Definitions, Prenatal, Perinatal and ECOH Flashcards
(129 cards)
1
Q
How many children are affected by caries by kindergarten?
A
1 in 4
2
Q
Definition: Prenatal
A
- Relates to pregnant women and occurring before birth.
- Marked by weeks from first day of last period with conception occurring two weeks after last period.
3
Q
Mean duration of pregnancy
A
280 days (40 weeks)
4
Q
Definition: Full term
A
36 wk 0 days - 41 wk 6 days gestation
5
Q
Definition: Preterm
A
20 wk 0 days - 36 wk 6 days of gestation
6
Q
Definition: Low birth weight (LBW)
A
<2,500 grams @ birth, regardless of gestational age
7
Q
Definition: Perinatal/Neonatal
A
Refers to mother and/or fetus from 20th week of gestation through 4 weeks post-partum or 28 days of extra-uterine life
8
Q
Definition: Infant
A
1mo - 12mo
9
Q
Definition: Toddler
A
- Originated as term to describe child learning to walk.
- 1yo - 36mo
10
Q
What steps are involved in OH care during pregnancy?
A
- Understanding implications of pregnancy on OH
- Implications of OH on pregnancy
- Protocol for prenatal providers
- Protocol for dental professionals
11
Q
Implications of OH on pregnancy
A
Poor OH is associated with:
- Decreased birthweight
- Growth restriction
- Preterm delivery
- Preeclampsia
- Early pregnancy loss
- Intrauterine fetal demise
12
Q
Protocol for prenatal provider
A
- Asses OH status for signs of dental and periodontal disease and ST pathology
- OH counseling:
- Safety of dental treatment during pregnancy, including radiographs and LA
- OH, dietary practices, morning sickness
- Use of folic acid and avoidance of tobacco and alcohol is protective for facial clefts
- Refer to dental home if last dental visit occurred more than 6mo ago for preventive care, assessment and treatment
- Promote coordinated care
13
Q
Protocol for dental care:
A
- Necessary dental treatment is safe throughout pregnancy
- Radiographs follow ALARA
- Manage oral disease as indicated
- Positioning during treatment: Semi-seated position avoid aspiration, pillow placement under right hip maintains uterus off the vena cava
- Second trimester poses greatest comfort, since generally nausea has stopped and uterus is a size where lying down is not uncomfortable
- Be familiar with guidelines for safety of medications during pregnancy
- Consult prenatal health care providers
- Address post-op pain with OB as needed, self medication can contribute to adverse events for mother and fetus
14
Q
Aspirin: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: Minimal
- Adverse Events: May affect fetal growth, premature closure of ductus arteriosus.
- Quality of Evidence: Good
- Restrictions/Special Considerations: Choose other analgesics
- Breastfeeding: Best to avoid
15
Q
Acetaminophen: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: None to minimal
- Adverse Events: Minimal
- Quality of Evidence: Good
- Restrictions/Special Considerations:
- Analgesic and antipyretic of choice
- Safe to use in normal doses
- Breastfeeding: Safe to use in normal doses
16
Q
Ibuprofen: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: Minimal
- Adverse Events:
- Oligohydramnios
- Premature closure of ductus arteriosus
- Neonatal effects (renal failure, increased risk of necrotizing enterocolitis or intraventricular hemorrhage)
- Quality of Evidence: Fair to good
- Restrictions/Special Considerations:
- Very short duration of use
- Avoid in 1st and 3rd trimester
- Do not use for >4-72hr
- Breastfeeding: Safe to use in normal doses
17
Q
Naproxen: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: Minimal
- Adverse Events:
- Oligohydramnios
- Premature closure of ductus arteriosus
- Neonatal effects (renal failure, increased risk of necrotizing enterocolitis or intraventricular hemorrhage)
- Quality of Evidence: Fair
- Restrictions/Special Considerations: Choose other NSAID if possible, some serious neonatal reactions reported and has long half-life
18
Q
Codeine: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: Small risk of heart defects
- Adverse Events: Neonatal withdrawal
- Quality of Evidence: Fair to good
- Restrictions/Special Considerations: Use minimum effective dose; crosses the placenta
- Breastfeeding: At high doses or when used for >4 days, may cause depression/drowsiness in breastfeeding infants, particularly those with CYP2D6*2 allele which results in rapid metabolism of codeine.
