OWUSU: Hello, everyone.
Welcome to today's webinar,
Maternal and Child Oral
Health Advocacy and Promotion.
Before we get started,
please note that all
the lines are on mute.
There will be Q&A
following the presentation.
But during the presentation,
also note that there will be
somebody
monitoring the questions box,
so if you have any issues,
please use the questions box
located on your control panel
to communicate with our staff.
Today, we are joined by
Beth Lowe, Dental Hygienist,
and Jolene Bertness, Health
Education Specialist at the
National Maternal and Child
Oral Health Resource Center
at Georgetown University.
The Resource Center is
part of Georgetown University's
McCourt School of Public Policy
and supports
health professionals,
program administrators,
educators, policymakers
and others,
particularly those
working in or with
state maternal and
child health programs
with the goal of
improving oral health services
for pregnant women,
infants, children, adolescents,
including those with
special health care needs
and their families.
Without further ado, I will
go ahead and hand things over
to Jolene, and whenever you're
ready, Jolene, you can begin.
BERTNESS: Okay.
Can everyone see the
slide on my screen right now,
Teaching and Reinforcing
the Importance of Oral Health?
Thanks, Teddy. And
good afternoon, everyone.
National Children's
Dental Health Month
creates a great opportunity
to increase awareness
of the state of oral
health in many places.
It also offers an
occasion to highlight
realistic and
cost-effective solutions
for individuals and
health care systems alike.
So, on behalf of my
Resource Center team,
Beth Lowe and I
would like to thank Teddy
and the Office
of Minority Health
for arranging this
conversation with you.
I also want to thank all of you
for taking time out of your day
to lean in, learn and share.
Good oral health is
essential to overall health.
Good oral health improves our
ability to speak, smile, smell,
taste, touch, chew, swallow
and make facial expressions
to show feelings and emotions.
However, oral diseases
from cavities to oral cancer
cause pain and
disability for many people.
So today, we're
going to spend some time
talking about how
we can work together
to improve oral
health in your communities.
Our goal is to
provide you with strategies
to prevent and manage oral
disease in pregnant women,
infants, children and teens,
including those with
special health care needs.
We'll also talk about
your role as peer educators
and the role of others in
promoting optimal oral health
and overall health.
And finally, I'd like
to show you how to find
helpful partners
and resources using the
National Maternal
and Child Oral Health
Resource Center's website.
In 2000, U.S. Surgeon
General David Satcher
released a report on oral health
revealing a little-known fact:
Dental caries is a common,
chronic childhood disease,
and it's preventable
through basic and inexpensive
public health interventions.
Still, over a decade
after the report's release,
children's oral health is not
on many people's radar screens.
Many of us do not
understand what defines
and contributes to
children's oral health,
the consequences of ignoring
it, or how to improve it.
Dental caries is a
destructive disease
that is caused by a bacterial
infection in your mouth.
The bacteria that causes caries
breaks down sugar in
food to produce acid,
and, over time, the
acid removes minerals
from the outer tooth surface
or the enamel of the tooth.
This wears the tooth
surface down and, over time,
causes a cavity or
a hole in the tooth.
Cavities are
permanently damaged areas
in the hard
surface of your teeth.
If they aren't
treated, they get larger
and affect deeper
layers of your teeth.
Cavities can lead to
severe toothaches, infections
and eventually tooth loss.
Cavities are caused by
a combination of factors,
including health behaviors
that lead to poor oral health
and barriers that limit our use
of preventive
interventions and treatment.
Health behaviors that can lead
to poor oral health include
tobacco use, excessive alcohol
use, and poor dietary choices.
Some barriers that
limit someone's use
of preventive
interventions and treatment
include limited access to and
availability of dental services
or perhaps a lack of
awareness of the need for care,
as well as the costs of care.
And finally, fear,
whether from community beliefs
or from personal experiences,
can also influence our attitudes
about where and
how we get oral care.
Teddy, how about we
launch a poll right now?
I just wanted to ask
a couple of questions,
because many myths and rumors,
combined with language barriers,
can often prevent us from
embracing recommendations.
So we're going to ask a couple
of questions that I'd like to --
if all of you can
take a moment to answer
and see if we can
get fact or fiction.
OWUSU: Okay, folks,
so the first poll is up.
The question is,
"Baby teeth are not
important. They just fall out."
Is that a fact or a myth?
We're going to leave
about 10 more seconds
for the answers to come in.
"Baby teeth are not
important. They just fall out."
Please use the poll, not
the questions box, to answer.
