children first dental visit

The results are in…decay is on the rise in Calgary

Is there a dental topic more polarizing than water fluoridation? Supporters adamantly defend this public health initiative and opponents are just as resolute in their position.

On the fence about community water fluoridation?  An internet search on the topic can lead to hours of reading, and information that is all over the map. Adding to public perplexity is the fact that within dental health communities you will find both supporters and opponents, even though the Canadian Dental Hygienists Association and Canadian Dental Association both have position statements supporting community water fluoridation, (1,2) as do a long list of other organizations and groups. (1)

One thing that is clear, regardless of your stance on fluoride, tooth decay rates have increased among children in Calgary since water fluoridation was discontinued in May 2011. This was brought to media attention in 2014, with Registered Dental Hygienist, Denise Kokaram speaking out about significant tooth decay being treated on the Alex Dental Health Bus,

 “more than half of the children who get treated on the bus have tooth decay”, she said. “We see lower self-esteem with these kids, attention spans are affected. Loss of days at school.”(3)

At this same time, Calgary pediatric dentist Dr. Sarah Hulland said

I’m seeing a lot more children having a lot more cavities. I’m seeing a lot of decay on 19- to 20-month babies, and this is even before they’ve got all the teeth in.

We frequently have to put them to sleep to rehabilitate them. We don’t have enough anaesthetists that actually help us to put them to sleep. We don’t have enough OR time. We don’t have enough manpower to actually do the care that needs to be given.

What used to be a one-month wait to see a pediatric dentist in Calgary is now at least three months.” (3)

Fast forward to today, and now we have hard data thanks to a recently published study carried out in Alberta. 

Lead author Lindsay McLaren, PhD, from the Cumming School of Medicine and O’Brien Institute for Public Health revealed children in Calgary are experiencing higher rates of tooth decay compared to children of the same age in Edmonton.

Comparing more than 5,000 grade two children in both cities, “there was a worsening in tooth decay in Calgary since the discontinuation of fluoridation in 2011, compared to Edmonton, where water is still fluoridated. In fact, the number of tooth surfaces with decay per child increased by 3.8 surfaces in Calgary during the time frame of the study, compared to only 2.1 in Edmonton. This is a statistically significant difference. The average child has about 20 teeth with four or five surfaces per tooth.”(4)

Dr.Mclaren says, “We first of all looked at trends over time in tooth decay in the two cities and whether there was a difference and after that we systematically went through and explored a number of possible alternative explanations for those differences. Everything pointed pretty consistently to fluoridation cessation being the main reason for the difference.”(4)

You can read the full study here htttp://www.ucalgary.ca/utoday/issue/2016-02-17/study-shows-tooth-decay-worsened-calgary-children-after-fluoride-removal (5)

At Lifetime Smiles Dental Hygiene Clinic, we provide our patients with recommendations based on their individual dental health needs, which may or may not include fluoride treatments. We respect a patient’s decision regarding treatments they consent to, and treatments they decline. 

When demineralization is present, or an individual (child or adult) is a high risk for tooth decay, fluoride and re-mineralizing fluoride alternatives can be recommended. Our philosophy of care is to treat individuals on an individual basis. 

Children should be seen for their first visit with a dental health care provider 6 months after their first tooth erupts, or by age 1 year. Lifetime Smiles Dental Hygiene Clinic offers to see children for this first visit at no charge. It is an important visit, despite the myth that baby teeth are NOT important. Baby teeth are VERY important. Let’s work together to ensure a future of cavity free adults, who do not require dental filling replacement over and over throughout their lives. Tooth decay is preventable. Let’s work together to prevent it.

