Showing posts with label 12/04/2009. Show all posts
Showing posts with label 12/04/2009. Show all posts

Friday, December 4, 2009

Infant Oral Health Care

Resident’s Name: Joanne Lewis Date: December 4, 2009

Guideline on Infant Oral Health

Background

- More than 40% of children have caries by the time they reach kindergarten.

- High caries rates occur in families; the children of mothers with high caries rates are at a higher risk of caries.

- It is well documented that there is vertical colonization of S mutans from mother to infant and that the acquisition of S mutans occurs at an average age of approximately 2 years.

- Modification of the mother’s oral flora at the time of the infants colonization can impact the child’s caries rate.

- The primary goal of early risk assessment is to screen for parent-infant groups who are at risk of ECC and who would benefit from early aggressive intervention.

- The ideal approach to infant oral health care is the early establishment of a dental home.

- Anticipatory guidance for the caregiver before and during the colonization process includes:

o Oral hygiene

o Diet

o Fluoride

o Caries removal

o Delay of colonization

o Xylitol gum

Recommendations

- All primary health care professionals who serve mothers and infants should provide caregiver education on the prevention of ECC. Oral health counseling during pregnancy is especially important.

- The etiology of ECC, oral health risk assessment, anticipatory guidance, and early intervention should be included in the curriculum of all medical, nursing, and allied health professional programs.

- Every infant should receive an oral health risk assessment from his/her primary health care provider by 6 months of age.

- Parents or caregivers should establish a dental home by 12 months of age.

- Health care professionals should support the establishment of a dental home for all infants by 12 months of age.

Thursday, December 3, 2009

Management of Persons With Special Health Care Needs

From Pediatric Dentistry vol. 28 No. 7 reference manual

Guideline on Management of Persons with Special Health Care Needs

Summary by Kris Hendricks


Purpose: AAPD accepts its responsibility to assist in treating this patient population


SHCN definition:

individuals who “have a physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be developmental or acquired and may cause limitations in performing daily self-maintenance activities or substantial limitations in a major life activity. Health care for special needs patients is beyond that considered routine and requires specialized knowledge, increased awareness and attention, and accommodation.”


SHCN patients are more vulnerable to oral disease than the general population.


SHCN disorders that are specifically manifest in the orofacial complex:

  • amelogenesis imperfecta
  • dentinogenesis imperfecta
  • cleft lip/palate
  • oral cancer


Disorders that include orofacial problems:

  • osteogenesis imperfecta
  • ectodermal dysplasia
  • epidermolysis bullosa


AwDA defines the dental office as a place of public accommodation. Failure to comply and accommodate SHCN patients is a violation of federal and/or state law.


Difficulties for SHCN patients:

  • lack of financial resources
  • lack of timely care can lead to more costly episodic care
  • medical benefits don’t extend to cover the dental needs
  • other health care needs may seem more important than dental
  • limited transportation
  • complex behavioral problems
  • anxiety
  • tough to transition these patients from care of pediatric dentist to generalist as they mature


Recommendations:

  • strong phone triage at initial contact
  • create a dental home--makes SHCN pts less likely to suffer from dental disease
  • patient and parent education
  • complete med history--updated at every recall
  • comprehensive exam and caries risk assessment
  • med consults as needed
  • must make attempts to communicate with hearing/speaking impaired
  • informed consent
  • proper behavior management/protective stabilization/sedation/general anesthesia
  • be cognizant of psychological well-being of SHCN patients
  • make appropriate referrals for things you cannot treat


Preventative strategy

  • education of patient and parent
  • daily supervision of OH regimen
  • Fluoride dentifrice
  • electric toothbrush
  • dietary counseling
  • sealants