Sorry about that.
Five more seconds.
All right.
Okay, the poll is
closed. Can you see it, Jolene?
BERTNESS: No, I cannot.
OWUSU: Sorry about that.
BERTNESS: That's okay.
OWUSU: But we have seven --
"Baby teeth are not
important. They just fall out."
We have 7 percent who
say that it is a fact
and 93 percent
who say it's a myth.
BERTNESS: Well, fantastic.
So the audience knows
that baby teeth are indeed --
they play a significant role in
children's
health and development.
They facilitate our speech.
They support kids' nutrition.
They also help to
preserve space in the jaw
for permanent adult teeth.
Oral health issues are
common in young children
and can lead to pain, infection,
along with trouble sleeping,
difficulty concentrating
and even emotional distress
or feeling bad
about the way they look.
Establishing healthy
oral habits at an early age,
including regular checkups,
can set a child up for a
lifetime of good oral health.
Teddy, can we
maybe do the next one?
Is there another one
you'd like to put up?
OWUSU: Sure.
The next fact or myth is,
"Tooth loss is part
of aging." Fact or myth?
"Tooth loss is part of aging."
Okay, we have 10 more
seconds to get your answers in.
Last bit.
Okay. So, "Tooth
loss is part of aging."
We have 27 percent
who think this is a fact
and 73 percent who
think it's a myth.
BERTNESS: All right, great.
Well, indeed, tooth
loss is not inevitable.
More people are keeping their
natural teeth for a lifetime,
and losing our natural teeth
can also affect nutrition,
our enjoyment of food,
speech and self-esteem.
So the important
thing to remember
is that we can keep
our teeth for a lifetime,
by continuing to
practice good oral care at home
and planning ahead for
extended health care needs,
including oral examinations,
even if we wear dentures,
and cleanings
for dental disease.
So today, one of our objectives
was to talk about
prevention strategies.
And what do we mean
about when we say prevention?
Prevention strategies
are designed to ensure
that a disease or
the disease process
fails to become
clinically evident.
Primary preventions are arguably
the most cost-effective
health care measures
because they eliminate the
need for further treatment,
as well as pain and suffering
associated with disease.
Secondary prevention
occurs when the focus shifts
from preventing the
beginning of disease
to preventing the
progression of that disease.
It's also highly
cost-effective in that
effects of the disease
can still be minimized,
but it also requires
early recognition and treatment
of the disease process.
Dental caries is
especially common
in children,
teens and older adults,
but anyone can have
caries, including infants.
Dental caries is an important
oral health indicator.
It's a key measure
for monitoring progress
toward our national
health promotion goals.
These goals include reducing the
proportion of young children
who have dental caries,
including
children with untreated --
Good self-care,
such as tooth-brushing
with fluoridated toothpaste
and professional treatment
is key to good oral health.
The American Dental
Association recommends
starting to brush
with fluoride toothpaste
as soon as an infant's first
tooth comes into the mouth.
And for most babies,
this happens between
about ages six and ten months.
The ADA recommends using a
smear of fluoride toothpaste
for infants and
children under age three
and a pea-sized amount for young
children ages three to six.
So if you're wondering
what that might look like,
this photo shows a picture of
a smear of fluoride toothpaste
on a child-sized toothbrush.
And this is what
a pea-sized amount
of fluoride
toothpaste looks like.
Having children brush
their teeth helps them develop
good oral hygiene habits
that can last a lifetime.
Seeing parents brush with
them helps them understand
that
tooth-brushing is important.
Brushing together
helps parents make sure
their children spend
enough time brushing.
However, it's
important to keep in mind
that young children don't
develop the fine motor skills
necessary to
brush their teeth well
until they're
about seven or eight
or about the time they
learn to tie their shoes.
To help children
form healthy habits,
it's good for them
to brush their teeth
with an adult supervising.
Those of you in the
audience who work in
community-based early
childhood education programs
like Head Start are in a really
unique position to help ensure
children receive the
benefits of tooth-brushing.
You can incorporate supervised
brushing in your program day
and work with parents to
help parents and children
develop a twice-daily
tooth-brushing habit at home.
The American Academy
of Pediatric Dentistry
recognizes dental caries
as a common, chronic disease
resulting from an imbalance
of multiple factors over time,
as we spoke about earlier.
To decrease the risk
of developing caries,
the AAPD
encourages both at-home and
professional
preventive measures.
Did you know that
these measures include
establishing a dental
home within six months
of eruption of the first tooth
and no later than
12 months of age?