19
Q
Morphine: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: Unlikely
- Adverse Events: Neonatal withdrawal
- Quality of Evidence: Fair to good
- Restrictions/Special Considerations: Use minimum effective dose; crosses the placenta
- Breastfeeding: At high doses or when used for >4 days, may cause depression/drowsiness in breastfeeding infants
20
Q
Meperidine: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: Unlikely
- Adverse Events: Neonatal withdrawal
- Quality of Evidence: Fair
- Restrictions/Special Considerations: Withdrawal symptoms in neonate may occur with prolonged or chronic use.
- Breastfeeding: At high doses or when used for >4 days, may cause depression/drowsiness in breastfeeding infants (other agents preferred)
21
Q
Penicillin: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: None
- Adverse Events: N/A
- Quality of Evidence: Good
- Restrictions/Special Considerations: Acceptable
- Breastfeeding: Acceptable; monitor for GI changes in infant
22
Q
Amoxicillin: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: Unlikely
- Adverse Events: N/A
- Quality of Evidence: Good
- Restrictions/Special Considerations: Acceptable
- Breastfeeding: Acceptable; monitor for GI changes in infant
23
Q
Cephalexin: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: Unlikely
- Adverse Events: N/A
- Quality of Evidence: Fair to limited
- Restrictions/Special Considerations: Acceptable
- Breastfeeding: Acceptable; monitor for GI changes in infant
24
Q
Ceftriaxone: Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
A
- Teratogenic Risk: Unlikely
- Adverse Events: N/A
- Quality of Evidence: Limited
- Restrictions/Special Considerations: Acceptable
- Breastfeeding: Acceptable; monitor for GI changes in infant
25
**Clindamycin:** Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
* Teratogenic Risk: **Unlikely**
* Adverse Events: **N/A**
* Quality of Evidence: **Limited**
* Restrictions/Special Considerations: **Acceptable**
* Breastfeeding: **Acceptable; monitor for GI changes in infant**
26
**Erythromycin:** Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
* Teratogenic Risk: **Minimal**
* Adverse Events: **N/A**
* Quality of Evidence: **Fair**
* Restrictions/Special Considerations: **Erythromycin estolate is avoided due to potential maternal hepatotoxicity**
* Breastfeeding: **Acceptable; monitor for GI changes in infant**
27
**Tetracycline:** Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
* Teratogenic Risk: **Moderate for tooth staining**
* Adverse Events: **Use after 25 weeks may result in staining of teeth and possible effects on bone growth and can cause maternal hepatotoxicity**
* Quality of Evidence: **Good**
* Restrictions/Special Considerations: **Avoid during pregnancy**
* Breastfeeding: **Do not use**
28
**Fluoroquinolones:** Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
* Teratogenic Risk: **Unlikely**
* Adverse Events: **Toxic to developing cartilage in animal studies**
* Quality of Evidence: **Fair**
* Restrictions/Special Considerations: **Avoid during pregnancy**
* Breastfeeding: **Choose alternative drug if possible**
29
**Clarithromycin:** Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
* Teratogenic Risk: **Unlikely**
* Adverse Events: **N/A**
* Quality of Evidence: **Limited**
* Restrictions/Special Considerations: **Choose alternative if possible**
* Breastfeeding: **Acceptable; monitor for GI changes in infants**
30
**Lidocaine:** Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
* Teratogenic Risk: **None**
* Adverse Events: **Crosses placenta and can reach fetal circulation**
* Quality of Evidence: **Fair**
* Restrictions/Special Considerations: **Acceptable**
* Breastfeeding: **Acceptable**
31
**Chlorhexidine:** Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
* Teratogenic Risk: **Unlikely**
* Adverse Events: **N/A**
* Quality of Evidence: **Fair**
* Restrictions/Special Considerations: **Acceptable for topical use and oral rinse**
* Breastfeeding: **Acceptable for topical use and oral rinse**
32
**Xylitol:** Teratogenic Risk, Adverse Events, Quality of Evidence, Restrictions/Special Considerations, Breastfeeding
* Teratogenic Risk: **Unlikely**
* Adverse Events: **N/A**
* Quality of Evidence: **Not available**
* Restrictions/Special Considerations: **No reference available on possible adverse pregnancy effects**
* Breastfeeding: **No reference available on possible adverse lactation effects**
33
Where do bacteria in the predentate infant likely remain dormant?
