THE NEXTDDS Blog

Identifying Children at High Risk for Dental Caries

Posted by THE NEXTDDS on Wed, Dec 28, 2016 @ 11:45 AM

dentist-examining-childs-teeth.jpgDental caries is largely preventable, but it remains one of the most common diseases of childhood—five times as common as asthma, and seven times as common as hay fever, according to the Centers for Disease Control and Prevention (CDC). The CDC states that 42% of children ages 2 to 11 have had cavities in primary teeth, and 21% of those ages 6 to 11 have had cavities in permanent teeth.1 Children will develop caries disease at different benchmarks of their early lives, with some adolescents being at a higher risk than others due to some very specific circumstances.

A recent THE NEXTDDS presentation on early childhood caries by Dr. Greg Psaltis, a pediatric dentist with over 30 years of experience, discusses the types of children who are at high risk for dental caries and stresses the role of the clinician in performing a comprehensive risk assessment as part of an effective oral hygiene regimen. Students need to learn why certain children may experience dental caries over others and understand the importance of a comprehensive risk assessment.

Here are the types of children at a high risk for dental caries and some of the key takeaways from the Psaltis presentation:

Socioeconomic, Premature Birth Rate, and Special Needs

A child’s risk of caries disease comes at the expense of how he or she is born, raised, and how he or she develops. Statistically, lower socioeconomic upbringings lead to a higher risk at dental caries as opposed to high socioeconomic standards.2 Children with premature birth rates, as well as special needs or disabilities, are also at a high risk.3 Since these children have less access to care and need to have more involved procedures (that become costly) due to their poor health, these roadblocks are correlated with a higher risk of dental caries.

Transfers from Healthcare Providers and/or Parents

In studying children at higher risk of caries disease, one interesting aspect is a factor that can be beyond their control. Typically, when a child is just learning how to adjust from being breastfeed to bottle-fed, or is having trouble eating, a healthcare provider or parent will demonstrate the motion of eating or drinking by putting the bottle or spoon into their mouths before giving it to the child. When this occurs, the bacteria from the healthcare provider or parent transfers over to the child, causing a high risk of caries.4

Diet

Children who eat sweet or starchy snacks are also at a higher risk, especially when they consume these treats more than three times daily.5 The frequency at which the child consumes the snacks is a bigger factor than the actual foods themselves. Eating these types of foods in pieces rather than the entire snack actually does more harm, as the continuous chewing raises the risk.6 Parents and guardians should be made aware of the fact that they need to dictate the child’s low-carb, less sugary diet, rather than the child dictate his or her own diet, which can be especially hard if the child is a picky eater. Fruits should be implemented over fruit roll ups!

With so many responsibilities involved in raising a child, it can be easy for parents to overlook the very serious threat posed by caries disease. Especially when it comes to something as simple as a shared spoon, or as long-term as an adjustment to the child’s diet, practitioners need to emphasize how much these important factors come into play with the risk of their child. With a comprehensive risk assessment, dentists can allow parents to keep their children healthy. Moving further into the CAMBRA Approach, identifying these patients who are at a high risk, then modifying their risk through various factors including diet and improving their overall health care routine will ensure safety.

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References

[1] Healy M. Young kids' tooth decay hits 'epidemic' proportions. USA Today. http://www.usatoday.com/story/news/nation/2014/03/02/cavities-children-teeth/5561911/. Published March 3, 2014. Accessed November 28, 2016.

[2] Popoola BO, Denloye OO, Iyun OI. Influence of parental socioeconomic status on caries prevalence among children seen at the university college hospital, ibadan. Ann Ib Postgrad Med 2013;11(2):81-86.

[3] Norwood Jr. KW, Slayton RL. Oral health care for children With developmental disabilities. American Academy of Pediatrics. http://pediatrics.aappublications.org/content/131/3/614. Published March 2013. Accessed November 29, 2016.

[4] Ramos-Gomez FJ, Crystal YO, Ng MW, et al. Pediatric dental care: Prevention and management protocols based on caries risk assessment.  J Calif Dent Assoc 2010; 38(10):746–761.

[5] Block SL. Put some ‘teeth’ into your pediatric preventive counseling. Healio.com/Pediatrics. http://m2.wyanokecdn.com/32e80aa87972ee67415ae2efb7474d04.pdf. Published September 2012. Accessed November 29, 2016.