But what we also
have to keep in mind
is that a dental home is more
than having an oral examination.
A dental home
provides a full range
of routine oral health
care that includes consistent,
coordinated,
culturally competent
and family-focused care
that takes into account
the strengths and the needs
of the child and their family.
It also includes assessment for
oral diseases and conditions,
preventive oral health care,
such as fluoride
varnish application
or fluoride supplements,
based on the child's risk
for developing oral disease.
A dental home also
includes treatment
of oral disease and injuries,
guidance on growth
and development issues
that may affect a
child's oral health,
like teething and
sucking a pacifier or fingers,
information about taking care
of a child's teeth and gums,
counseling about nutrition,
including their food choices
and their eating habits,
and of course referrals.
And when I talk about referrals,
we're talking about referrals
from oral health
specialists as needed,
as well as referrals
to health professionals
for general health
care that may be identified
in a dental home.
Early dental
visits help to teach kids
that oral health is important,
and children who receive quality
oral health care early in life
are more likely to
have a good attitude
about oral health professionals
and dental visits.
The National Survey
of Children's Health
found that, nationwide,
about a little over half
of children ages one to five
had one or more
preventive dental care visits
within the past year.
So about half of young children
did not have a
preventive care visit.
State programs such as the state
Title V MCH health programs
have long
received the importance of
improving the availability
and quality of services
to improve oral
health for children.
I encourage you to work
with your state programs.
They can help monitor
and guide service delivery
and assure that
all kids have access
to preventive
oral health services.
Coordinated
efforts such as these
endorse the fact that
good health is not possible
without good oral health.
Coordinated
efforts are long overdue.
The Institute of
Medicine outlined solutions
to reduce existing oral
health care disparities
in groups such as
children, ethnic minorities
and rural populations,
and in their recommendations,
they suggested
integrating oral health care
into overall health care.
They also recommended recruiting
underrepresented minorities
into dental education programs
and making community-based care
an educational requirement,
meaning that we are to
treat diverse populations
in different settings.
Those of you who are
providing primary care
or who work in
primary care settings
are well-positioned to
support preventive care
and reduce the impact of a wide
variety of oral conditions,
especially dental caries.
Because young kids visit family
physicians and pediatricians
more often than
they visit a dentist,
it's important for
these health professionals
to understand
the disease process,
how to prevent the disease,
and interventions available
to them and families they serve
to maintain and restore health.
Nurses and
physician assistants can also
screen for oral disease and
deliver preventive services.
Teddy, should we try
another fact or fiction?
There's an awful lot of
misinformation and advice given
based on anecdotal
experience or emotion.
So let's consider another.
OWUSU: All right.
Fact or myth:
"Oral health doesn't
affect my overall health."
BERTNESS: Now, we've probably
gone over this quite a bit.
So the mouth, of course, is
an integral part of our bodies,
and it's important to our
overall health and well-being.
OWUSU: So we have about
75 percent of the votes in.
So we'll allow
about five more seconds.
BERTNESS: Okay.
OWUSU: All right, I think I
see where this is trending.
[Bertness Laughs]
BERTNESS: Let's
certainly hope so.
We've reiterated
that many times.
OWUSU: Right. And you did an
amazing job. [Bertness Laughs]
Because 100 percent of
the audience selected myth.
BERTNESS: Great.
And now let's try one more.
OWUSU: All right. Okay.
"If I'm not in pain, I
don't need to see the dentist."
That's a unique spelling,
but the word is dentist.
"If I'm not in pain, I
don't need to see the dentist."
Fact or myth?
So Jolene, either you're
a really great presenter,
or these questions
are a layup. [Laughing]
BERTNESS: That one is
probably a pretty simple one,
that we do not wait
until we're in pain.
But unfortunately, that is
what a lot of people do do.
They wait until they have pain,
which means that there's
really a serious infection,
and that's something that
we definitely want to prevent
from happening.
We want regular examinations
where dentists can
monitor the health of our teeth
and soft tissues over
time, before we get pain.
So once again, oral health
is key to overall health.
We get it.
But also understand that it is
important at all stages of life.
But it is particularly important
at certain times in our lives.
Pregnancy is a unique period
that is characterized by
complex physiological changes,
and it's important
for women to understand
that these changes may adversely
affect our oral health.
During pregnancy, estrogen and
progesterone levels increase,
and this increase in hormones
can exaggerate the
way gum tissue reacts
to the bacteria in our mouths.
This condition is often referred
to as pregnancy gingivitis.