Crevices of the tongue and tonsils until the non-desquamating surfaces of primary teeth emerge, although direct proof is yet to be shown
34
Infants born via C-section vs. children born vaginally
Children born c-section are colonized by *S. mutans* earlier than children born vaginally, presumably because vaginal delivery plays an important role in acquisition of the oral biome
35
Preventive strategies during the prenatal period
* AAPD recommends emphasis with education/anticipatory guidance (promoting OH habits, health diet, regular dental visits)
* Risks associated with maternal bacterial levels are also addressed, although emerging evidence suggests that the microbiome is more complex
36
Breastfeeding: AAPD/WHO stance
AAP and WHO recommend exclusive breastfeeding for the first 6mo, continued through one year or longer as mutually desired by mother and infant
37
Breastfeeding contraindications
* Medical conditions of mother/child
* Environmental contaminants from maternal exposure
* Medications or drugs due to maternal use
38
Benefits of breastfeeding
* **Infant**
* **Bonding**
* **Immunologic**: Maternal antibodies and decreased incidence of URI/LRI; otitis media, GI infections
* **Metabolic**
* **Decreased risk of SIDS**
* Positive effect on cognitive development
* Protective effects on malocclusion at 5yo remains controversial
* **Mother**
* **Reproductive:** Decreased post-partum blood loss, rapid involution of uterus, increased child spacing
* **Physical benefits:** Decreased risk of later rheumatoid arthritis, CV disease, breast and ovary cancers
* **Social/Emotional:** Decreased risk of post-partum depression, child abuse
39
Breastfeeding challenges
* Difficulty ranges from 25-80%
* Latching problems, poor infant sucking, insufficient weight gain, sore nipples, breast engorgement, poor milk supply, mastitis
* Some difficulties linked to ankyloglossia, but controversy exists whether frenotomy/frenulectomy improves breastfeeding and non-breastfeeding outcomes (e.g. articulation, food clearance, orthodontic/periodontal development)
40
Breastfeeding and ankyloglossia
* Limited quality evidence exists addressing the benefit of surgical intervention, no consensus on most effective surgical approaches
* **Ankyloglossia prevalence: ~5%; higher in males**
* **_50% of babies with ankyloglossia who are breastfed have no feeding trouble_**
41
Non-nutritive sucking (NNS): AAP stance
AAP states pacifiers may be used during breastfeeding, but delay introduction until breastfeeding is well-established (~1mo)
42
Non-nutritive sucking (NNS): Benefits
* Pacifier use is protective for SIDS - exact mechanism not well understood
* Not associated with decrease in duration of breastfeeding
43
Non-nutritive sucking (NNS): Challenges
* Prolonged NNS → malocclusion (anterior open bite, increased OJ, posterior cross-bite)
* Recommend cessation by **_3yo or with establishment of terminal planes of occlusion_**
* **_Prolonged pacifier use (past 6mo) may increase incidence of otitis media and increased risk of oral candida and GI infections_**
44
Pacifier recommendations
* US - must comply with CPS requirement 16, CFR Part 1511 of the US Consumer Product Safety Commission and certify it has passed all safety standards
* **_Shield: At least 1.5in across (3.8cm) and have ventilation holes_**
* **_Do not tie to neck, hand or crib = strangulation hazard_**
45
Motivational Interviewing
Incorporates individual's stage of readiness to change
* **Use open ended questions:** Require more than one word answer
* **Use non-judgmental affirmation:** Listen with compassion and not accusation
* **Use reflective listening:** Be empathic, provide unconditional acceptance, avoid vague statements
* **Use periodic summary statements:** “Out of all the things we discussed, what are you most likely to do”
46
**Diet** at 1-12mo, 12-24mo, 24-36mo
* 1-12mo
* Nutrition and dental health
* Breastfeeding
* Bottle use and weaning
* Sippy-cup use and content
* Review caries process
* 12-24mo
* Role of carbs (juice) exposures
* Retention of food
* Revisit sippy cup issues
* Review caries process
* 24-36mo
* Snacks
* Frequency issues
* Role of carbs (juice) exposures
* Revisit sippy cup issues
* Review caries process
47
**OH** at 1-12mo, 12-24mo, 24-36mo
* 1-12mo
* Bacterial acquisition
* Establish bedtime routines (brush, book, bed = B's)
* OH as part of general hygiene
* Positioning baby for OH
* Special techniques
* ‘Smear’ or ‘grain of rice’ amount of F toothpaste
* 12-24mo
* Reinforce bedtime routines (brush, book, bed = B's)
* Child participation
* 'Smear’ or ‘grain of rice’ amount of F toothpaste
* Introduce flossing when teeth are in contact, little evidence supports benefits of flossing
* 24-36mo
* Power brushes/toddler techniques
* Floss
* Continued parental participation
