Pediatric Oral Health Promotion and Disease Prevention

	Martin J. Davis

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Prevention of:

	Caries
	Periodontal Diseases
	Trauma
	Habits and Growth Problems

Pediatric HP/DP Data

	50% under Age 12 Caries Positive
		7 X Asthma
	Age 5-17: Caries Reduced 18 to 8 DMF
	80% of Caries in 20% of Children
	40% under 12 Have Gingivitis
	AAPD Member Study

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Caries: An Infectious Disease

	Transmission from Caretaker
		High Caries Rate > High Infectivity
	Occurs from 6 to 24 months
		Mutans Streptococcus
			50% Positive by Year 1
		Lactobacillus et al
	Delayed Infection = Decreased Caries

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Toothpaste

	Vehicle for Fluoride
	One Inch = 1 mg = (Daily Dose)
	Pea Size Amount
	ADA Seal of Approval

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Brush

	Soft, Multitufted, Rounded Bristles
	Large Handle/Small Head
	Mechanical Good/Better
	Parents to Age 6
	Acidogenesis > 24 Hours

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Risk Factors

	Diet
		Frequency and Form
	Genetics
		Saliva, IgA, Enamel, Morphology
	Transmission Potential
	Nutrition
	Early Lesions = Higher Later Caries

Risk Assessment

	To Identify Individual Level of Risk
	Focus Resources
		Recall Interval
		Timing Radiographs
	First Visit Age 1!

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Anticipatory Guidance

	Fluoride Sources
	Diet
	Hygiene
	Habits
	Trauma

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Early Childhood Caries

	Prolonged Frequent Ingestion
	Maxillary Incisors > Molars, Canines
	White Spot
	Presence in Head Start > 90%

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Prevention of ECC

	DC Bottle by 10-12 Months
	15 to 20 Minute Feeding
	INFANT HELD DURING FEEDING
	NEVER START = Never Have to Stop!

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Therapeutic Options

	Dietary Counseling
	Salivary Analysis
	Fluoride Sources
	Antimicrobials
		Especially Medically Compromised
	Sealants

Diet

	Frequency and Form
	Demin vs. Remin
	Stephan Curve
		Neutral 1 HOUR
	Soda in 5 Minutes vs. 2 Hours

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Cariogenicity

	Impossible to Rank
	Safe Foods?
		Chocolate, Cheese
	Caramel vs. Cookie
	Retention

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Fluoridation

	Provides Continuous Low Level
	61% U.S. Households
	Bottled Water RARELY Fluoridated
	Ambient Sources

Topical Fluoride

	APF 1.23% 4 Minutes
		60 Second Brands Less Effective
	5 cc (1 tsp) Total Both Trays
	Sit Upright > No Ingestion
	Saliva Ejector

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Fluoride Varnishes

	Long History in Europe
	Excellent Clinical Effectiveness
	0.1% Difluorosilane
		Durafluor,FlourProtector, etc.
	Easy to Use: Paint THIN Layer on Dry Teeth
	24 Hour Slight Yellowing

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Fluorosis

	Fluoridated Water
	Swallowed Toothpaste
	PolyViFluor via Pediatrician
	Ambient Fluorides
		Mechanically Deboned Meat
		Tea
		Reconstituted Formula/Drinks

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Antifluoridationists

	Referendum
	Cancer
	Sterility
	Communist Plot
	Individual Powerlessness

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Antimicrobials

	Chlorhexidine (0-12% Rinse)
	Chlorhexidine Varnish
		Not USA
	Vaccines (Cell Wall X Rx)
		ABs via Saliva
	Transgenic Plants for IGA

Sucrose Substitutes

	Xylitol
		Non-acidogenic
		May Support Remin
		Mutans Inhibition

Food Additives

	Enhanced Remineralization
			Buffering
			Lactoperoxidase,Lactoferrin
	Fill Micropores in Enamel
		Amorphous CaPo4

Future Preventive Efforts

	Chimeric Molecules
	Food Additives Mimic Salivary Chem.
	Biofilm Inhibitors Block Attachment
	Selective Niche Infection: Nonpathogen
	Genetic Engineering
		Patients? Microorganisms?

HP/DP and Managed Care

	Directed Utilization
		Most Services to High Need
	Prevention = Less Treatment
	Less Treatment = Decreased Overhead
	Decreased Overhead = Increased Income

HP/DP Overview

	Fluoride + Sealants= 85% Caries Reduction
	Dietary Control
	Antimicrobials
	Food Additives