Other possible issues
that a woman may
experience during pregnancy
include dry mouth or
perhaps the oral effects
of iron deficiency anemia.
And some women may
experience morning sickness,
and in such a case, if
they're vomiting frequently,
they could also
develop tooth erosion
or a wearing away of the enamel
from the frequent
contact with acid.
Many women see an
obstetrician/gynecologist
as their primary care provider.
This creates a great
opportunity for OBGYNs
to educate women about the
importance of oral health,
because they see them
throughout their lifespan,
including during pregnancy.
As part of
routine prenatal care,
providers should
review these two questions
with all pregnant
women at every visit:
Do you have a dental home?
And do you have any pain
or problems with your mouth?
Providers can
encourage all pregnant women
to schedule a dental examination
if it has been
more than six months
since their last examination
or if they have any
oral health problems.
You should refer women for oral
health care in a timely manner
with a written note or call,
as that would be the
practice with referrals
to any medical specialist.
It's important to establish
relationships in communities
between prenatal care and
oral health professionals.
This helps to facilitate
a collaborative approach
to women's overall health needs.
It's also important for
prenatal care providers
to be aware of
patients' health coverage,
for dental services in
particular, during pregnancy,
so that referrals to
an appropriate provider
can be made.
We have to keep in mind
that state Medicaid coverage
for oral health care during
pregnancy varies considerably.
A few years ago,
the National Maternal and Child
Oral Health Resource Center
convened a meeting of experts
to discuss oral health care
during pregnancy.
This meeting was funded by
the Health Resources
and Services Administration
and was in collaboration with
the American College of
Obstetricians and Gynecologists
and the American
Dental Association.
The meeting resulted in a
national consensus statement
that communicates a
very important message:
Receiving oral health
care during pregnancy
is safe throughout pregnancy
and is effective in improving
and maintaining oral health.
The American College of
Obstetricians and Gynecologists
later issued a committee opinion
acknowledging that oral
health is a vital component
of general health
and should be
sustained during pregnancy
and throughout a
woman's lifespan.
So if you're a
women's health professional,
we encourage you to
look for opportunities
to educate your peers about the
significance of oral health.
Help them to
recognize oral health problems
and inform them about procedure
safety during pregnancy.
This will help them
feel more comfortable
with evaluating oral health
and more likely to
address it with their patients.
Women also need
to be reassured that
prevention, diagnosis and
treatment of oral conditions,
including dental
X-rays and local anesthesia,
are safe during pregnancy.
Conditions that
require immediate treatment,
such as
extractions and restorations,
are also safe during pregnancy.
Delaying treatment can
only complicate things.
The preconception period
provides a great opportunity
to intervene earlier
to optimize the health of
potential mothers and fathers.
Preconception care aims
to target existing risks
before pregnancy
so research can be used to
improve reproductive health
and optimize our
knowledge before we conceive.
These interventions include
prevention and management
of infectious diseases
and screening for and
managing chronic conditions,
including dental caries.
In early 2014, the CDC,
Centers for Disease
Control and Prevention,
estimated the
baseline prevalence
of 38 preconception
health indicators.
This indicator on
the screen is defined
as visiting a
dentist or dental hygienist
for a teeth cleaning in the 12
months before becoming pregnant.
It could be
monitored at the state level
for ongoing surveillance of the
status of preconception health
among women of reproductive age.
The CDC found that the baseline
prevalence of that indicator
was about 51 percent,
so just as within children,
only about half of
women who are pregnant
had a preventive dental visit
before they became pregnant.
And for all
reporting areas combined,
the prevalence of this
indicator varied significantly
by age and race/ethnicity.
For example, about 62
percent of women ages 35 to 44
reported having
their teeth cleaned
in the 12 months
before pregnancy.
This compares to about 41
percent of women ages 18 to 24.
That's about a spread
of 20 percentage points.
Oral health may not
feel like a priority
during this phase of
life, but it should be.
It's important to maintain
basic habits, eat healthy
and keep regular
dental appointments to ensure
that your health will be in
great shape for the future.
Before moving on,
I'd like to take just a moment
to recap where we've been
and talk a bit
about where we're going.
First, I defined dental caries.
Then we talked about strategies
for preventing
and managing caries.
We also talked about
the role of pure education
in reinforcing healthy practices
during early childhood and
pregnancy and preconception.
Now I'd like to
share some information
about the Oral
Health Resource Center.
You'll find that I
might refer to it as OHRC
in the next few minutes.