* Encourage ‘smear size’ or grain of rice until able to expectorate
48
**Fluoride exposure** at 1-12mo, 12-24mo, 24-36mo
* 1-12mo
* F mechanisms
* Sources of F
* Choice of F vehicles
* Toxicity issues/storage
* Formula and F
* F dentrifice use, when first tooth emerges
* 12-24mo
* F dentrifice use
* F in food sources
* Avoiding excessive F ingestion
* 24-36mo
* F use revisited at every interval
* Daily access
49
**Non-nutritive habits** at 1-12mo, 12-24mo, 24-36mo
* 1-12mo
* Pacifier use and types/safety
* Oral stimulators
* 12-24mo
* Digit habit issues
* Effect on occlusion
* 24-36mo
* Revisit habit issues
50
**Injury prevention** at 1-12mo, 12-24mo, 24-36mo
* 1-12mo
* Signs of trauma
* Child abuse oral signs
* Emergency access plan/instructions
* Implications for permanent teeth
* Car seats
* 12-24mo
* Daycare instructions
* Electric cord safety
* Replantation warning re: primary teeth
* Child proofing
* 24-36mo
* Helmet safety
* Seat belts
* Safety network
* Reinforce emergency access plan/instructions
51
**Dental and oral development** at 1-12mo, 12-24mo, 24-36mo
* 1-12mo
* Milestones
* Patterns of eruption
* Environmental and genetic influences
* Teething
* Infant oral cavity
* 12-24mo
* Occlusion
* Spacing issues
* Speech and teeth
* Tooth calcification
* 24-36mo
* Last primary tooth erupted
* Exfoliation
* Future orthodontic needs
* Radiographs
52
Key concepts of chronic disease model (CDM) for ECOH (9 points)
* Dental caries is a complicated disease influenced by biological, social, behavioral, educational, environmental, and health system factors.
* CDM aims to address underlying risk factors in a targeted and individually tailored basis in collaboration with health care professionals.
* Caregivers are actively engaged in health management (self-management) using evidence-based protocols of care set by professionals.
* Providers should not prescribe goals, but work with caregivers to define goals.
* Limit the number of self-management goals to 1-2 items at each encounter avoiding overwhelming information.
* Techniques such as motivational interviewing, coaching, role modeling, peer engagement, positive reinforcement, and social reward are used to engage caregivers for the purpose of addressing barriers to change.
* Every dental encounter should be considered a health management opportunity to engage and coach the caregiver by revising risk factors and customizing care plan.
* Frequency of health management visits should be established based on patient's risk level (1-3 months for high risk patients).
53
Chemotherapeutic agents for ECOH: **Fluoride TP** - MOA, evidence to support use in preventing ECC
* MOA:
* **Inhibit demineralization**
* **Promote remineralization**
* **Antibacterial**
* Evidence to support use in preventing ECC: **Moderate**
54
Chemotherapeutic agents for ECOH: **Fluoride varnish** - MOA, evidence to support use in preventing ECC
* MOA:
* **Inhibit demineralization**
* **Promote remineralization**
* **Antibacterial**
* Evidence to support use in preventing ECC: **Moderate**
55
Chemotherapeutic agents for ECOH: **Fluoride tablets/drops**- MOA, evidence to support use in preventing ECC
* MOA: **Improve enamel crystallinity**
* Evidence to support use in preventing ECC: **Insufficient**
56
Chemotherapeutic agents for ECOH: **SDF** - MOA, evidence to support use in preventing ECC
* MOA: **Arrest carious lesions**
* Evidence to support use in preventing ECC: **Moderate**
57
Chemotherapeutic agents for ECOH: **Silver nitrate** - MOA, evidence to support use in preventing ECC
* MOA: **Arrest carious lesions**
* Evidence to support use in preventing ECC: **Moderate**
58
Chemotherapeutic agents for ECOH: **Topical iodine** - MOA, evidence to support use in preventing ECC
* MOA: **Suppress the microbial flora**
* Evidence to support use in preventing ECC: N/A
59
Chemotherapeutic agents for ECOH: **Casein phosphopeptide amorphous calcium phosphate** - MOA, evidence to support use in preventing ECC
* MOA: **Remineralizing agent**
* Evidence to support use in preventing ECC: **Insufficient**
60
Chemotherapeutic agents for ECOH: **Chlorhexidine varnish/gel** - MOA, evidence to support use in preventing ECC
* MOA: **Antibacterial**
* Evidence to support use in preventing ECC: **Insufficient**
61
Chemotherapeutic agents for ECOH: **Probiotic bacteria** - MOA, evidence to support use in preventing ECC
* MOA: **Biofilm shift**
* Evidence to support use in preventing ECC: **Insufficient**
62
Frenectomy
Excision of the frenulum left to heal by secondary intention
63
Frenotomy
Simply cutting or incision of the frenulum
64
Frenuloplasty
Excisions involving sutures releasing the frenulum and correcting the anatomic situation
65
Are anomalies in frenulum attachment higher in females or males?
