritive Sucking Habits

  Normal part of development, effects depend on intensity, frequency, and duration
• Pacifier Use and Safety


  Guidance on proper pacifier use and safety
• First Dental Visit


  Lap examination with dentist and caregiver
• Social Determinants of Health

  • Income and social status
  • Employment and working conditions
  • Education and literacy
  • Childhood experiences
  • Physical environments
  • Social supports and coping skills
  • Healthy behaviours
  • Access to health services
  • Biology and genetic endowment
  • Gender
  • Culture
  • Race / Racism
• Effects of Poor Oral Health

  • Infection
  • Pain
  • Tooth loss
  • School performance
  • Social functioning
  • Self-esteem
  • Burden of cost