I'd also specifically like
to share some key resources
that you can easily
access from our website
at MCHOralHealth.org.
The Resource Center
is funded by a grant
from the Federal Maternal
and Child Health Bureau
to help states and communities
address current and emerging
public oral health issues.
Our activities are primarily
organized around four goals
that relate to knowledge
building, program development,
easy-to-access
communication systems
and, importantly, collaboration.
I'd first off like to share --
this slide shows picture of
our library from our website.
And I wanted to
talk a little bit about
what you will be able to
find if you come to the website
and search our library.
These include conference
proceedings, curricula,
policies, reports and standards.
And the materials that
you'll find in the library
might include things
from government agencies,
national and
state organizations,
community programs,
as well as Maternal and Child
Health Bureau-funded projects.
You can use the
library to assist you
in providing
education and training,
or you might like
to do some research.
You're developing a program,
or you simply
want to stay abreast
of what's
happening in the field.
One of the resources
we've also pulled together
from many of the materials in
our library is this timeline.
The timeline
traces significant events
that have occurred
in the United States
and that have
impacted the oral health
and, ultimately, the
overall health and well-being
of children, teens,
women and families.
You can use this
tool to educate students
or professionals new to
public health or oral health
and remind professionals
working in the field
about important events
that have shaped our history.
Each page in the timeline
contains a date, a milestone.
It includes
background information
and information about
the milestone's impact.
I particularly like
a lot of the pictures
that are included as well.
This is our
Bright Futures Toolbox,
and this is one of the
first go-tos on our website
for many of you.
The toolbox
highlights materials for
promoting and
improving oral health
of infants,
children and adolescents.
You can use it to find
oral health information,
identify services
needed to improve oral health,
learn how to develop
and implement programs
or find
information about training
for professionals,
providers and students.
This is an example of one
of the tools that you can find
in our Bright Futures Toolbox.
It's a series of
modules that we designed
to help people who are working
in community-based settings --
that might be Head Start
programs, Home Visiting, WIC.
It's designed to help
you promote oral health
in the course of
promoting general health.
The modules present information
about dental caries,
the risk factors
and prevention --
much of what we've
already discussed here today.
But they also
explain how to perform
a risk assessment in screening
and highlight guidance that
you can share with parents.
There's also a
companion presentation
available to
assist with training events.
The Bright Futures
Toolbox points to a variety
of different types of resources
for learning about oral health
and oral health services,
including videos
and even widgets
for finding oral health care.
We also compile lists of
recent materials and websites
to help busy people easily
find resources on key topics.
This is a photo of our library.
Many of the topics
are listed on this slide,
and of course it
includes dental caries.
Each of our highlights includes
statements supported by
references from the
recent professional literature,
and you might want
to use these statements
for things like reports, so
if you're writing a proposal,
you're doing a presentation.
They also feature publications
that we've developed,
as well as key websites
and materials from others.
After you look
through all the resources
and each of the highlights,
you can use the library's search
to identify more resources,
or you might even like
to suggest a resource.
We would love that.
Or suggest a topic
for a resource highlight.
The Resource Center
also produces materials,
and we pull these things
together often in directories
so that you can
easily access what's new.
Other examples of
materials that we produce
are policy briefs
and papers that describe
strategies for action
and tip sheets that describe
program development strategies.
We also work with our partners
to develop and share
materials for pregnant women.
This tip sheet is an excerpt
from the consensus statement
that I mentioned earlier.
It communicates
the important message
that receiving oral health care
is safe throughout pregnancy
and is effective in improving
and maintaining oral health.
The tip sheet is currently
available in multiple languages,
including Arabic, Chinese,
English, Korean, Portuguese,
Russian, Spanish and Vietnamese.
We've also developed
this brochure series
for sharing with parents.
It provides information about
the importance of oral hygiene
and oral health care
during pregnancy and infancy
and also how to ensure
that infants and young kids
enjoy the best
possible oral health.
All OHRC's materials can be
downloaded from our website
in PDF.
You're also welcome to photocopy
or print them from the PDF.
Looking for partners.
Keep in mind that we routinely
collaborate with others.
That's the way we do our work.
We gather, develop and share
information and materials.
We work with partners
also to provide information
about organizations,
programs and initiatives
and other groups that
can serve as resources.
You can find
these organizations,
such as clearinghouses,
resource centers,
directly linked on our website.
We also link to data sources,
state offices of oral health,
as well as Medicaid
provider enrollment information
for those who are
looking to become providers.
