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Vicky Chen Tasoula Petrou Slide 2 Early Childhood Caries (ECC) (baby bottle caries) Form of dental caries that affects the teeth of infants and young children. Most common chronic infectious childhood disease. Though not life threatening, may result in pain, function impairment, deterious influence on child growth rate, body weight, ability to thrive-> reduce quality of life Leading oral health problem of early childhood. Slide 3 Caries Slide 4 ECC is an aggressive form of dental caries that begins on tooth surfaces which are usually not affected by decay, such as labial surfaces of maxillary incisors, in contrast to dental caries which usually involves plaque retentive areas. Thus it is thought that there may be distinctive risk factors involved in the progression of ECC. Slide 5 Risk Factors was historically attributed to inappropriate and prolonged bottle use or breastfeeding. Primary Secondary: Bottle feeding Breastfeeding Oral Hygiene Fluoride Education of the parents Socioeconomic factors Slide 6 Bottle feeding when children are allowed to sleep with a bottle in their mouth, has been considered cariogenic. (formulated milk, fruit juices, carbonated beverages). reduction in salivary flow, thus decreasing salivary neutralization capacity. prolonged exposure to fermentable carbohydrates. decrease in plaque pH thus initiating the caries process. Slide 7 Breastfeeding Despite many advantages (optimal infant nutrition, immunological protection), prolonged breast-feeding apparently carries a risk of developing dental caries or nursing caries. (WHO) has therefore recommended that children be breastfed until 24 months of age. Slide 8 Oral Hygiene presence of dental plaque is a high risk factor for developing caries in young children. children who did not have their teeth cleaned at bedtime had a higher risk of developing ECC. As young children lack the ability to clean their own teeth effectively, parents are recommended to clean their childrens teeth at least until they reach school age. Slide 9 Fluoride important for enamel resistance, reducing the amount of minerals lost during demineralization and accelerating remineralization. Regular tooth-brushing with fluoridated toothpaste and brushing before going to bed. Slide 10 Education of the parents correlated with the occurrence and severity of ECC in their children. Milgrom showed that the mother is not only the reservoir of cariogenic bacteria, but that her dental knowledge, behavior, as well as the general care of her child are also some of the factors that contribute to caries risk. Slide 11 Socioeconomic Factors There is evidence of powerful links between the individuals socio-economic experience for disadvantaged children and adverse health events. Children born into low-income families are more likely to have low birth weight which impacts on oral health. Can further influence health literacy, which, in turn, affects general health. ECC is more common in children from single parent families and those with parents of low educational level. In this families, oral health is not ranked highly in priority. Slide 12 Clinical Appearance affects teeth upon eruption and is associated with a characteristic clinical presentation. The initial lesions appear as white spots on the facial tooth surface of maxillary incisors adjacent to the gingival margin, spreading later to the maxillary molars and mandibular molars. Slide 13 Stage 1: Healthy teeth and gums Slide 14 Stage 2: Chalky, white spots/lines on the tooth near the gum line Slide 15 Stage 3: Yellow / brownish discolouration or cavities. Slide 16 Stage 4: Well advanced decay or loss of tooth structure. Slide 17 Severe case of ECC Slide 18 Consequence Dental pain, which affects children's regular activities, such as eating, talking, sleeping, and playing. Additional carious lesions in their primary and permanent dentition. Loss of the childs front teeth at an early age. Further developmental setbacks involving speech articulation as these years are critical for speech development. Delays in physical development, especially in height and weight. Decrease in appetite, ultimately resulting in malnutrition. Psychological trauma from dental procedures required to restore their teeth-poor self-esteem. Numerous extractions done in GA condition (has its own risks). Slide 19 Treatment depending on the progression of the disease, the childs age, as well as the social, behavioral and medical history of the child. Early stage-close monitoring, fluoride, OHI. Advanced stage-When cavitation has occurred, more definitive treatment is required. Early stages of cavitation can be treated restoratively, while advanced stages will require more complicated measures such as strip crowns for the anterior teeth and stainless steel crowns for the posterior teeth. Pulpectomies or extractions may be indicated. GA and sedation ( depend on cooperation of child) Slide 20 Childhood and early adolescence are crucial periods in the development of healthy dentition. Therefore it is essential to prevent the extensive consequences and treatment