Males
66
Maxillary frenulum classification
* **Mucosal:** Attached up to the mucogingival junction.
* **Gingival:** Frenal fibers are inserted within the attached gingiva.
* **Papillary:** Frenal fibers are extending into the interdental papilla.
* **Papilla penetrating:** Fibers cross the alveolar process and extend to the palatine papilla.
67
What types of maxillary frenulums are the most common?
**_Mucosal**_ and _**gingival_** are most common.
Infants have highest prevalence of papillary penetrating phenotype.
68
Why is a restrictive maxillary frenulum associated with feeding difficulties in newborns?
The restrictive maxillary frenulum results in a poor seal. **_Reflux_** also results from this poor seal due to intake of air. This can lead to ***colic/irritability***.
69
When is treatment for a maxillary frenulum suggested?
* When the attachment exerts a traumatic force on the gingiva, causing the papilla to blanch when the upper lip is pulled.
* If the attachment causes a diastema **_\>2mm_**.
* **_\*RARELY\* closes spontaneously_**!
70
What is the agreement between ortho and pedo with frenectomies?
Frenectomies **_should not be performed before the permanent canines erupt_** and that the operation should follow orthodontic closure of the space.
71
How can a mandibular labial frenulum lead to bone loss?
The mandibular labial frenulum can pull on fibers inserted into the free marginal tissue → pocket formation → food + plaque accumulation → inflammation, recession, pocket formation, bone loss.
72
What is the WHO recommendation with breastfeeding?
Breastfeed for child's first **_6mo_** to achieve optimal growth, development and health.
73
What is the AAPD recommendation for breastfeeding?
Exclusive breastfeeding for 6mo.
74
What are common symptoms for tongue-tie/lip-tie babies?
* Poor or shallow latch on the breast or bottle
* Slow or poor weight gain
* Reflux
* Irritability from swallowing excessive air
* Prolonged feeding time
* Milk leaking from the mouth due to a poor seal
* Clicking or smacking noises when nursing/feeding
* Painful nursing
75
What is **ankyloglossia**?
* **_Partial_ ankyloglossia:** Congenital developmental anomaly of the tongue characterized by a short, thick lingual frenulum resulting from limitation in tongue movement.
* **_Total_ ankyloglossia:** Tongue appearing to be fused to the floor of the mouth.
76
Prevalence of ankyloglossia
4-10%
77
What kind of tongue mobility is most important for nursing, feeding, speech and development of the dental arch?
The tongue's ability to **_elevate_** rather than protrude.
78
What difficulties are associated with ankyloglossia?
* Feeding difficulties in neonates
* Limited tongue mobility
* Speech difficulties
* Malocclusion
* Gingival recession
* During breastfeeding:
* Ineffective latch
* Inadequate milk transfer and intake
* Persistent maternal nipple pain
* All of which may lead to possibly early cessation of breastfeeding
79
What speech sounds do patients with ankyloglossia struggle with?
* Speech assessment outcomes are **_highly variable_**.
* Consonants
* S, Z, T, L, SH, CH, TH, DG, especially difficult to roll the R.
80
How does tongue-tie affect the palate, soft palate?
