NURS 330 - Peds quiz 2 Flashcards
What is the most chronic disease of childhood
Tooth decay
5x more common than asthma
7x more common than allergies
Early Childhood Carries (ECC)
Tooth decay
Early Childhood Carries (ECC) Complications
Pain/Infection
Malnutrition
Loss of sleep
Missed school days
How many Canadian children have tooth decay?
2/3 of all Canadians aged 6-11 have tooth decay
1 in 3 kids entering grade 1 have tooth decay
Access to oral healthcare in Canada
85% of Canadians report that they have good oral health
75% have visited the dentist within the last year
32% have no dental insurance
53% between ages 60&79 have no dental insurance
50% of low income families have no dental insurance
Serious Complications of Poor Oral Health
Diabetes (from mouth yeast infection), Cardiovascular disease, Pre-term LBW babies, Obesity, Cognitive Function, Aspiration pneumonia
Bacterial cause of Dental Carries
Streptococcus Mutans:
- Gram positive coccus
- commonly found in the oral cavity
Process of tooth decay
Bacteria + Sugar = ACID
Acid + tooth = CAVITY
Primary modifying factors of tooth decay
Tooth anatomy, saliva, biofilm pH, use of fluoride, diet specifics, oral hygiene, immune system, genetic factors
Secondary modifying factors of tooth decay
socioeconomic status, education, lifestyle, environment, age, ethnic group, occupation
Non-disease state of teeth
Normal equilibrium between demineralization and remineralization
Pathological factors of tooth decay
Cariogenic bacteria, subnormal salivary function and diet
Protective factors of tooth decay
Salivary flow & components, Fluoride/Calcium/Phosphate
Antibacterials & chemotherapeutics
Where are dental carries usually found?
Smooth surfaces (near gumline) just at or below where 2 teeth touch, pits and fissures, exposed root surfaces, underneath existing fillings, teeth which hold dentures or other dental work in place
Clinical appearance of dental carries: early lesions
White, chalky appearance, often seen at gumline or where ortho brackets were placed
Clinical appearance of dental carries: Progressing/advanced lesions
Light brown, wet appearance
Caviated
Clinical appearance of dental carries: Inactive/Arrested lesions
Dark brown or black, leathery appearance
Feel hard with probing
Periodontal Disease
Inflammation of the supporting tissue of the teeth
Progressive destructive change leading to loss of bone and periodontal ligament
Periodontitis increase the risk for…
Cardiovascular disease, diabetes, respiratory diseases, adverse pregnancy outcomes
Risk factors for ECC
Fluoride exposure, diet, sleep time routine, oral hygiene, habits, special health needs, previous carries, oral bacteria, poor family oral health, socioeconomic status
Fluoride Exposure (risk for ECC)
GOOD when it is in water - prevents tooth decay (should not use too much)
Dietary habits (risk for ECC)
Consistent bottle use
Types, consistency and frequency of food and liquid intake
Sleeping habits (risk for ECC)
Sleeping with a bottle increases risk for tooth decay
Oral Hygiene (risk for ECC)
Starting brushing teeth as soon as they have them
wipe gums with clean cloth if they do not have teeth
Child should go to dentist by age 1 to increase comfort
Poor family oral health (risk for ECC)
Carries experience of the primary caregiver
Transmission of bacteria
Parental attitude toward oral hygiene (did parent group up with dental insurance?)
Socioeconomic Status (risk for ECC)
Disparities in dental disease by income
Access to care (insurance, clinic close by, ability to book appointment)
Low-income children suffer twice as much for untreated dental disease
High Risk Biologically if…
Mother/primary caregiver has cavities
Parent/caregiver has low socioeconomic status
Child has > 3 meal sugar-containing snacks or beverages per day
Child is put to bed with a bottle containing natural or added sugar
Child is a recent immigrant
Child has special healthcare needs
High risk Protectively if…
Child receives no fluoride in drinking water/supplements
Child does not brush teeth daily with fluoride toothpaste
Child does not receive topical fluoride from health professional
Child has no dental home/regular dental care
High risk Clinically if…
Child has white spot lesions or enamel defects
Child has visible cavities or fillings
Child has plaque on teeth
Oral health screening
Medical Hx and allergies
When did you last see dentist? (if > 1 years, ask about access)
How often are teeth brushed/flossed? (if <8, confirm that parent is assisting)
Do teeth hurt? (esp in bed or when eating icecream)
Extra-oral exam
Look at general appearance, any visible asymmetries or swelling (swelling may be in eye/cheek/lips/neck areas)
Intra-oral screening: teeth
Count teeth
document cavities/dark staining using letter “D” under tooth in question
Record if fillings with “F” or broken with “B”
If in doubt, document decay
Intra-oral screening: soft tissues
Look at floor of mouth (under tongue) and gums
If any swellings record with “A” under the tooth number
Swellings require immediate attention
Tooth Brushing recommendations
Brush twice daily (nightime = most important)
Soft or extra-soft bristles
Fluoride toothpaste (rice grain until 3yrs, pea size 3-6yrs)
Assist children up to 8 yrs
Flossing recommendations
Start when teeth touch
Do before toothbrushing
Target areas toothbrushing can’t access
Plaque control - Interdental cleaning
Target space beneat interproximal contact area of teeth
Fluoride Varnish
Topical fluoride
Safe in young children
Easy to apply
Application q6months
Fluoride Varnish Application
Dry teeth with gauze
Apply to teeth (not gums)
Wait desired time and close mouth
Instruct pt not to brush or floss until evening, eat soft diet for the day.
teeth may feel rough and discolored until brushing
Fluoride varnish contraindications
People with allergies to colophony or pine rosin
Those at low risk for dental caries
Those who attend dentist regularily
Enemies for your teeth
Starchy, refined carbs (chips, potatoes, crackers, bread, pasta) Sugary candy (hard candies, taffy&caramel, chocolate, cookies/cake/brownies) Acidic foods & fruit (lemons & citrus, diet sodas, vinegars) and Sugary beverages & juice (all soda, fruit juices, alcohol, sugar-added coffee/tea)
When to wean baby from bottle
12-15 months
When should cup be introduced
6-8months
How often can child have juice
NO MORE than 1-2oz/day and NEVER in a bottle
