Inspiring and Innovative Preventive Oral Care for Infants and Toddlers
Oral Health America Webinar Series December 12, 2018
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/Oral Health America
@Smile4Health
2018
HOUSEKEEPING INFORMATION • •
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Please remember to MUTE your phone. Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions. • Questions will be accepted in writing through the control panel on the upper right hand of your screen. • Submit questions at any time; we will address them at the end of the presentation. Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org Your feedback is important to us. Please take our brief webinar evaluation after this session; link will be sent via email.
2018
CE Credit Available
2018
ABOUT ORAL HEALTH AMERICA America’s leading national oral health nonprofit focused on the nation’s oral and overall health for 63 years, with particular emphasis on children and youth, older adults and Americans whose voices are not wellrepresented in oral healthcare conversations. OHA employs strategic partnerships and communications to connect the dots between oral and overall health
SMILES ACROSS AMERICA®
CAMPAIGN FOR ORAL HEALTH EQUITY
WISDOM TOOTH PROJECT®
2018
Early Childhood Caries Prevention Project
School-Based Prevention Programs
Demonstration Projects
Product Donation
Enrichment
2018
toothwisdom.org
Advocacy
Health Education & Communications
Professional Symposia
Demonstration Projects
2018
Addresses oral health inequities in our society and identifies possibilities for closing the oral health divide in America. The campaign strives to: Educate and engage the public, including policymakers, about the importance of oral health for overall health Emphasize the need to prioritize oral disease alongside other chronic health conditions Lead, participate and observe on legislative issues impacting oral health policies critical to OHA, our programs and stakeholders 2018
INSPIRING AND INNOVATIVE PREVENTIVE ORAL CARE FOR INFANTS & TODDLERS HAMIDA ASKARYAR MPH, RDH, MCHES PROGRAM MANAGER UCLA SCHOOL OF DENTISTRY; SECTION OF PEDIATRIC DENTISTRY
LEARNING OBJECTIVES 1.
Prevalence of early childhood caries (ECC) and why we need to address it
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Early establishment of a dental home by 12 monthsbehavioral model (“Age one visit�)
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Systemic-oral health link- perinatal health
4.
Medical-dental integration models
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Caries risk assessments using Caries Management by Risk Assessment (CAMBRA)
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White Spot Lesions- what can providers and parents do?
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Promote use of age appropriate combination therapy approaches including emphasis on prevention and parental involvement to achieve long lasting good oral health for young patients
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Self-management goals
9.
Sealants and Silver Diamine Fluoride
bio-
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Research | Training | Policy WWW.UCCOH.ORG
www.uclachatpd.org
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What is Early Childhood Caries (ECC)?
Presence of 1 or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child 5 years, 9 months or younger.
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EXAMPLES OF SEVERE EARLY CHILDHOOD CARIES (SECC)
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ECC IS AN INFECTIOUS, TRANSMISSIBLE DISEASE 1. The development of dental caries is a dynamic process of demineralization of the dental hard tissues by the acidic byproducts of bacterial metabolism , alternating with periods of remineralization 2. Caused by Mutans streptococci, lactobacilli, and other acid-producing bacteria 3. Transmission both vertical and horizontal (eg. toys, siblings)
CONCEPTUAL FRAMEWORK OF CHILDREN’S ORAL HEALTH CHILD, FAMILY, & COMMUNITY INFLUENCES ON CHILD ORAL HEALTH OUTCOMES Time Community Level Influences Family Level Influences Community Oral Health Environment Social Environment