High-arched palate, elongated soft palate
81
Where may you see gingival recession associated with ankyloglossia?
Localized gingival recession on lingual mandibular incisors
82
Treatment/post-operative care for ankyloglossia?
* Dressing placement or the use of abx is not necessary
* Post-op:
* Soft diet, regular OH, analgesics PRN
* Post-op exercises are necessary to prevent reattachment of the wound and relapse of the previous symptoms associated with tongue/lip-tie.
83
Benefits of using lasers to treat tongue-tie?
* Shorter operative working time
* Better hemostasis
* Reduce intra- and post-op pain and discomfort
* Fewer post-op complications
* No need for suture removal
* Increased patient acceptance
84
What are the most commonly used caries risk indicators?
* Presence of caries lesions
* Low salivary flow
* Visible plaque on teeth
* High frequency sugar consumption
* Presence of appliance in mouth
* Health challenges
* Sociodemographic factors
* Access to care
* Cariogenic microflora
85
What are risk factors that will put patients into **moderate risk**?
* Recent immigrant (all ages)
* SHCN (all ages)
* Defective restoration (\>6yr)
* Intraoral appliances (\>6yr)
86
What are protective factors with CRA?
* **Fluoride exposure**
* Optimally fluoridated H2O
* Brushing daily with fluoridated toothpaste
* Receiving topical fluoride from health professionals
* Regular dental cares
* **Dental home**
87
Recall schedule according to risk level
* **Low:** 6-12mo
* **Moderate:** 6mo
* **High:** 3mo
88
Radiograph schedule according to risk level
* **Low:** 12-24mo
* **Moderate:** 6-12mo
* **High:** 6mo
89
Role of CRA?
* Fosters the treatment of the disease process instead of treating the outcome of the disease.
* Allows an understanding of the disease factors for a specific patient and aids in individualizing preventive discussions.
* Individualizes, selects, and determines frequency of preventive and restorative treatment for a patient.
* Anticipates caries progression or stabilization.
90
What factors are involved in current CRA models?
* Diet
* Fluoride exposure
* Susceptible host
* Microflora
Interplay with a variety of social, cultural and behavioral factors.
91
What is CRA?
The determination of the likelihood of the increased incidence of caries (i.e. the # of new cavitated or incipient lesions) during a certain time period or the likelihood that there will be a change in the size or activity of lesions already present.
92
Definition: Caries risk indicators
Variables that are thought to cause the disease directly (e.g. microflora) or have been shown useful in predicting it (e.g. life-time poverty, low health literacy) and include those variables that may be considered protective factors.
93
What are most commonly used caries risk indicators?
* Presence of caries lesions
* Low salivary flow
* Visible plaque on teeth
* High frequency of sugar consumption
* Presence of appliance in mouth
* Health challenges
* Sociodemographic factors
* Access to care
* Cariogenic microflora
94
How are CRA forms organized?
* By **_age_**: 0-5yo, \>/= 6yo.
* Incorporating three factor categories:
* **Social and biological risk factors**
* **Protective factors**
* **Clinical findings appropriate for the patient age**
* Addressing risk factors of high, moderate, and low, based on treatment categories:
* Diagnostics
* Interventions (fluoride, diet, counseling, sealants)
* Restorative care
95
What are care pathways?
* Documents designed to assist in clinical decision-making.
* Provide criteria regarding diagnosis and treatment and lead to recommended courses of action.
* Further refine the decisions concerning individualized treatment and treatment thresholds based on specific patient's risk levels, age, and compliance with preventive strategies.
* Yield greater probability of success, fewer complications, more efficient use of resources than less standardized treatment.
96
Factors that place patients as **low risk** for CRA?
* 0-5yo, /= 6yo are same for low risk factors.
* Protective factors:
* Optimally fluoridated H2O or fluoride supplements
* Teeth brushed daily w/ fluoridated toothpaste
* Topical fluoride from health professional
* Dental home/regular dental care
97
Factors that place patients as **moderate risk** for CRA?
* 0-5yo
* Recent immigrant
* SHCN
* \>/= 6yo
* Recent immigrant
* SHCN
* Defective restorations
* Intraoral appliance
98
Factors that place patients as **high risk** for CRA?
