DH care for infants, children, and adolescents Flashcards
PEDIATRIC DENTISTRY
___-defined specialty that provides both ____ and ______ preventive and therapeutic oral health care for infants and children through _____, including those with ____ healthcare needs.
Requires __ years of additional specialized training in addition to the __ years of dental school
Age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral healthy care for infants and children through adolescence, including those with special healthcare needs.
Requires 2 years of additional specialized training in addition to the 4 years of dental school
_______ ACADEMY OF _______ DENTISTRY
Membership organization for _______ dentistry
Mission statement: “To advance ____, ________, and _____ that promote optimal oral health and oral health care for children.”
Professional and ______ information available on the website (________)
Membership organization for pediatric dentistry
Mission statement: “To advance policies, guidelines, and programs that promote optimal oral health and oral health care for children.”
Professional and parental information available on the website (www.aapd.com)
age ranges
infant:
toddler:
preschooler:
school age:
adolescent:
infant: 0-1
toddler: 1-3
preschooler: 3-5
school age: 6-11
adolescent: 12-17
role of the RDH
Inform and educate _____
- Consider _____ circumstances, social determinants of health (SDOH), and _______ preferences (i.e. language)
- Oral health literacy is directly related to the prevalence of _______ in children
- Start during _______
_________ collaboration
- Interprofessional _______ and __________
- Collaborative approach increases opportunity for children to receive
______ and _______ dental hygiene services to reduce _____ risk
Inform and educate caregivers
- Consider economic circumstances, social determinants of health (SDOH), and communication preferences (i.e. language)
- Oral health literacy is directly related to the prevalence of dental caries risk in children
- Start during pregnancy
Interprofessional collaboration
- Interprofessional education and collaborative practice
- Collaborative approach increases opportunity for children to receive
education and preventive dental hygiene services to reduce caries risk
what is oral health literacy?
________ patient education resources has resources available in __ languages
the degree to which individuals can obtain, process, and understand the basic health information and services needed to make
appropriate health decisions
Dentalcare.com Patient Education resources has resources available in 6 languages
ECC
“The presence of __ or more decayed (____ or ______), missing due to caries, or filled tooth surface in a primary tooth.” in children __ months or younger (less than __ years old)
Public health crisis for ___, _____, and ______
Cause: prolonged or repeated exposure of a tooth to ____________
Ex. ____, ____, or ______
_______ teeth most susceptible
“The presence of one or more decayed (non-cavitated
or cavitated lesion), missing due to caries, or filled tooth surface in a primary tooth.” in children 71 months
or younger (less than 6 years old)
Public health crisis for infants, children, and adolescents
Cause: prolonged or repeated exposure of a tooth to
fermentable carbohydrates
Ex. Milk, formula, or juice
Maxillary anterior teeth most susceptible
BACTERIAL AND VIRAL TRANSMISSIONS
Streptococcus ____ and Streptococcus _____
Vertical transmission:
Horizontal transmission:
EX: 2; who is most susceptible
Streptococcus mutans and Streptococcus sobrinus
Vertical transmission: transmission through the caregiver’s saliva to the child.
Horizontal transmission: indirect exposure of saliva through
sharing of spoons, testing foods before feeding to child, and
cleaning off a pacifier with mouth vs. water.
EX: Dental caries, Herpetic infection; Children between 19-33 months are most susceptible