[6] Psaltis G. Types of children at high risk for dental caries. September 2016. http://www.thenextdds.com/Podcasts/Types-of-Children-at-High-Risk-for-Dental-Caries/. Accessed November 30, 2016.

Tags: Early Childhood Caries, caries, dental caries, caries management

The Challenges of Early Childhood Caries

Posted by THE NEXTDDS on Wed, Dec 21, 2016 @ 12:02 PM

ecc-1.jpgEarly Childhood Caries (ECC) is defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child. The ADA recognizes that Early Childhood Caries is a significant public health problem in selected populations and is also found throughout the general population.1 Because they are inhibited by age and need to be cared for by their parents, infants and toddlers can sometimes lack proper dental care at a critical time in their lives. Other factors that force adults to miss appointments (e.g., cost, lack of insurance) can also play a part in a child’s lack of proper oral hygiene. However, there are even still more reasons why ECC has become an important healthcare issue.

Breastfeeding

Early Childhood Caries is unique because the patient's maxillary incisors are at greatest risk for decay, while mandibular incisors are often unaffected due to the child’s tongue suckling protecting them. In addition to a bottle habit or extensive and prolonged breastfeeding, these conditions also can also be known as nursing caries. At any rate, nursing toddlers must have their teeth brushed with toothpaste and receive proper oral hygiene even prior to the eruption of the first tooth, and recommendations for a proper diet should be provided at the first dental visit.2

Toothbrushing

As aforementioned, infants and young children are not capable of taking care of their teeth on their own and require parental supervision. To parents, dentists must emphasize the importance of maintaining their infant’s teeth, both to desensitize the oral cavity now, and to prepare them for future treatment. Over time, young children will be responsive to the method.

A good instructional technique involves seating the parent with the child standing between their legs and reclining his or her head backward onto their lap. The parent should embrace the child’s head in a stable position with one hand and proceed to brush the child’s teeth using a soft toothbrush with double-rounded bristles with the other. A gentle, tiny dab of fluoridated toothpaste should be used to clean the gums and teeth.

Fluoride

ecc-2.jpgFluoride should be introduced to the ECC patient in order to delay or prevent the progression of carious lesions,3 as children less than three should not be treated with sedation or other invasive treatment. Topical fluoride varnishes in a resin or synthetic base should be applied to the patient's tooth surfaces in order to prevent the process of cavity formation. This varnish-based application can help minimize the risk of inadvertent fluoride consumption.

Although the primary side effect of fluoride varnishes has been the temporary yellow-brown tooth discoloration apparent when adhering, this effect has been eliminated in new tooth-colored varnishes.4 Varnish application should be repeated at six months, or three-month intervals for high-risk children.

Establishing a proper oral hygiene regimen5 as early as possible for infants and young children will both work to decrease the potential of severe ECC and all the complications that lie with it, as well as allow the infants to become accustomed to their routine care and eventual dental visits. Assessing and managing the risk involved with dental caries is a key aspect of being a dentist, and despite the challenges that many children and infants face in lieu of healthy oral care, treatment is essential for maintaining overall wellness.

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References

[1] Statement on Early Childhood Caries. American Dental Association. http://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-early-childhood-caries. Accessed December 7, 2016.

[2] Nunn ME, Braunstein NS, Kaye EAK, Dietrich T, Garcia RI, Henshaw MM. Healthy Eating Index Is a Predictor of Early Childhood Caries. Journal of Dental Research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774803/. Published April 2009. Accessed December 7, 2016.

[3] Larsen CD, Daronch M, Moursi AM. Caries Prevention for Kids. Dimensions of Dental Hygiene. http://www.dimensionsofdentalhygiene.com/2013/02_February/Features/Caries_Prevention_for_Kids.aspx. Published February 2013. Accessed December 5, 2016.

[4] Kupietzky A. Early Childhood Caries. THE NEXTDDS. http://www.thenextdds.com/Articles/Early-Childhood-Caries/. Published December 13, 2010. Accessed December 5, 2016.