So if for some reason you don't
find what you're looking for,
you can always use our search
tool to find other information,
and of course there's
always the phone and email,
because with all
areas in health,
new resources
regularly become available,
so I encourage you to continue
to visit OHRC's website
for the most up-to-date
information about practices
and policies.
You can also stay
informed about new resources
by subscribing to our
email distribution list,
OHRC Announcements.
We highlight publications,
website features and other news
as recent developments occur.
Or you can join our
conversation on Twitter,
subscribe to our YouTube channel
or post our
badge on your website.
It's a great way to provide
a gateway to our homepage.
So today, in
closing, I wanted to say that
oral health may begin at home,
but it's really up to
all of us to also make it
a point of focus in
our classrooms and offices
and our conversations
with our friends and families
and in our communities.
If we want to ensure
optimal health for all,
we need to be able to
talk about the importance
of oral health in different
ways, in different environments,
and with different people.
Teaching early and
often enables children
to develop lifelong, sustainable
beliefs, attitudes and skills,
and interaction
between the home, the school
and the community is critical.
It includes interaction
between parents, our peers,
our teachers and
health care professionals.
Repetition of information
is a key learning principle,
and, in this case, reinforcing
the importance of oral health.
I want you to take that home.
Teddy?
Thanks to all of you
for this opportunity,
and we look forward
to working with you.
I think perhaps it's
time to take some questions.
OWUSU: Yes, ma'am.
Thank you very much, Jolene, for
that wonderful presentation.
To start things
off, can you please
show the audience your contact
information one more time --
BERTNESS: Sure.
OWUSU: And just have that
out during the questions,
because we get
that question a lot.
So the first question is,
"Regarding some of the
resources your office offers,
do you guys offer
toothbrushes or toothpaste
for tabling events,
or what kind of materials
do you all offer for free?"
BERTNESS: We do not offer
toothbrushes and toothpaste.
However, we are able
to provide resources
to help you find
those kinds of things.
So if you were to just
email us or give us a call,
we'd be happy to share
that information with you.
OWUSU: Okay. The
next question is,
"What materials do you have
for lower literacy levels?"
BERTNESS: Many of the materials
that I shared earlier,
the brochures as
well as the tip sheets,
have been created for people
with lower literacy levels
in mind.
We also do have other
resources on our website.
If you were to do a
search of our library
just using the advanced search
box and type in low literacy,
we use that as a
keyword as well,
so that's a great
way for you to be able
to easily find
those kinds of materials.
OWUSU: Okay. Just
going through some of these.
So does your office provide
early education webinars?
So I guess education
on oral health care?
BERTNESS: Yes, we absolutely do.
In fact, we work quite a lot
and have over many years now
with Head Start programs,
and in fact, my
colleague, Beth Lowe,
who is joining us on
the phone here as well,
is working in that area.
In particular,
Beth does a newsletter
for Head Start programs
called Brush Up in Oral Health,
and Beth has also
participated in other webinars
for early care and
education professionals.
I think it's really
an important aspect,
and if you were to go,
again, to the website --
perhaps maybe I could
even show you where that is --
you can find lots of
resources that we're using,
including a way to
choose curricula for programs,
the newsletter
that I just mentioned.
Beth, is there anything else
that you would like to share?
LOWE: Well, this last one
ties into some of the
low literacy information.
We have also produced a
handout series for parents
called Healthy
Habits for Happy Smiles,
and that essentially
addresses one-topic issues,
so if you're counseling a family
or working with a family
and you're using more
of an incremental approach
to try to improve
their oral health care,
you can take certain topics
such as pacifier use, weaning,
you know, a variety
of different things --
how to position a
child to brush their teeth.
Those are all
available on our website
and on Head Start's -- I'm
going to get this wrong --
it's called ECLKC, but it's
Early Childhood Knowledge
and Learning Center [sic],
which is the gateway website
for many of the
Head Start materials.
If you just googled
"Head Start oral health,"
that should get you right into
our web page there as well.
OWUSU: Okay, thank you, ladies.
Beth, you may be more equipped
to answer this question.
"Do you feel the fingertip
toothbrush for infants
is necessary, and, if so,
what age would you recommend
parents to start wiping
the gums, tongue and cheeks
of their infants or children?"
LOWE: The fingertip brushes --
I've heard mixed
reviews on those,
because sometimes
children can bite down on them
and they slide off
the parent's finger,
and then they
become a choking hazard.
The best bet is just to start
using an infant-sized toothbrush
as soon as the teeth appear.