recognition of ECC
white spot lesions =
cavitation of white spot lesions=
later stages=
white spot lesions = demineralization
cavitation of white spot lesions= brown cavitated areas
later stages= severe caries
progression of ECC
A. earliest caries affect the ________, followed the by ___ as they erupt.
B. severe extensive lesions develop in ___ teeth except the _______ due to protect by the _____
A. earliest caries affect the MAXILLARY ANTERIOR TEETH, followed the by MOLARS as they erupt.
B. severe extensive lesions develop in ALL teeth except the MANDIBULAR ANTERIOR TEETH due to protect by the TONGUE
epidemiologic indices
Decayed, Missing, Filled teeth (DMFT)
- Measures ________
- Total number ____ decayed,
missing, or filled in an individual
- Decayed (D):
- Missing (M):
- Filled (F):
Decayed Missing, Filled
Surfaces (DMFS)
- Measures _____
- Counts tooth _____ rather than
individual teeth
- Posterior (5) surfaces: M, D, B, L, O
- Anterior (4) surfaces: M, D, F, L
dmft / dmfs
- Use these indices for ______
dentition
Decayed, Missing, Filled teeth (DMFT)
- Measures dental caries
- Total number of teeth decayed,
missing, or filled in an individual
- Decayed (D): carious tooth,
secondary decay, retained roots,
temporary filling, filled tooth with
another surface decayed
- Missing (M): only those missing
due to decay or disease
- Filled (F): only those filled due to
caries
Decayed Missing, Filled Surfaces (DMFS)
- Measures dental caries
- Counts tooth surfaces rather than
individual teeth
- Posterior (5) surfaces: M, D, B, L, O
- Anterior (4) surfaces: M, D, F, L
dmft / dmfs
- Use these indices for primary dentition
PRIMARY TOOTH ERUPTION/SHEDDING AGES
MAX
central incisors
lateral incisors
canines
first molar
second molar
MAND
central incisors
lateral incisors
canines
first molar
second molar
MAX
central incisors: 8-12 months/6-7 years
lateral incisors: 9-13 mon/7-8 years
canines: 16-22 mon/10-12 years
first molar: 13-19mon/9-11 year
second molar: 25-33mon/10-12 yrs
MAND
central incisors: 6-10 mon/6-7 yrs
lateral incisors: 10-16 mon/7-8yrs
canines: 17-23mon/9-12yrs
first molar : 14-18mon/9-11yrs
second molar: 23-31mon/10-12 yrs
dental care barriers (8)
Lack of parental knowledge about prevention of oral disease(s)
Language
Cost/No insurance
No dental home established
Timing conflicts
Transportation
Insurance not accepted by the dentist
Rural areas
AAPD and the American Academy of Pediatrics recommend that the first dental visits for children no later than _______ of age
Early visits include referral to _______ when appropriate
define Dental Home:
Emphasis is placed on ____ intervention before serious health problems can develop.
AAPD and the American Academy of Pediatrics recommend that the first dental visits for children no later than 12 months of age
Early visits include referral to dental specialists when appropriate
Dental Home: “ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way”
Emphasis is placed on early intervention before serious health problems can develop.
Establish ____, create a positive, ___ environment
OHI- teach ______ appropriate behaviors and prevent management problems
Nutrition, ______ incorporation, ________ techniques, etc.
Increase oral health literacy of _____
Schedule dental hygiene visits according to the _____ needs
Usually every __ months
Schedule _____ or _______
Establish rapport, create a positive, fun environment
OHI- teach parents appropriate behaviors and prevent management problems
Nutrition, fluoride incorporation, toothbrushing techniques, etc.
Increase oral health literacy of parents
Schedule dental hygiene visits according to the child’s needs
Usually every 6 months
Schedule early morning or after naps
Dental hygienists must engage both ______ and ____ in informed consent or assent, respectively, education, and self-care recommendations
Report suspected ___ or ____ to proper authorities
Tx:
- Complete __________
- Comprehensive oral assessment- use ____, _____, ____
Document: (5)
Remove: (3)
Dental hygienists must engage both caregiver and child in informed consent or assent respectively, education, and self-care recommendations
Report suspected abuse or neglect to proper authorities
Tx:
Complete health history
Comprehensive oral assessment- use DMFT/dmft, DMFS/dmfs, CRA
Document informed consent, client education, treatment provided, and important observations about the child’s behavior, including complications, and how they were addressed
Remove biofilm, stain, and calculus
INFANT ORAL CARE (0-1)
6-10 months
- eruption of the first ____ teeth
- Primary teeth are vulnerable to ___ upon eruption
20-30 months
- ___ primary teeth are present
Teething education and intervention for caregivers
- OTC _____ gels (no _____-based for children under __)
- Teething interventions (teething ___ or ___ toothbrush) can provide comfort
Healthy _______ are crucial
6-10 months
- eruption of the first primary teeth
- Primary teeth are vulnerable to caries upon eruption
20-30 months
- all primary teeth are present
Teething education and intervention for caregivers