Social Support
Family Health Care System Composition Characteristics
Use of Dental Care Development
Health Behaviors and Practices
Dental Insurance Biologic and Genetic Endowments
Oral Health
Family Function Health Behaviors, Practices, and Coping Skills of Family
Physical Environment Physical Safety
Host & Teeth
Child Level Influences
Physical Attributes
Health Status of Parents
Dental Care System Characteristics
Microflora
Socioeconomic Status
Culture
Social Capital
Substrate (diet)
Fisher-Owens et al. R03DE016571 Fisher-Owens, Gansky et al. 2007
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Prevalence of total dental caries and untreated dental caries in primary or permanent teeth among youth aged 2-19 years by age, USA 2015-2016 60%
54% 51% 50%
46%
40%
30%
21%* 20%
15%
13%
13% **
9%
10%
0%
2-19 yrs
2-5 yrs Total Caries
6-11 yrs
12-19 yrs
Untreated Caries
Fleming E, Afful J. Prevalence of total and untreated dental caries among youth: United States, 2015–2016. NCHS Data Brief, no 307. Hyattsville, MD: National Center for Health Statistics. 2018. 16
TRENDS IN PREVALENCE OF TOTAL DENTAL CARIES AND UNTREATED DENTAL CARIES IN PRIMARY OR PERMANENT TEETH AMONG YOUTH AGED 2–19 YEARS: UNITED STATES, 2011–2012 THROUGH 2015– 2016 60
50
47.5
16.1
18
2011-12
2013-14
50
45.8
Percent
40 30 20
13
10 0
Total Dental Caries
2015-16
Untreated Dental Caries
Fleming E, Afful J. Prevalence of total and untreated dental caries among youth: United States, 2015–2016. NCHS Data Brief, no 307. Hyattsville, MD: National Center for Health Statistics. 2018. 17
CA DEMOGRAPHICS
California is one of the most ethnically diverse states in the U.S. Over 1.6 million children under 5 years of age
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PREVALENCE OF ECC IN OUR STATE ECC still the #1 chronic disease among children. Over 70% of CA kids by the time they reach 3rd grade have caries. Untreated ECC can lead to many detrimental effects for the child involved (pain, suffering, anesthesia, delayed development (due to lack of adequate nutrition and sleep) lost school days etc.) as well the whole family (mental anguish, cost, lost wages, etc.). Communities of color consistently lack access to care and face many barriers to health care Latinos constitute more than half of the youth population they carry the majority of the burden of ECC
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INTERPROFESSIONAL COLLABORATION PROBLEMS ▪ Healthcare systems have limited capacity to provide early access to dental services for young children (anticipatory, preventative care)
SOLUTIONS
▪ Children have greater access to medical care than to dental care ▪ Primary care providers have been called to work in partnership to improve access to oral health ▪ Establish a dental home by age 1 and begin early anticipatory guidance and preventive intervention
http://www.aapd.org/assets/1/7/MCHB_DentalHome_Report1.PDF 20
SMILES FOR LIFE FREE ONLINE TRAINING & APP
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Progressive periodontal disease and risk of very preterm delivery. This study demonstrates that maternal periodontal disease increases relative risk for preterm or spontaneous preterm births. Furthermore, periodontal disease progression during pregnancy was a predictor of the more severe adverse pregnancy outcome of very preterm birth, independently of traditional obstetric, periodontal, and social domain risk factors. http://www.greenjournal.org/cgi/content/abstract/107/1/29
Offenbacher S, Boggess KA, Murtha AP, Jared HL, Lieff S, McKaig RG, Mauriello SM, Moss KL, Beck JD. 2006. Obstetrics & Gynecology 107(1):29-36. 23
AAPD RECOMMENDATIONS ▪ Every pregnant woman should receive a comprehensive oral health evaluation from a dentist. ▪ Radiographic assessment and treatment of oral conditions should be performed with attention tondmaternal and fetal safety and patient comfort (safest is 2 trimester). ▪ Caregivers must establish a dental home for infants by 12 months of age.