In terms of
wiping an infant's gums,
you can do that as soon after
the baby is born as possible.
We recommend
wiping the infant's gums
primarily because
it gets the child
used to having someone
working in their mouth,
and anyone who's dealt
with a two-year-old before
knows how difficult that can be.
So by starting early, it
just kind of gets them used to
having somebody
brushing their teeth
or working in their mouths.
So that's one of the primary
reasons that we use that.
However, if the
finger brushes --
they can assure that
those stay on the finger,
they're okay to use.
But once the
teeth first come in,
it's just finding
an infant toothbrush,
with a smear of
fluoridated toothpaste as well.
OWUSU: Thank you.
Jolene, would you
mind going to the slide
where you listed your partners?
BERTNESS: Sure.
OWUSU: We have a
question from the audience
wondering if you
also partner with
the DentaQuest Foundation.
BERTNESS: We certainly do.
That's a very good question.
And that is one of the web links
that you will find on
our website, too, as well.
OWUSU: Okay, great.
And could you go into
some detail about tooth loss,
mainly in the
primary or permanent teeth?
I guess more so
teeth will be lost, right?
How do you manage that or
I guess mitigate the loss?
BERTNESS: Certainly.
When we talk about tooth loss in
young children in particular,
the primary teeth are important.
We don't want people to be
losing teeth due to disease.
Certainly, teeth do fall out,
and that is
something that happens
as a natural course
of the development.
But what's very
important for us to understand
is that it shouldn't be
happening due to disease.
LOWE: If I can step in
here a little bit, too,
primary teeth are incredibly
important for saving a space
for the permanent teeth that
are developing underneath them.
If primary teeth are lost early,
the other teeth
will tend to drift,
because they all
want to touch each other,
so they tend to drift towards
the center of the mouth,
and when they do that,
they then block the space.
The space fills in
for the permanent teeth
that are developing underneath
the now-missing tooth
that blocks that space out,
So then that
leads to extra crowding
and what we call malocclusion,
where the teeth don't
touch together properly,
so it can cause
problems with bites and speech
and all those kind of things.
So the really main
reason for maintaining
all of the primary teeth
until it's age-appropriate
for them to be shed
is to keep the permanent teeth
in inclusion with each other
and that there's
enough space for them.
I hope that
answers that question.
OWUSU: Okay.
How do you feel about
oral pulling for adults?
LOWE: That's a good question.
It's pretty much not
an effective approach
for maintaining oral health.
I mean, really, the main things
for maintaining oral health
is to have optimal oral hygiene,
watch your sugar
intake, your dietary intake.
How frequently you eat
food makes a huge difference
in how much acid that is in
your mouth throughout the day.
The more frequently you eat,
the more often your teeth
are going to be bathed in acid,
which will end up
causing tooth decay.
And then, actually,
access to fluoridated water
is also incredibly
important for adults,
because we get minute amounts
of the fluoride in our saliva,
and that also gives
it a topical effect.
So eating well, using
fluoridated toothpaste,
brushing and
flossing as an adult,
brushing twice a day and
flossing at least once a day
is really the key factors,
and also making sure that,
if you have any dental disease,
that you have that
fixed or restored,
because if a person
has active tooth decay,
they have a much higher burden
of the bacteria that causes
tooth decay in their mouth,
and that will make the
other teeth in the mouth
more susceptible to tooth decay.
So it's really kind of a folk --
the teeth pulling is
more of a folk practice
that isn't really
based in any evidence,
whereas fluoridated
toothpaste, fluoride water,
watching your diet are
all definitely science-based
or evidence-based.
OWUSU: And kind of along
with the first part of
your answer to that question,
are there things more
harmful to teeth than sugar?
LOWE: No, sugar's
the bad guy. [Laughing]
Sugar's the bad guy --
OWUSU: I guess they
mean like a daily --
I'm sorry. Go ahead.
LOWE: Sugar's
really the bad guy,
but we also need
sugar, so we have to be smart
about how we eat.
Sugars that are processed sugars
are very easy for
the bacteria that cause
tooth decay in our
mouth to break down,
whereas other
sugars, natural sugars
or sugars that
are included in --
the complex
sugars that are included
in almost every
food that we eat --
that takes longer for
the bacteria to break down.
Each time we eat
something with sugar in it,
whether it's a
natural or complex sugar,
the pH level in
our mouths goes down
into the acidic level,
and that's where
tooth decay can occur.
The key is, you want to see --
and that acid is in the
mouth for about 20 minutes
after we eat something.