- OTC analgesic gels (no benzocaine-based for children under 2)
- Teething interventions (teething toys or soft toothbrush) can provide comfort
Healthy eating habits are crucial
EDUCATION TIPS TO CAREGIVERS (Infants Ages 0-1)
Brush _____ teeth as soon as they are ____ (soft bristled brush)
Before teeth are visible, clean infant’s ___ after each _____
Put babies to bed without a ____ or with only a ____ bottle
Wean off bottle at ___ months old
Reduce ____ use
Clean child’s teeth after sugary _____ use
____ dental hygiene appointments
_______ for children who are at ____-____ risk of ECC
Brush primary teeth as soon as they are visible (soft-bristle brush)
Before teeth are visible, clean the infant’s gums after each feeding
Put babies to bed without a bottle or with only a water bottle
Wean off bottle at 12-14 months old
Reduce pacifier use
Clean child’s teeth after sugary medicine use
Regular dental hygiene appointments
Fluoride varnish for children who are at moderate to high risk of ECC
TODDLER TO PRESCHOOL AGE (1-5 yrs)
Dental home should be established by __ year(s) old
Discuss ______ habits, homecare, _____ and ______
Avoid frequent _______/eating between meals
Oral hygiene care= _____ responsibility
Emphasize _____ oral hygiene care
2-3 years
Most susceptible to ________
Teach proper _____ techniques
Age 4
discourage ____ sucking
Avoid ______
Practice ______ conversation about the dentist
Dental home should be established by 1 year old
Discuss dietary habits, homecare, growth and development
Avoid frequent snacking/eating between meals
Oral hygiene care= caregiver’s responsibility
Emphasize preventive oral hygiene care
2-3 years
Most susceptible to dental trauma
Teach proper brushing techniques
Age 4
discourage thumb sucking
Avoid mouth rinses
Practice positive conversation about the dentist
Oral Health Considerations- Toddler to Preschool (age 1-5 years)
2-3 year old
- parents should take turns ______ with the child
- __ minute timer tool
- Recommend brushing after _____ and before ________
Control the amount of ______ is on toothbrush
- < 3 years:
- 3-6 years:
< 6 years
- ingesting ______ under a pea-sized amount can lead to mild ______
- Teach them to ____ out toothpaste; not ______ it
2-3 year old
- parents should take turns brushing with the child
- 2 minute timer tool
- Recommend brushing after breakfast and before bedtime
Control the amount of toothpaste is on toothbrush
- < 3 years: a smear or grain of rice size
- 3-6 years: a pea sized amount
< 6 years
- ingesting fluoride under a pea
sized amount can lead to mild fluorosis
- Teach them to spit out toothpaste; not swallow it
speech and language development
- ________ loss of primary teeth
- ____ habits: Prolonged thumb and finger sucking can cause:
Malocclusions
Accident and Injury Prevention
* Greatest incidence: __ years of age
- premature loss of primary teeth
- digit habits: Prolonged thumb and finger sucking can cause: narrow maxillary arch, open bite, posterior cross bite, increased overjet, and decreased overbite
Malocclusions
Accident and Injury Prevention
* Greatest incidence: 2-3 years of age
DIETARY FACTORS FOR TODDLERS AND PRESCHOOLERS
___, ______ meals during the day
Healthy snacks:
- _________ foods from grain, veggies, fruit, meats, dairy
Limit sweet foods/drinks to ___ or less per day
Limit juice to ___ ounces per day
Do not send to bed with a ______
Use “___VS____” rather than “____VS____”
Small, healthy meals during the day
Healthy snacks:
- Non-cariogenic foods from grain, veggies, fruit, meats, dairy
Limit sweet foods/drinks to 2-3 or less per day
Limit juice to 4-6 ounces per day
Do not send to bed with a sippy cup
Use “healthy vs unhealthy” rather than “good vs bad”
School Age: ages 6-12 years
- ___ exam should occur prior to ___
- More ______ with oral hygiene; Age __- child may be able to brush by themselves
- ________ assessment completed
- Use ___, videos, and ___ engagement
6 to 7 years of age
- Primary teeth will begin to _____
- Primary prevention: ______
Sports-related injuries
- 50-90%: (3 areas)
- Recommend mouth guards; Academy of Sports Dentistry (ASD)- custom-fabricated mouth guard
Ultrasonic scaling used only on _____ teeth
- Oral exam should occur prior to school
- More independent with oral hygiene; Age 6- child may be able to brush by themselves
- Periodontal assessment completed
- Use pictures, videos, and positive engagement
6 to 7 years of age
- Primary teeth will begin to exfoliate
- Primary prevention: Dental sealants
Sports related injuries
- 50-90%: Upper lip, maxilla, maxillary incisors
- Recommend mouth guards; Academy of Sports Dentistry (ASD)- custom-fabricated mouth guard
Ultrasonic scaling used only on permanent teeth
TIPS FOR EFFECTIVE CLINICAL MANAGMENT
oral exam:
Explain ___ to examination
Avoid using negative words (___,___)
_____ involvement
Use __-__-__ to gain cooperation.
Use _____, videos, and ____
engagement
Explain prior to examination
Avoid using negative words (hurt, pain)
Parental involvement
Use tell-show-do to gain cooperation.
