A DENTAL HOME FOR PATIENTS with AUTISM

DR. NOEL V. VALLESTEROS President Elect, Philippine Pediatric Dental Society Inc. Executive Director, Pediatric Dentistry Center Philippines

ARTICLE II PURPOSE & OBJECTIVES

DEFINITION OF PEDIATRIC DENTISTRY:

The specialty of Pediatric Dentistry is the practice and teaching of and research in comprehensive preventive and therapeutic oral health care of children from birth through adolescence. It shall include care for special patients beyond the age of adolescence who demonstrate mental, physical and/or emotional problems.
2

We recognize that providing both primary and comprehensive preventive and therapeutic oral health care to individuals with special health care needs (SHCN) is an integral part of the specialty of pediatric dentistry. Individuals with SHCN may be at an increased risk for oral diseases throughout their lifetime. AAPD Reference Manual 2013 Oral diseases can have a direct and devastating impact on the health and quality of life of those with certain systemic health problems or conditions.

THE 1ST DENTAL VISIT

An oral health consultation visit within six months of eruption of the first tooth is recommended to educate parents and provide anticipatory guidance for prevention of dental disease.

THE 1ST BIRTHDAY

t a h t s t s e g g u s y l g n i s a e l r a c t n n i e e d c g n n i t n e v Evide e r p t a l u f s s e c c u n s i e g e b t to b s u m s t s i t e n h e t d n , i e h s t i w s disea n o i t n e v r e t n i e v i t n e v e r p . e f i l f o r a e y t s r i f

AAPD 2011

EARLY CHILDHOOD CARIES (ECC)

E T A L O O T S I TWO

The WHITE SPOT

DENTIN CARIES

PULP CARIES

The SINGLE GREATEST RISK FACTOR for future

caries is DENTAL CARIES EXPERIENCE.
American Dental Association (ADA) Centers for Disease Control (CDC) American Academy of Pediatric Dentistry (AAPD)

Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in both the temporary and permanent teeth.
Bethesda, MD, 1997 Conference on ECC

The Philippines presents one of the highest levels of dental caries.

12 year old children: 3.25 DMFT

Eh baby teeth lang naman yan Mapapalitan din yan noh.

Upper Tooth Central Incisor Lateral Incisor Canine First Molar Second Molar Lower Tooth Central Incisor Lateral Incisor Canine First Molar Second Molar

When It Arrives When It Leaves (Month) (Year) 7.5 9 18 14 24 When It Arrives (Month) 6 7 16 12 20 7 8 11 9 11 When It Leaves (Year) 6 7 10 9 10

DENTAL CARIES TETRALOGY

CARIES

FOOD
BACTERIA (PLAQUE)

SUGAR

ACID
DEMINERALIZATION

TOOTH DECAY

REMINERALIZATION

CRITICAL pH 5.5- 5.7

DEMINERALIZATION

Nursing caries is related with the practice of the habit at night

(Kroll and Stone 1967)

when the flow of saliva is diminished.

(Scheneyer et al 1956)

DENTAL CARIES
is a dietary-carbohydrate and saliva-modified infectious bacterial disease

 Remineralization (Saliva is the sole source of Calcium and Phosphate essential for rebuilding hydroxyapatite structures.) Protection against demineralization Buffering acidic challenges (bicarbonate in stimulated saliva) Flushing the oral cavity

In Western civilization, infants generally are weaned from the breast or bottle by 1 year of age.
(Illingsworth 1975; Rudolph 1977)

Problems of

PAIN, INFECTION, MALOCCLUSION, MALNUTRITION

Dental disease was found to have an impact on childrens well being. There was a significant change in complaint of pain, eating preferences, quantity of food eaten, and sleep habits before and after treatment of dental caries.
( Low et al. 1999)

PAIN

Comprehensive dental rehabilitation resulted in catch-up growth, such that children with a history of nursing caries no longer differed in percentile weights from comparison patients.
(Acs et al. 1999)

INFECTION

MALOCCLUSION
PREMATURE LOSS OF PRIMARY TEETH

LOSS OF ARCH LENGTH

Arch length deficiency can produce or increase the severity of malocclusions with crowding, rotations, ectopic eruption, crossbite, excessive overjet, excessive overbite, and unfavorable molar relationships.

Brothwell DJ, 1997

Children are hard to manage. More dentists are afraid of children ? T than children afraid of dentists. N ME Oral rehabilitation is difficult. Pediatric dental treatment is expensive.

T A E R T O N

Thus, PREVENTION is the immediate solution!!!

 Exposure to the correct amount of fluoride is

considered by the World Health Organization (WHO) to be the most effective preventive measure against caries.

FLUORIDE
Reduction in acid solubility of enamel Remineralization of early carious lesions Increase in the rate of post-eruptive enamel maturation Inhibition of acid formation by plaque bacteria

The caries-reducing effect of fluoride is almost exclusively TOPICAL.

O P S E T I H W E H T

V E R T is

! E L B I S R E

Lesions as white spots and dentine caries can be remineralized and healed with fluoride.
ten Cate 2001

Fluoride Varnish Application for Nursing Caries Prevention applied at 9 mos. of age reapplied every 6 mos. up to 3 years of age.

CARIES-REDUCING EFFECT of FLUORIDE: MAINTAINANCE with HOME-USE FLUORIDES

ECC is a result of PARENTAL OVERINDULGENCE And LAX PARENTING

BRUSHING with Fluoride Toothpaste is NONNEGOTIABLE!

Factors that affect effectiveness of fluoride toothpaste:

1. Timing (upon tooth eruption) 2. Available free fluoride concentration 3. Amount used 4. Tooth brushing time 5. Rinsing method 6. Frequency of use 7. Time of application

1. TIMING
Primary anticaries effect of fluoride is topical (post eruptive).
Burt BA, Eklund SA, 1999

Brushing should start as soon as the first deciduous tooth erupts.

Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention DH/British Association for the Study of Community Dentistry, 2007

2. AVAILABLE FLUORIDE CONCENTRATION

Best choice is the toothpaste with 1000 to 1500 ppm free fluoride.
FDI and WHO Recommendation

Current best practice includes recommending twice daily use of a toothpaste containing 1000 ppm F for children in optimally fluoridated and fluoride deficient communities

ISSUE ON KIDDIE TOOTHPASTES?

500-700 ppm F

Sodium fluoride 0.22% 0.10% w/w fluoride ion

Ice cream-, candy- flavored toothpastes should NOT be used for children.
WHO , 1994

Toothpaste tubes should be kept out of reach of children.

NON-FLUORIDE TOOTHPASTES?!

Plaque removal by toothbrushing alone or with unfluoridated toothpaste is not effective in caries reduction.
Sutcliffe, 1996

Safety of Fluoride Toothpaste:

Concern over fluorosis from swallowed fluoride toothpaste in infant (6 mo) and young child (2 yr): The risk for fluorosis is low when fluoride toothpaste is used properly, even with adult or standard fluoride toothpaste.

3. AMOUNT OF FLUORIDE TOOTHPASTE

thin smear, half a pea 6 mos- 2yrs years (0.05-1g)

smear- a thin film of paste covering less than of the brush

Knee-toKnee Position

Parents should do the brushing

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