of ECC. Slide 21 Study in New Zealand In 2009 just over half of 5 year old NZ children were caries free. An average of just over 48 percent had experienced dental caries by the end of preschool years. Slide 22 Prevention Improving oral health is one of the 13 population health objectives for the Ministry of Health and District Health Boards (DHBs) in the New Zealand Health Strategy It is supported by the strategic vision for oral health Good Oral Health for All, for Life (Ministry of Health 2006). Slide 23 Good Oral Health for All for Life Primary health care services and professionals/ PHOs GPs and practice nurses provide early anticipatory guidance (in the first six months) about the prevention of dental caries. Lift the Lip Lead maternity carers preventive oral health behaviours, including breast feeding, bottle feeding issues, tooth brushing and the importance of parental oral health. School dental service Slide 24 Oral health professionals include dentists, dental therapists, dental hygienists and dental assistants. provide: Free dental services to children from 0 to 17 years of age (until their 18 th birthday). preventive advice and guidance to reduce the risk of future dental caries. preventive treatments, including the use of fluoride varnish to reduce the risk of dental caries. treatment services, including dental fillings and extraction of teeth. Slide 25 DenLite Slide 26 Dental Denlite Project Slide 27 Why?? Effective preventive measure Efficiency of service delivery Creating a friendly experience Making SDS of easier access Slide 28 Friendly Dental Therapist Slide 29 DenLite Assessments Slide 30 Slide 31 Check for Oral soft, hard tissue and occlusion (abnormal or health) Teeth (presence,shape,position,mobility,plaque and cavitation.) DenLite assessment may stop with first indication of further clinical treatment. Slide 32 For children that need treatment.. Consent form is issued and appointment will be made for treatment to be done at the school dental clinic. Slide 33 Success of DenLite The Denlite project has resulted in: Improved access to pre-school dental care Increased parents and pre-school staffs knowledge of oral health issues and preventative measures Improved efficiency of service delivery by working collaboratively with other services. (e.g.Plunket Health Nurses) Slide 34 Success of DenLite Won the Waikato DHB Best of Health Award 2004. The judges said, The project focused on a national health priority to improve oral health and significantly increased the numbers of children being enrolled with the dental service which in turn will have a significant flow-on effect on their education and ongoing health status. The highly collaborative and innovative project created linkages across a variety of agencies and communities that had not previously existed and created a model that can be used in other parts of New Zealand. DenLite programme has also been included in the Waikato community oral health proposal as an important way of improving preschool oral health. Slide 35 Conclusion ECC is preventable and manageable with the right information and skills. A closer co-operation between healthcare professionals, dental therapists and paediatric dentists is required. Distribution of preventive health care literature, early referral and prompt treatment of the children with the signs of decay can help improve oral /dental health of children, thus improving their overall well being. Slide 36 Reference and Bibliography American Academy of Paediatric Dentistry. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. URL: http://www.aapd.org.www.aapd.org Berkowitz RJ. 2003. Causes, treatment and prevention of early childhood caries: a microbiologic perspective. Journal of the Canadian Dental Association 69(5): 3047. Davies GM, Duxbury JT, Boothman NJ, et al. 2007. Challenges associated with the evaluation of a dental health promotion programme in a deprived urban area. Community Dental Health 24: 11721. Gussy MG, Waters E, Kilpatrick NM. 2006. A qualitative study exploring barriers to a model of shared care for pre- school childrens oral health. British Dental Journal 201(3): 16570. Gussy MG, Waters E, Walsh O, et al. 2006. Early childhood caries. Current evidence for aetiology and prevention. Journal of Paediatrics and Child Health 42: 3743. Hallett KB, ORourke PK. 2003. Social and behavioural determinants of early childhood caries. Australian Dental Journal 48(1): 2733. Lee M, Dennison PJ. 2004. Water fluoridation and dental caries in 5- and 12-year-old children from Canterbury and Wellington. New Zealand Dental Journal 100(1): 105. Ministry of Health. 2002a. Reducing Inequalities in Health. Wellington: Ministry of Health. Ministry of Health. 2002b. Well Child Tamariki Ora National Schedule. URL: http://www.moh.govt.nz/wellchild.www.moh.govt.nz/wellchild Ministry of Health. 2004a. Child Oral Health Services Service Specification. URL: http://www.moh.govt.nz/moh.nsf.www.moh.govt.nz/moh.nsf Ministry of Health. 2004b. DHB Toolkit Improve Oral Health. URL: http://www.moh.govt.nz/oralhealth.www.moh.govt.nz/oralhealth Slide 37 Thank you for your attention!