* 0-5yo
* Mother/primary caregiver has active dental caries
* Parent/caregiver has life-time of poverty, low health literacy
* Child has frequent exposure (\>3x/day) between meal sugar containing snacks or beverages per day
* Child uses a bottle or non-spill cup containing natural or added sugar frequently, between meals and/or at bedtime
* Non-cavitated (incipient/white spot) caries or enamel defects
* Visible cavities or fillings or missing teeth due to caries
* Visible plaque on teeth
* \>/= 6yo
* Mother/primary caregiver has active dental caries
* Parent/caregiver has life-time of poverty, low health literacy
* Child has frequent exposure (\>3x/day) between meal sugar containing snacks or beverages per day
* \>/= 1 interproximal caries lesion
* Active non-cavitated (white spot) caries lesions or enamel defects
* Low salivary flow
99
Caries management pathway for **low risk 0-5yo** (diagnostics, interventions [fluoride, dietary counseling, sealants], restorative)?
* Diagnostics
* RC every **6-12mo**
* Radiographs every **12-24mo**
* Interventions
* **Fluoride: Drink fluoridated H2O, 2x/day brushing w/ fluoride TP**
* **Dietary counseling: Yes**
* **Sealants: Yes**
* Restorative
* **Surveillance**
100
Caries management pathway for **moderate risk 0-5yo** (diagnostics, interventions [fluoride, dietary counseling, sealants], restorative)?
* Diagnostics
* RC every **6mo**
* Radiographs every **6-12mo**
* Interventions
* **Fluoride: Drink fluoridated H2O, 2x/day brushing w/ fluoride TP, fluoride supplements, topical fluoride every** ***_6mo_***
* **Dietary counseling: Yes**
* **Sealants: Yes**
* Restorative
* **Active surveillance of non-cavitated (white spot) caries lesions**
* **Restore cavitated/enlarging caries lesions**
101
Caries management pathway for **high** **risk 0-5yo** (diagnostics, interventions [fluoride, dietary counseling, sealants], restorative)?
* Diagnostics
* RC every **3mo**
* Radiographs every **6mo**
* Interventions
* **Fluoride: Drink fluoridated H2O, 2x/day brushing w/ fluoride TP, fluoride supplements, topical fluoride every** ***_3mo_*****, SDF on cavitated lesions**
* **Dietary counseling: Yes**
* **Sealants: Yes**
* Restorative
* **Active surveillance of non-cavitated (white spot) caries lesions**
* **Restore cavitated/enlarging caries lesions**
102
Caries management pathway for **low** **risk \>/= 6yo** (diagnostics, interventions [fluoride, dietary counseling, sealants], restorative)?
* Diagnostics
* RC every **6-12mo**
* Radiographs every **12-24mo**
* Interventions
* **Fluoride: Drink fluoridated H2O, 2x/day brushing w/ fluoride TP**
* **Dietary counseling: Yes**
* **Sealants: Yes**
* Restorative
* **Surveillance**
103
Caries management pathway for **moderate risk \>/= 6yo** (diagnostics, interventions [fluoride, dietary counseling, sealants], restorative)?
* Diagnostics
* RC every **6mo**
* Radiographs every **6-12mo**
* Interventions
* **Fluoride: Drink fluoridated H2O, 2x/day brushing w/ fluoride TP, fluoride supplements, topical fluoride every** ***_6mo_***
* **Dietary counseling: Yes**
* **Sealants: Yes**
* Restorative
* **Active surveillance of non-cavitated (white spot) caries lesions**
* **Restore cavitated/enlarging caries lesions**
104
Caries management pathway for **high** **risk \>/= 6yo** (diagnostics, interventions [fluoride, dietary counseling, sealants], restorative)?
* Diagnostics
* RC every **3mo**
* Radiographs every **6mo**
* Interventions
* **Fluoride: Drink fluoridated H2O,** ***_brushing w/ 0.5% fluoride gel/TP_*****, fluoride supplements, topical fluoride every*****_3mo_*****, SDF on cavitated lesions**
* **Dietary counseling: Yes**
* **Sealants: Yes**
* Restorative
* **Active surveillance of non-cavitated (white spot) caries lesions**
* **Restore cavitated/enlarging caries lesions**
105
Why is dental care medically necessary?
* Preventing and eliminating orofacial disease, infection and pain.
* Restoring the form and function of the dentition.
* Correcting facial disfiguration or dysfunction.