Use pictures, videos, and positive
engagement
ADOLESCENTS (12-17)
susceptible to: (7)
worried about ______
Susceptible to:
high caries incidence
traumatic injury
periodontal disease
poor nutritional habits
orthodontics
restorative care
oral malodor
worried about esthetic appearance
adolescents ages 12-17
PUBERTY AND MENSES
- _______ ___ characteristics develop
- Bacteria associated with increased _____ levels
- _____ species & ________ = periodontal disease
- Plaque-induced ______ modified by _______ factors
- Puberty-associated gingivitis and menstrual cycle gingivitis
- Peak levels of ____ and ______
- Swollen, ______ gingival tissues, ____ _____, aphthous ulcers, swollen salivary glands, increase in gingival ______
OHI AND TREATMENT
OHI- Increased ______, extra ____ toothbrush, power toothbrush, meticulous _____ cleaning
Treatment- topical _______ (for apthous ulcers), periodontal _______, scaling, root planing,
_______ mouth rinses, ______ rinses, gels, and varnish
PUBERTY AND MENSES
- Secondary sex characteristics develop
- Bacteria associated with increased estrogen levels
- Prevotella species & Tannerella forsythensis = periodontal disease
- Plaque induced gingivitis modified by systemic factors
- Puberty associated gingivitis and menstrual cycle gingivitis
- Peak levels of estrogen and progesterone
- Swollen, erythematous gingival tissues, herpes labialis, aphthous ulcers, swollen salivary glands, increase in gingival exudate
OHI AND TREATMENT
OHI- Increased toothbrushing, extra soft toothbrush, power toothbrush, meticulous interdental cleaning
Treatment- topical corticosteroids (for apthous ulcers), periodontal debridement, scaling, root planing,
antibacterial mouth rinses, fluoride rinses, gels, and varnish
Oral Health Considerations:
Adolescents (ages 12-17)
Teach:
_____ education
_____, smokeless tobacco, secondhand smoke
Oral effects: (3)
_____
Obstructive sleep _____ (OSA)
Oral _____
_______ abuse
Teach:
Tobacco education
Smoking, smokeless tobacco, secondhand smoke
Oral effects: leukoplakia, periodontal disease, oral cancer
Vaping
Obstructive sleep apnea (OSA)
Oral piercings
Substance abuse
Dental Hygiene Treatment: Adolescents (12-17)
Assess the presence, position, and development of ________
Provide _____ if removal is indicated
Oral manifestations of _____ transmitted diseases
Potential effects of ____ fluctuations and use of oral _____ on periodontal tissues
Oral findings of _____ or _______
Traumatic injury to teeth; Providing _______
Pregnancy: educate about the oral health of the _____ and _______
Assess the presence, position, and development of
third molars
Provide referral if removal is indicated
Oral manifestations of sexually transmitted diseases
Potential effects of hormone fluctuations and use of oral contraceptives on periodontal tissues
Oral findings of anorexia nervosa or bulimia
Traumatic injury to teeth; Providing mouth guards
Pregnancy: educate about oral health of mother and infant
REASONS FOR A REFERRAL (7)
- SEVERELY CROWDED, MALPOSED, OR
CONGENITALLY MISSING TEETH - OVERBITE, OVERJET, CROSSBITES, OR
OTHER MALOCCLUSIONS REQUIRING
INTERVENTION - LOSS OF PRIMARY MOLARS:
- Usually disrupts the eruption and alignment
of permanent molars and premolars - PATHOLOGY OR SYSTEMIC ILLNESS
- SUSPECTED CHILD ABUSE OR
NEGLECT - SUBSTANCE ABUSE IN THE FAMILY
- FAILURE TO PROVIDE SAFETY
MEASURES
DOCUMENTATION
Overall appraisal of _____ status and key ______ findings
Existing pathology: (4)
Oral hygiene status and ________ assessment
Procedures completed (_____)
Informed ______
Instructions provided to _____/______
Child’s ______ throughout appointment (objective observations)
Treatment planned for next visit
Overall appraisal of physical status and key health history findings
Existing pathology: soft tissue, gingiva, caries, occlusal status
Oral hygiene status and caries risk assessment
Procedures completed (services rendered)
Informed consent
Instructions provided to patient/parent
Child’s behavior throughout appointment (objective observations)
Treatment planned for next visit
ODU SODH CLINICAL CONSIDERATIONS
Only ages __ years or older can be seen
Parent or caregiver is encouraged to wait in the __________
Need to discuss ____, sign for _______, pay for ______, and participate in ____
Ages 5-12:
Use the ____ medical history and dental history form
No _____
Ages 13+:
Record _____
Use ___ medical and dental forms
Occlusion: Angle’s class
- Only if permanent _____ and/or first _____ are present
Additional findings
Periodontal charting:
- ___- full mouth
- Probe any _____ teeth
Dental charting
- _____ spacing
Scaling
- Only if _____ is present
- No calc = no scaling grade
Tx Plan:
- Ages 5-12: _____
- Do NOT treatment plan _______
Only ages 5 years or older can be seen
Parent or caregiver is encouraged to wait in the
waiting room
Need to discuss health history, sign for informed consent,
pay for treatment, and participate in OHI
Ages5-12:
Use the Child medical history and dental history form
No vitals
Ages 13+:
Record vitals
Use adult medical and dental forms
Occlusion: Angle’s class
Only if permanent canines and/or first molars are present
Additional findings
Periodontal charting:
FGM- full mouth
Probe any permanent teeth
Dental charting
Primate spacing
Scaling
Only if calculus is present
No calc = no scaling grade
Tx Plan:
Ages 5-12: D1120
Do NOT treatment plan calculus class