[5] Margolis F. Tricks or Treatments: Techniques for Managing Adolescent Patients. THE NEXTDDS. http://www.thenextdds.com/Articles/Tricks-or-Treatments--Techniques-for-Managing-Adolescent-Patients/. Published August 31, 2012. Accessed December 5, 2016.

Tags: Early Childhood Caries, caries, dental caries, caries management

Understanding the CAMBRA Approach for Caries Management

Posted by THE NEXTDDS on Thu, Nov 10, 2016 @ 05:04 PM

Murphree3.jpgIt’s interesting to see how far dentistry has come in such a short amount of time. As the industry grows, dentists are constantly adapting to new technology and methodologies for restoring their patient's teeth to ideal form and function. Despite how common dental caries and periodontitis are in the modern patient population, new understandings are still being applied to the risks of the disease, improving patient education, and assessing the preventive measures that must be enforced to combat these risks.

The acronym CAMBRA stands for Caries Management By Risk Assessment. It encompasses a methodology of identifying the cause of caries disease through the assessment of risk factors for each individual patient and then managing those risk factors through behavioral, chemical, and minimally invasive restorative procedures.1 In an effort to forego the dependence on operative procedures (the so called “drill and fill”) for dental caries, a CAMBRA Approach can be more cost-effective for the patient, and be less invasive over time.

Given these benefits, it’s easy to see why CAMBRA has become the new standard of care for many practices due to the growing body of research and experts to confirm its efficacy. Since dental caries is a multifactorial process, using CAMBRA can support dentists in managing the disease by three main ways: 1) determining the contributory factors, 2) assessing the risk level for the patient, and 3) ultimately helping the patient find a clear treatment regimen. Risk factors can include visible cavities, enamel lesions, white spots, three-year-old fillings, harmful bacteria, inadequate saliva flow, and frequent snacking.2

The University of California San Francisco (UCSF) School of Dentistry is just one of the many schools that advocate this relatively new, but wholistic technique to dental caries treatment. In a recent article, Dr. Peter Rechmann, Professor of Preventive & Restorative Dental Science, and Dr. John Featherstone, Dean of UCSF School of Dentistry and leading researcher for the school’s new CAMBRA Approach, discussed how the school has adapted to this new curriculum.

Murphree5.jpgThe CAMBRA Approach can be a way to create a long-term goal for the patient and practitioner instead of a short-term solution. Instead of more invasive operative procedures, utilizing a series of chemotherapeutic agents or fluoride-based solutions in the CAMBRA Approach can create a conservative option for the dentist and encourage additional self-care by the patient. In a couple years’ time, CAMBRA began to take a hold nationwide, and Dr. Rechmann is leading a team to study and confirm the approach’s effectiveness.

With many professionals looking to avoid irreversible cavity preparations to manage dental caries, CAMBRA is a very contemporary topic in today's dental schools. Dental students at the UCSF School of Dentistry, for example, learn about dental caries and the CAMBRA approach during their first year of training. Despite this emphasis both at UCSF and many dental schools across the country, operative procedures continue to be the standard response to dental caries for many private practices, and the challenge lies in instilling CAMBRA after graduation. The biggest barrier, besides a change in practice philosophy and patient compliance, is that most insurance companies do not yet reimburse preventive therapies for adults, meaning patients face higher costs and dentists make less profit from incorporating CAMBRA. But as insurance companies see proof of the long-term cost savings of prevention, they may be more likely to expand coverage to these measures.2

While implementing CAMBRA can involve a small learning curve for the practice, it is ultimately in the best interest of the patient and the professional looking for a diagnostic-based, minimally invasive approach to the management of dental caries. On behalf of THE NEXTDDS user community, we'll continue to monitor the progress of the UCSF research team and share their findings.
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References

[1] Bernie KM. CAMBRA: Caries management by risk assessment. DentistryIQ. http://www.dentistryiq.com/articles/2011/03/cambra.html. Published March 1, 2011. Accessed October 27, 2016.

[2] Bai N. Prevention-oriented approach to dentistry helps patients avoid the drill. University of California San Francisco. http://www.ucsf.edu/news/2016/10/404626/prevention-oriented-approach-dentistry-helps-patients-avoid-drill. Published October 20, 2016. Accessed November 4, 2016.

Tags: caries, CAMBRA, dental caries, caries management

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