THE NEXTDDS Blog

3 Reasons Why Dental Caries are Prevalent in Pediatric Patients

Posted by THE NEXTDDS on Wed, Jun 28, 2017 @ 01:00 PM

caries-1.jpgAs reported by the National Institute of Dental & Craniofacial Research, 42% of children between the ages of 2 and 11 have had dental caries in their primary teeth, with that percentage increasing for multicultural children and those from low income families.1 Many circumstances beyond the child’s control predispose him or her to dental caries. In order to take preventive measures with your adolescent patients, it is important to know what you can do as a practitioner to identify at-risk patients. Just as important, understanding the etiology of dental cases should also be on the mind of every dentist.

With diagnostic technology advancing and preventive measures, such as fluoride, readily available, why do dental caries continue to be prevalent among children? Courtesy of educator and pediatric dentist Dr. Greg Psaltis, here are some reasons why dental caries continue to affect pediatric patients.

The Vulnerable Population

To start, it’s important to focus on how the vulnerable population (e.g., patients of low socioeconomic status) is different from the rest of the population. Children who are at a higher risk for dental caries often have oral health needs that are unmet and untreated.2 Those from minority groups3 or are of special needs4 have an even tougher time obtaining adequate treatment. Without consistent treatment, vulnerable communities have a lack of self-care instructions, have no “dental home,” and no overall oral health education.

Early_Childhood_Caries.jpgWith limited access to care, caries in pediatric patients don’t get properly diagnosed, which continues this trend of neglected treatment. As treatment for dental caries is delayed, the child's condition worsens and becomes more difficult, the cost of treatment increases, and the number of clinicians who can perform the more complicated procedures diminishes.5

Geographic Disparities

There’s a major disparity between the geographic distribution of dentists and where dental care is most needed. While many dental students show interest in practicing in urban and rural areas,6 there is still a lack of dentists presently in these areas. In rural Southern and Midwestern states, for example, patients have to travel far to see a dentist, particularly one that takes Medicaid insurance. The ADA’s Health Policy Institute recently introduced a detailed, interactive map that lays out the geographic access to dental care within each state in the U.S.

To counteract this unfortunate reality, many dental schools, educational grants, and organizations such as dental support organizations look to turn dental students towards the advantages of practicing in these areas, often through loan repayment programs. For many, the idea of being financially supported to work in an underserved community, while also possibly having more production than a more competitive state (e.g. California) is a compelling offer. With more dental schools opening to address these geographical shortages in dentists, students now are more aware of these disparities than ever before.

Federal Insurance Programs

While the number of children under Medicaid and similar insurance coverages has increased over the years, with more children insured now than ever before, it’s not always easy to find providers. Because of the low reimbursements options that are offered to dentists through these coverages, some dentists refuse to see patients that have this insurance. With dental caries rampant amongst pediatric patients and families that are of a low socioeconomic status,2,3 Medicaid is often the only affordable and appropriate coverage for these patients. This stalemate between low-income families and available Medicaid dentists continues to thwart the improvement of children in vulnerable communities.

 

Dental caries affects millions of pediatric patients. The question lies in how this disease can best be managed in young populations, with a heavier lens on those that have direct barriers to access. Without the combined efforts of both the knowledgeable dentist and the continued improvement to healthcare systems, children in these vulnerable communities and areas will continue to be at a high risk. When these parties come together to overcome these barriers to care, children will be better cared for and better educated on the importance of sustaining their oral health.

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References

1. Dental Caries (Tooth Decay) in Children (Age 2 to 11). National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/DentalCariesChildren2to11.htm. Published May 28, 2014. Accessed June 12, 2017.

2. Grant J, Peters A. Children's Dental Health Disparities. The Pew Charitable Trusts. http://www.pewtrusts.org/en/research-and-analysis/analysis/2016/02/16/childrens-dental-health-disparities. Published February 16, 2016. Accessed June 12, 2017.

3. Swann BJ. Impact of Racial Disparities. Perspectives on the Midlevel Practitioner. http://www.dimensionsofdentalhygiene.com/ddhnoright.aspx?id=23960 Published October 2016. Accessed June 12, 2017.

4. Mitchell JM, Gaskin DJ. Dental Care Use and Access for Special Needs Children. Maternal and Child Health Research Program. https://mchb.hrsa.gov/research/documents/finalreports/mitchellR40mc04296FinalReport.pdf. Published March 2007. Accessed June 12, 2017.

5. Çolak H, Dülgergil ÇT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. Journal of Natural Science, Biology, and Medicine. 2013;4(1):29-38. doi:10.4103/0976-9668.107257.

6. Sweeney SE, Groves RM. 2016. The changing dental career landscape: The impact of dental school graduates’ pathway into the profession. Mahwah, NJ: Next Media Group. Accessed November 23, 2016. Available at http://thenextmediagroup.com/shop/researches/

Tags: children's health, Early Childhood Caries, caries, dental caries, pediatric patients

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

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