American Academy on Pediatric Dentistry Council on Clinical Affairs. "Guideline on perinatal oral health care." Pediatr Dent 32.6 (2011): 109-13. 24
AAPD RECOMMENDATIONS: • Limit sugary foods and drinks • Brush twice a day with fluoridated toothpaste • Flossing once daily • Pregnancy is a unique time when women may gain access to oral health coverage- Dental portion of Medi-CAL • Make and keep regular appointments • Drink fluoridated tap water every day • Talk to a dentist or doctor ways to manage problems • Important to receive a caries risk assessment • Dentist might recommend use of chlorhexidine or xylitol as appropriate, after the baby is born Ramos-Gomez F NM. Into the future: pediatric CAMBRA protocols. J Calif Dent Assoc 2011;39(10):723-33 American Academy of Pediatric Dentistry. American Academy of Pediatric Dentistry reference manual 2014-2015. Pediatr Dent 2014;36(6 reference manual): 154-60 25
CAMBRA CAries Management
By
Risk
Assessment
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CAMBRA Assists the provider to systematically: 1. Assess each child’s and his caregiver’s caries risk in an individualized manner 2. Customize a restorative plan in conjunction with preventive care. 3. Plan a timely, specific and appropriate periodicity schedule based on caries risk. Ramos-Gomez F, Ng MW. Into the future: keeping healthy teeth caries free: pediatric CAMBRA protocols. J Calif Dent Assoc. 2011 Oct;39(10):723-33. PubMed PMID: 22132584; PubMed Central PMCID: PMC3457698. 27
1. CAMBRA • Asking question regarding protective and risk factors. • Short videos: http://www.uclaiocp.org/sixstep-protocol.html
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CAMBRA’s easy to use organized format of risk and protective factors, clinical findings, and selected self management goals helps to facilitate oral health education, deepens the appreciation of oral health information and increases the understanding of how individual behaviors can affect caries development and progression.
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2. Knee To Knee Child is supine, head in care provider's lap.
• The child can see the parent. • The parent can see what care provider sees.
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3. Toothbrush Prophylaxis • Aids in plaque removal.
• Demonstration of proper brushing technique.
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4. Clinical Exam
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White Spot Lesions
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EARLY CHILDHOOD CARIES
SEVERE EARLY CHILDHOOD CARIES
CAN YOU LIST SOME CARIES RISK FACTORS FOR CHILDREN? Factors for high caries risk include: 1. Decayed/missing/filled surfaces greater than the child’s age 2. Numerous white spot lesions 3. *High levels of mutans streptococci
4. Low socioeconomic status 5. High caries rate in siblings/parents 6. Diet high in sugar 7. Presence of dental appliances 36
5. Fluoride Varnish Application • To prevent tooth decay. • Every 1-6 months depending on caries risk
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Prevention and Management • Enhancing enamel resistance using topical fluorides. • Fluoride ion has a preventive effect against caries by: • Modifying bacterial metabolism in dental plaque. • Inhibiting the production of acids. • Reducing demineralization and favors the remineralization of early carious lesions.
American Academy of Pediatric Dentistry (AAPD), Fluoride Therapy, Updated 2018. Available online at: http://www.aapd.org/media/Policies_Guidelines/BP_FluorideTherapy.pdf 38
FACTS ABOUT FLUORIDE: CDC ▪ Safe: no convincing scientific evidence has been found linking it to adverse health effects. Occurs naturally in water ▪ Effective: can reduce tooth decay by about 25% ▪ Reduce disparities: cost effective method for delivering fluoride to all members of the society regardless of age, educational attainment, or income levels
▪ Cost saving: saves money to families and the health care system ▪ Public Health Achievement: 1 of the 10 greatest public health achievements of the 20th century. Nearly 75% of US population receives optimally fluoridated water ▪ International fluoride use: nearly all developed countries practice water fluoridation. WHO supports water fluoridation
