Early childhood caries
Caries can develop early in babies. The American Academy of Pediatric Dentistry states, "once a child's diet includes anything besides breast-milk, erupted teeth are at risk for decay" (AAPD, 2010). A cavity initially shows up on children's teeth as caries. "Early childhood caries present as white spots or lines on the maxillary incisors" (Douglass,2004). If not treated by a dentist, caries turn yellow brown and develop into cavities.
Caries are mutant streptococci bacteria. These “bacteria metabolize monosaccharide and disaccharide sugars to produce acid that demineralizes teeth and causes cavities” (Douglass, 2004). Sometimes a child's teeth erupt with enamel defects. This tends to occur in premature infants, low birth weight infants and in children of low socioeconomic status.
Some of the risk factors of early childhood caries are having a parent who smokes or is of low socioeconomic status , a child or parent who's diet is high in sugar, a child with special health needs or a child who is put to bed with a bottle.this needs more
On average, a child visits the dentist for the first time by age three. “More than 30% of children of low socioeconomic status” (Douglass, 2004) have caries by that age. By kindergarten age, 50% of all children have caries (Rothe, 2010). Primary care physicians see children at least 11 times for well-child visits through age three and serve as the entry point into the dental care system" (Douglass, 2004).This puts family's physician's offices in a unique situation. A nurse working for a family physician's office can provide early risk assessment, education on prevention, and in some cases, can even detect tooth caries in young children, making referral to a dentist as needed.
From birth to age three months, nurses should assess a child for risk of caries. These risks include infants who were premature or have special health needs, infants who have mothers with high caries rates and families of low socioeconomic status. If a parent or child falls into the risk groups, education should include not propping a bottle and focus on dietand includediscouraging fruit juices. The mother should also be educated that soy based formulascan contain sucrose which causes cavities. According to the AAPD website, daily tooth cleaning should begin as soon as the first tooth erupts, and nurses should discuss tooth cleaning at this visit.
From four to six months of age, nurses should assess a child for signs and symptoms of teething. The mother should be asked if they use city water that is treated with fluoride, if they have a well that supplies water, or other non-treated water. At six months, a child should be receiving treated water or be referred to a dentistfor a supplement, although "systemic supplementation is not recommended for breastfed babies" (Douglass, 2004). At this visit, the nurse should provide education on fluorinated toothpaste, how to choose a toothbrush and brushing instructions.
The caregiver should brush the child's teeth twice per day using a soft brush and a dab of toothpaste the size of a pencil eraser. The parent should stand behind the child and support the child's head. Excessive toothpaste should be spit out. (please feel free to rewrite brushing instructions) Infant tooth wipes have also been shown to be as effective as a toothbrush and in some cases, are more easily tolerated by the infant (Galganny-Almeida, 2008).
At age six to twelve months, systemic supplementation of fluoride begins. Even if a child receives supplements from a dentist, the nurse should make sure that the parent understands that "supplementation should not be given with formula or milk because they decrease absorption" (Douglass, 2004). The nurse should also look for signs of fluoride overdose at this visit, and make the parent aware of the signs. i dont like the wording of these .. please feel free to rewrite “Overdoses of fluoride can cause mottling of the teeth” (Douglass, 2004), so an assessment of how much fluoride the child is getting is important. Excessive fluoride can cause nausea and vomiting. “For an average five year old,a dose of 5 mg per kg of fluoride represents 95mL or about one half of a typical 8-oz tube” (Douglass, 2004). Larger doses can cause “convulsions, tetany, decreased myocardial contractility, ventricular arrhythmias and cardiac arrest” (Douglass, 2004). Fluoride supplements should never exceed 120mg. Another thing parents need to be aware of is that "from six months to age 3, your child may have tender gums when teeth erupt" (AAPD).
Parents should be educated to limit sugary foods to meal times instead of allowing the child to have them many times during the day. A sippy cup should be introduced around age six months, but in between meal drinks should be limited to water and milk (formula for a child under 1 year of age). Juice, if given at all, should be limited to 4 to 6 oz per day, and only consumed with meals. The American Academy of Pediatric Dentistry recommends having a home dental plan in place by age twelve months, so this can be discussed at this visit.
At twelve months, a doctor or nurse can examine a child's teeth with the child laying supine with their head in the care provider's lap. The nurse or doctor should look for white spots, cavities or defects. If any are noted, an immediate referral should be made to a dentist. If a child is considered low risk, they can wait to see a dentist until around their third birthday, but a child with any of the mentioned risks needs to see a dentist at twelve months of age.
Nurses can help education parents on dental care. In a University of Nebraska Medical Center study, parents were recruited to take a one hour class about dental care. Thirty minutes of this class was a power point slide show written at third grade level. The parents were then asked questions about dental health before and after the presentation. “The presentation covered: how to perform infant oral hygiene procedures (brushing), appropriate dietary practices for infants, timing of the first dental visit and periodicity of dental screenings, importance of oral health of parents/caregivers and emergency care for infant oral trama” (Rothe, 2010). The parents showed overall improvement on post test scores.