106
Definition: **Medically necessary care**
The reasonable and essential diagnostic, preventive, and treatment services (including supplies, appliances, and devices) and follow up care as determined by qualified health care providers in treating any condition, disease, injury or congenital or developmental malformation to promote optimal health, growth and development.
* Must take patient's age, developmental status, psychosocial well-being, and clinical setting into account.
107
What is included in medically necessary care?
* All supportive health care services that are necessary for provision of optimal quality therapeutic and preventive oral care.
* Includes:
* Sedation
* GA
* Utilization of surgical facilities
108
What % of children experiences caries by 5yo?
60%
109
What oral conditions may impact general health and well-being?
* Relationship between periodontal disease and cardiovascular disease.
* Relationship between periodontal disease and adverse pregnancy outcomes, including pregnancy hypertension.
* Association between OH and respiratory disease (the mouth can harbor respiratory pathogens that may be aspirated, resulting in airway infections)
110
What are the goals of CRA?
* Prevent disease by:
* Identifying and minimizing causative factors (microbial burden, dietary habits, dental morphology).
* Optimizing protective factors (fluoride exposure, OH, sealants)
111
A child who receives sealants is \_\_% less likely to receive restorative services over the next __ years than children who do not.
A child who receives sealants is **_72%**_ less likely to receive restorative services over the next _**3 years_** than children who do not.
112
Sealant success may be \_\_% even after a decade.
Sealant success may be **_80-90%_** even after a decade.
113
If sealants are safe and effective, why is their use low?
* Initial insurance coverage for sealants is often denied and insurance coverage for repair/replacement may be limited.
* All Medicaid programs reimburse DDS for placement of sealants on permanent teeth, but only 1 in 3 reimburse for primary molar sealants.
114
When does the AAPD encourage establishment of dental home?
By 12mo
115
WHO definition: Social determinants of health
The conditions in which people are born, grow, work, live, and age, and wider sets of forces and systems shaping the conditions of daily life.
116
Definition: Health equity
The absence of systemic disparities in health between and within social groups that have different levels of underlying social advantages or disadvantages.
117
What are measures of socioeconomic position?
* Income
* Educational attainment
* Occupation
* Race/ethnicity
118
What does directly addressing SDH involve?
* Systematic policy and environmental changes that improve living conditions and alleviate policy.
* Universal housing programs
* Health insurance programs like Medicare for older Americans, Medicaid and Children's Health Insurance Program (CHIP) for children, programs that prevent food insecurity
119
What are vulnerable populations?
Communities that have limited access for reasons including geography, finances, medical status, age, societal discrimination.
* Also extends to LGBTQ youth, military connected families, families w/o consistent housing, youth w/ mental illness, immigrants.
120
Juvenile facilities are required to provide a dental exam by a licensed dentist within __ days of admission.
Juvenile facilities are required to provide a dental exam by a licensed dentist within **_60_** days of admission.
* After that, treatment only completed on emergency basis, w/o access to routine care and other resources to facilitate management of their dental needs.
121
What efforts should be made with youth in the juvenile justice system?
To establish dental home and reinstate insurance coverage prior to release from the facility.
122
What mental health condition has the highest rate of mortality?
Eating disorders - may cause severe enamel erosion and increased risk of caries.
123
What is the main cause of youth homelessness?
Physical, sexual and/or emotional abuse from parents or guardians
124
When does the AAPD encourage establishing a dental home?
**_By 12mo_**
125
When should the dental home be established?
No later than 12mo.
126
What should the dental home help address?
Anticipatory guidance + preventive, acute, and comprehensive OH care; includes referral to dental specialists when appropriate
127
What is dental neglect?
The willful failure of parent/guardian to seek + follow through with treatment necessary to ensure a level of OH essential for adequate function and freedom from adequate pain + infection
128
When is someone considered to have a dental disability?
If orofacial pain, infection or pathological condition and/or lack of functional dentition affect nutritional intake, growth + development, or participation in life activities
129
ECC vs. S-ECC
* ECC: 1 or more decayed missing or filled tooth surface. DMFT under 6
* S-ECC under 3, smooth surface caries
* 3-5yo: 1 or more cavitated, missing, filled surface in primary maxillary
* Under 3yo → 4 or more DMFT
* 4yo → 5 or more DMFT
* 5yo → 6 or more DMFT