American Academy of Pediatric Dentistry (AAPD), Fluoride Therapy, Updated 2018. Available online at: http://www.aapd.org/media/Policies_Guidelines/BP_FluorideTherapy.pdf 39
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TIPS FOR TALKING ABOUT COMMUNITY WATER FLUORIDATION
https://ilikemyteeth.org/wpcontent/uploads/2014/10/SayThisNotTh at.pdf https://ilikemyteeth.org/wpcontent/uploads/2014/12/SayThisNotTh at-Spanish.pdf
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Use of Fluoridated toothpaste • Fluoridated toothpaste is recommended for all children. • A smear (the size of a grain of rice) of toothpaste should be used up to age 3. • After the 3rd birthday, a pea-sized amount may be used. • Parents should dispense toothpaste for young children and supervise and assist with brushing. • Fluoride varnish is recommended in the primary care setting every 3–6 months starting at tooth emergence. • Over-the counter fluoride rinse is not recommended for children younger than 6 years. WHY? 2014 ADA Consensus & 2018 AAPD Fluoride Therapy 42
Recommendations
<3 years
>3 years
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CALCIUM-BASED CARIES PREVENTATIVE AGENTS: A REVIEW AND A META-EVALUATION OF SYSTEMATIC REVIEWS + METAANALYSIS ▪ CPP-ACP-containing remineralization agents have superior remineralization potential compared to other forms of calcium-and-phosphate-based remineralization agents, such as functionalized tricalcium phosphate (fTCP) and amorphous calcium phosphate (ACP). *
▪ CPP-ACP/CPP-ACFP can be considered as an addition to fluorides, but not as an alternative until long-term well-designed clinical trials assessed by systematic reviews and meta-analysis are available. **
*Ekambaram M, Mohd Said SNB, Yiu CKY. 2017 **Bijle, Mohammed Nadeem Ahmed, 2018 44
Combination therapy
OTC, Bioavailable Ca + F, 900 ppm F
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PreviDent® 5000 Plus (1.1% Sodium Fluoride) Prescription Toothpaste (Rx only) PreviDent® 5000 Enamel Protect (1.1% Sodium Fluoride, 5% Potassium Nitrate) Rx only Prescription Strength Toothpaste for Sensitive Teeth
Fluoridex toothpastes contain 1.1% neutral sodium fluoride, concentrated at 5000ppm - more than four times the active ingredient of nonprescription brands.
Prescription-strength Clinpro™ 5000 toothpaste Contains 1.1.% NaF (5000 ppm fluoride ion).
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CARIES MANAGEMENT PROTOCOL: ▪Provide nutritional counseling
▪Support self-management goal ▪Deliver preventive interventions ▪Implement active surveillance of incipient lesions (check frequently) ▪Arrest caries
▪Restore caries with interim therapeutic restoration (ITR)** ▪Provide definitive restoration **Policy on Interim Therapeutic Restorations (ITR): http://www.aapd.org/media/Policies_Guidelines/P_ITR.pdf 47
DIET & CARIES: HEALTHY VS. UNHEALTHY SNACKS REM: ANYTHING IN MODERATION IS OK…RINSE WITH WATER AFTER EATING SUGARY FOODS ▪ Whole Fruits & Vegetables: NOT IN POUCHES!! ▪ Nuts*, seeds, turkey slices, beef, tofu, fish ▪ Yoghurt, cheeses
▪ 100% Whole grain snack crackers or popcorn (older kids) ▪ AVOID having the teeth bathed in sugar all day looong!!
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GUIDELINE: SUGAR INTAKE FOR ADULTS AND CHILDREN Per a new WHO guideline, adults and children should reduce their daily intake of free sugars to less than 10% of their total energy intake.
Additional Health Benefits
â&#x2013;Ş A further reduction to below 5% or roughly 25 grams (6 teaspoons) per day would provide additional health benefits
WHO calls on countries to reduce sugars intake among adults and children", 2016 49
BREASTFEEDING AND THE RISK OF DENTAL CARIES - Children exposed to longer versus shorter duration of breastfeeding up to age 12 months (more versus less breastfeeding), had a reduced risk in caries - Children breastfed >12 months had an increased risk of caries when compared with children breastfed < 12 months - Amongst children breastfed > 12 months, those fed nocturnally or more frequently had a further increased caries. Tham et al Acta Paediatr 2015 50
Self Management Goals
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6. Self Management Goals â&#x20AC;˘ Care-provider explains what he saw and evaluated, and how caries happen. â&#x20AC;˘ Then agrees with the patient on two goals to work upon, to increase the protective factors and lower the risk factors for the following visits.