So what we want to do is,
we want to see high
peaks and very short low peaks
where the bacteria or
the acid is in our mouths
for very short periods of time
and have it go back
up into the safe zone
or the zone where
it's being buffered.
And so by doing that,
minimizing the number of times
that we consume anything
with sugar, including drinks,
that is going to minimize your
risk of developing tooth decay.
So sugar's a
biggie, but we need it.
So we have to be smart about it.
OWUSU: And Beth,
do you have information on
what a safe amount of sugar is,
a daily amount of sugar?
LOWE: I'm not sure
exactly what it is.
But if you check the
nutrition standards,
generally they have those.
But again, in terms of
sugar, the best approach
is to look for the more
complex, natural sugars
than the sugars that are
refined or in processed foods.
Jolene, do you happen to know
if there's a daily
recommended amount for sugar?
BERTNESS: No, I don't.
I think the answer you
provided is very good.
OWUSU: Okay, thanks.
We have about two more minutes,
so we're going to get through
these last couple of questions.
An attendee asked,
"I have heard that even
seltzer with no sugar is bad.
Is that true or false?"
Sounds like a poll question.
LOWE: Yeah,
that's a good question.
Actually, carbonation --
it's not so much creating
problems with tooth decay.
It is actually involved in
erosion of tooth surfaces,
which means that it
kind of thins away --
makes the enamel that's
covering the tooth's surface
a little bit thinner,
and if you drink carbonated
drinks really regularly
and very frequently,
you can get some enamel
erosion on the tooth's surface,
and that can erode the enamel.
And so that can cause
sensitivity to hot and cold.
Can also cause
teeth to possibly break
where the enamel shears
off of the tooth's surface
or could break off
of the tooth's surface,
making it very difficult
for teeth to hold fillings
if they needed to
have any kind of fillings.
But again, this is a
chronic, long-term use
where you're having
carbonated beverages
basically drinking
them throughout the day.
OWUSU: Okay.
And we have a
question about coffee.
Is the discoloration that
occurs from drinking coffee
damaging to teeth, or
is it just aesthetic?
LOWE: It's just
an aesthetic thing.
You know, after a while --
as a practicing hygienist,
when I was
practicing dental hygiene,
I had a lot of
patients who had coffee stain,
and some of it can be removed,
but then some of it
becomes part of the tooth,
or it gets incorporated
into the tooth's surface,
and so it can't be removed.
Some people try
whitening to do that,
and again, there are
some issues with that
where you can increase your
sensitivity to hot and cold
and other issues if
you use it a long time.
But in terms of
causing damage to the teeth,
it really doesn't.
It's really more of an aesthetic
issue for many people.
OWUSU: Okay. And final question:
"Are there special care
needs for pregnant women?
Do they need
more dental checkups?
Is there anything
you can recommend?"
LOWE: That would depend.
That's on a case-by-case basis.
You know, everybody responds
to bacteria differently,
and everybody
comes into a practice
with a different
set of health issues.
Some women go through
pregnancy without any problems
with their teeth and gums,
whereas others have a lot.
Their gums react very quickly
to the byproducts of
bacteria that come in contact
with the teeth.
So it's really on a
case-by-case basis.
The best advice is to
do what we do every day,
to keep our mouths as
clean as we possibly can,
to see the dentist
on a regular basis
just to make sure that
there isn't anything going on
and to treat any unmet
need as soon as it comes up.
One of the things
that you can do with women
who have a lot of
morning sickness --
because with morning sickness,
there's a lot of acid in the
vomit, and so a number of --
one of the recommendations
is to use a teaspoon full
of baking soda
and mix it with water
and then swish
that through the mouth,
and that's probably the
only major preventive issue
that's different than
what we would do normally
or recommended for
all of us normally.
OWUSU: All right, thank you.
Thank you all for
joining us today.
That will
conclude today's webinar.
If you would
like to reach Jolene,
her email is
BertnessJ@Georgetown.edu.
If you would like a copy of
today's PowerPoint presentation,
you can email me, Teddy Owusu,
at
TOwusu@MinorityHealth.HHS.gov.
And Beth's email is
EAL38@Georgetown.edu.
Thank you all for
joining us again.
Thank you, ladies, for a
wonderful webinar presentation,
and I hope everybody else has
a great rest of the evening.
BERTNESS: Great.
Thanks so much, Teddy,
and everyone else as well.
LOWE: Thank you,
Teddy, and thanks, everybody,
for spending some time with us.
OWUSU: All right.
Bye-bye. Thanks.