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DENTAL SEALANTS: A CLINICAL PERSPECTIVE Who really needs sealants? Must assess... ▪ Caries risk for the patient & the tooth in question ▪ Presence and extent of occlusal & interproximal decay ▪ Eruption status of the tooth ▪ Cooperative ability of the patient ▪ Ability to isolate the tooth ▪ Insurance?? Some won’t pay after age 12 yrs. “To Seal is the Deal”
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“MONITORING OF SOUND AND CARIOUS SURFACES
UNDER SEALANTS OVER 44 MONTHS” Regardless of lesion severity (ICDAS 0-4, permanent molars), sealants were 100% at 12 ms and 98% effective over 44 ms in managing occusal surfaces at ICDAS 0-4 (ie. only 4 of 228 (<2%) teeth progressed to ICDAS > 5 (associated with sealants in need of repair and none to halfway or more through the dentine radiographically).
Fontana M, Platt JA, Eckert GJ, González-Cabezas C, Yoder K, Zero DT, Ando M, Soto-Rojas AE, Peters MC. Monitoring of sound and carious surfaces under sealants over 44 months. J Dent Res. 2014 Nov;93(11) ICCMS Caries Management, International Caries Classification and Management System, ICDAS, 2018. Available online at: https://www.iccms-web.com/ 55
PIT AND FISSURE SEALANT RECOMMENDATIONS: ▪ Sealants should be placed on pits and fissures of primary and permanent teeth of children and adults when it is determined that the tooth, or the patient, is at risk of experiencing caries ▪ Pit-and-fissure sealants should be placed on early (noncavitated) carious lesions in children, adolescents and adults to reduce the percentage of lesions that progress ▪ Resin-based sealants are the first choice of material ▪ Glass ionomer cement may be used as an interim preventive agent (fluoride releasing is a plus) ▪ A compatible one-bottle bonding agent, which contains both an adhesive and a primer, may be used between the previously acid-etched enamel surface and the sealant material
▪ Routine mechanical preparation of enamel before acid etching is NOT recommended, BUT tooth should be CLEAN ▪ Follow sealant manufactures guidelines Beauchamp et al., 2008. JADA 2008;139(3):257-267. 56
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EVIDENCE BASED CLINICAL PRACTICE GUIDELINES ON NONRESTORATIVE TREATMENTS FOR CARIOUS LESIONSPRIMARY TEETH NONCAVITATED LESION ▪ Occlusal: ▪ Sealants + 5% NaF Varnish or sealants alone ▪ If sealants not feasible: ▪ 5% NaF varnish or ▪ 1.23% APF gel or ▪ Resin infiltration + 5% NaF varnish or ▪ 0.2% NaF mouth rinse * ▪ Interproximal: ▪ 5% NaF varnish or ▪ Resin infiltration alone or ▪ Resin infiltration plus 5% NaF varnish or ▪ Sealants alone* ▪ Facial-lingual: ▪ 1.23% APF gel or ▪ 5% NaF varnish
CAVITATED LESION ▪ Occlusal: ▪ 38% SDF solution**
▪ Interproximal: ▪ 38% SDF solution** ▪ Facial-lingual:
▪ 38% SDF solution** Of course continue preventive NaF varnish regularly!!
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SILVER DIAMINE FLUORIDE The American Academy of Pediatric Dentistry (AAPD, 2017) recently published guidelines for the Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs
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The 3 Actions Areâ&#x20AC;Ś 1) SDF was bactericidal to cariogenic bacteria, mainly Streptococcus mutans and inhibited the growth of cariogenic biofilms on teeth. 2) Mineral loss of demineralized enamel and dentine was reduced after SDF treatment and a highly mineralized surface rich in calcium and phosphate was formed on arrested carious lesions. 3) SDF inhibited collagenases (enzymes that break down collagen bonds) and thereby protected dentine collagen from destruction. Zhao IS, Gao SS, Hiraishi N, Burrow MF, Duangthip D, Mei ML, Lo EC, Chu CH. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J. 2018 60
SILVER DIAMINE FLUORIDE – NEW OPTION! ▪ SDF can offer a new option for children and special needs patients, who do not want to undergo repeated and lengthy use of general anesthetic and sedation drugs during surgeries or procedures. ▪ No clinical signs of pulpal inflammation or reports of unsolicited/spontaneous pain. ▪ Cavitated caries lesions that are not encroaching on the pulp. If possible, radiographs should be taken to assess depth of caries lesions. ▪ Cavitated caries lesions on any surface as long as they are accessible with a brush for applying SDF. (Orthodontic separators may be used to help gain access to proximal lesions.)
Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs. AAPD , 2017, available at: http://www.aapd.org/media/Policies_Guidelines/G_SDF.pdf
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CLINICAL APPLICATION OF SDF ▪ Remove gross debris from cavitation to allow better SDF contact with denatured dentin ▪ Carious dentin excavation prior to SDF application is not necessary. As excavation may reduce proportion of arrested caries lesions that become black, it may be considered for esthetic purposes. ▪ A protective coating may be applied to the lips and skin to prevent a temporary henna-appearing tattoo that can occur if soft tissues come into contact with SDF.
▪ Isolate areas to be treated with cotton rolls or other isolation methods. If applying cocoa butter or any other product to protect surrounding gingival tissues, use care to not inadvertently coat the surfaces of the caries lesions. ▪ Caution should be taken when applying SDF on primary teeth adjacent to permanent anterior teeth that may have non-cavitated (white-spot) lesions to avoid inadvertent staining. 62
SDF – UNDESIRABLE EFFECTS The main undesirable effects of SDF is its esthetic result: ▪ permanently blackens enamel and dentinal caries lesions and creates a temporary henna-appearing tattoo if allowed to come in contact with skin. ▪ Skin pigmentation is temporary since the silver does not penetrate the dermis.
American Academy of Pediatric Dentistry (AAPD), Fluoride Therapy, Updated 2018. Available online at: http://www.aapd.org/media/Policies_Guidelines/BP_FluorideTherapy.pdf 63
SDF FOLLOW-UP ▪ SDF Effectiveness in arresting dental caries lesions range from 47-90% with one-time application, depending on size of cavity and tooth location. ▪ Follow-up at 2-4 weeks after initial treatment to check the arrest of the lesions treated. ▪ Reapplication of SDF may be indicated if the treated lesions do not appear arrested (dark and hard). Additional SDF can be applied at recall appointments as needed, based on the color and hardness of the lesion or evidence of lesion progression. ▪ Caries lesions should/can be restored after treatment with SDF. ▪ When lesions are not restored after SDF therapy, biannual reapplication shows increased caries arrest rate versus a single application 64
HTTPS://WWW.YOUTUBE.COM/WATCH?TIME_CON TINUE=22&V=Z1MVN-UYKCM
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WATCH OUR UCLA 4 MINS PARENT ORAL HEALTH EDUCATION VIDEO: HTTP://WWW.UCCOH.ORG/RESOURCES.HTML HTTPS://YOUTU.BE/QIABUZLKZ-A
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MANAGEMENT OF ECC: PARADIGM SHIFT Past: Surgical Management • Repaired damage and defects • Didn’t address the underlying disease process • Required special skills and operating rooms
Future: Chronic Disease Management (CDM) • Detailed explanation of social determinants of health environment, healthcare, social, genetics, behavioral (40%) • Old vs. new practices- provider telling patient what to do vs. patient playing a vital role in their chronic condition • CRA (CAMBRA)- risk-based care paths • Tailored counseling- prevention & mgmt. • Interprofessional care
Ramos-Gomez F, Ng MW. Into the future: keeping healthy teeth caries free: pediatric CAMBRA protocols. J Calif Dent Assoc. 2011 Oct;39(10):723-33. PubMed PMID: 22132584; PubMed Central PMCID: PMC3457698.
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Question and Answer Session • Questions are welcome! This session may last for 10-15 minutes. • Write your questions in your control panel on the upper right hand of your screen. • Submit questions at any time.
2018
For more information:
http://www.uccoh.org/research.html Hamida Askaryar MPH, RDH haskaryar@dentistry.ucla.edu Dr. Francisco Ramos-Gomez frg@dentistry.ucla.edu
UCLA School of Dentistry 10833 Le Conte Ave. Room 23-020 Los Angeles, CA 90095
HELPFUL REFERENCES: ▪ Ramos-Gomez F, Askaryar H, Garell C, Ogren J. Pioneering and Interprofessional Pediatric Dentistry Programs Aimed at Reducing Oral Health Disparities. Front Public Health. 2017 Aug 14;5:207. doi: 10.3389/fpubh.2017.00207. eCollection 2017. PubMed PMID: 28856133; PubMed Central PMCID: PMC5557784. ▪ Kumar J. California Oral Health Plan 2018-2028. California Department Of Public Health. Available at https://www.cdph.ca.gov/Documents/California%20Oral%20Health%20Plan%202018%20FINAL%201%205%202018.pdf
▪ Finlayson TL, Gupta A, Ramos-Gomez FJ. Prenatal Maternal Factors, Intergenerational Transmission of Disease, and Child Oral Health Outcomes. Dent Clin North Am. 2017 Jul;61(3):483-518. doi: 10.1016/j.cden.2017.02.001. Review. PubMed PMID: 28577633. ▪ Section On Oral Health. Maintaining and improving the oral health of young children. Pediatrics. 2014 Dec;134(6):1224-9. doi: 10.1542/peds.20142984. PubMed PMID: 25422016. ▪ Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. The Cochrane Database of Systematic Reviews 2002, Issue 1
▪ Dye BA, Vargas CM, Fryar CD, Ramos-Gomez F, Isman R. Oral health status of children in Los Angeles County and in the United States, 19992004. Community Dent Oral Epidemiol. 2017 Apr;45(2):135-144. doi: 10.1111/cdoe.12269. Epub 2016 Dec 6. PubMed PMID: 27922188. ▪ Haber J, Hartnett E, Allen K, Hallas D, Dorsen C, Lange-Kessler J, Lloyd M, Thomas E, Wholihan D. Putting the mouth back in the head: HEENT to HEENOT. Am J Public Health. 2015 Mar;105(3):437-41. doi: 10.2105/AJPH.2014.302495. Epub 2015 Jan 20. PubMed PMID: 25602900; PubMed Central PMCID: PMC4330841. ▪ Ramos-Gomez F, Ng MW. Into the future: keeping healthy teeth caries free: pediatric CAMBRA protocols. J Calif Dent Assoc. 2011 Oct;39(10):72333. PubMed PMID: 22132584; PubMed Central PMCID: PMC3457698. ▪ Ramos-Gomez FJ, Silva DR, Law CS, Pizzitola RL, John B, Crall JJ. Creating a new generation of pediatric dentists: a paradigm shift in training. J Dent Educ. 2014 Dec;78(12):1593-603. PubMed PMID: 25480274 ▪ The State of Little Teeth, Report by the AAPD available at :http://www.aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf ▪ Resources from the DentaQuest foundation, available at: http://www.dentaquestfoundation.org/what-were-learning/essential-resources ▪ Section on Pediatric Dentistry and Oral Health.. Preventive oral health intervention for pediatricians. Pediatrics. 2008 Dec;122(6):1387-94. doi: 10.1542/peds.2008-2577. Epub 2008 Nov 17. Review. PubMed PMID: 19015205. ▪ AAP Oral Health Toolkit available at https://www.aap.org/en-us/about-the-aap/aap-press-room/campaigns/tiny-teeth/Pages/default.aspx ▪ Atchison, K. A., R. G. Rozier, and J. A. Weintraub. 2018. Integration of oral health and primary care: Communication, coordination, and referral. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201810e 70
CE Credit Available
2018
Contact Information •
Hamida Askaryar MPH, RDH UCLA School of Dentistry 10833 Le Conte Ave. Room 23-020 Los Angeles, CA 90095 haskaryar@dentistry.ucla.edu
•
Tiffany Gadson Programs Associate Oral Health America Tiffany.Gadson@oha-chi.org
2018
THANK YOU! Letâ&#x20AC;&#x2122;s improve the oral and overall health of all Americans together.
2018