References

  1. http://www.cdha.ca/CDHA/The_Profession/Resources/links/position_statement_water_fluoridation.aspx
  2.  http://www.cda-adc.ca/en/about/position_statements/fluoride/
  3. http://www.cbc.ca/news/canada/calgary/dental-decay-rampant-in-calgary-children-pediatric-dentist-says-1.2864413
  4. http://www.ucalgary.ca/utoday/issue/2016-02-17/study-shows-tooth-decay-worsened-calgary-children-after-fluoride-removal
  5. http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291600-0528 

Post Author: Sally Lloyd BScDH, Registered Dental Hygienist at Lifetime Smiles Dental Hygiene Clinic , Calgary,AB

Parents flip the lip

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I drafted this post some time ago but held back. I didn’t want parents to think I am criticizing them. I understand how many times throughout a child’s life that parenting can be difficult. I don’t want to add to any external pressure, but reading an article yesterday that “the federal government is spending a million dollars to send five chartered plane loads of Nunavut children to the hospital in Churchill, Man., for dental surgery”  pushed me into sharing this. That coupled with the fact that after discussing this with a patient of mine she stated “I wish you would tell all parents this”. This is my attempt to reach more parents.

Dental decay is preventable

Granted there is an access to care issue for these Nunavut children in this media report, but that wouldn’t explain the situation in other areas of Canada. There is no shortage of tooth decay and dental treatment being carried out in Calgary by pediatric dentists.

Parents – please flip the top lip up and have a look at your baby’s teeth. Do this often, and realize that brown spots are not normal. Flip the lip when you brush. Their tight little lips prevent thorough plaque removal. Often it is far easier to brush the side of their teeth that the tongue touches when they open wide for this task, than to brush the surface covered by their lips.

Take your child to a dental health care provider by age 1 year (6 months after 1st tooth erupts). Yes, it is a short apt if nothing is wrong, but a very important appointment. Don’t wait until there is a problem, or until age 3 years old. Do they have the appropriate number of teeth for their age? Are they tongue tied? Is their lip tied? Are you struggling to clean their teeth? Are you confused about toothpaste that is age appropriate?  This is only a fraction of what could be reviewed and discussed at this first visit. Regulated dental healthcare workers are required to attend continuing education. That phrase “when we know better, we do better” applies. Therefore, what was reviewed at your older child’s exam 9 years ago maybe be quite different than what is reviewed today with a much younger child.

Wipe off baby teeth with a washcloth or baby toothbrush

Don’t lay a baby down with any liquid other than water

Don’t let a child sip for extended times from a sippy cup – think if it this way – every time they take a sip of apple juice (even diluted) a 20 minute acid attack takes place in their mouth (approximately). If they are sipping from their sippy cup intermittently for 1.5 hours (length of a kids movie) that is almost 2 hours of acid attack

Why fruit juice?….  Why not water?

When the time is right – Have Dental Sealants Placed

I am a parent and trust me there was a period of time that it took myself and my husband to hold our son down so that we could brush his teeth –  he was about 2.5 years old when he began to hate having his teeth brushed. I mean hate it. Of course, we hated doing it just as much.   Me: ” It’s your turn”;  my husband: “No, it’s your turn”  – and usually it would take 2 of us to do it. I would put my thumb in my son’s mouth toward the back baby molars- where when he bit down it wasn’t with any amount of force. Then while my thumb was there, we could get his teeth brushed. He couldn’t close completely so I could maneuver a toothbrush around. The thumb technique sometimes allowed me to do it without help from a second adult. This nightly battle went on for about 6 months- then he was over it. He began to want to “do it himself” of course, but the deal was – he had a turn then an adult had a turn. This event takes minutes, not hours – get it done – get it over with.

Children DO NOT have the dexterity to brush and floss well enough until age 10. If you don’t believe me, have them “do it themselves”, then put disclosing liquid on their teeth. The liquid that turns plaque bacteria purple or red. You will then understand how a child who “brushes everyday” still gets cavities. They aren’t brushing well enough to remove the majority of plaque. It’s not their fault, it’s not that they aren’t trying. They don’t have the co-ordination. Sometimes once “disclosed” – it is quite evident that they are right or left handed and they have missed an entire quadrant of their mouth. Not just one or two teeth, but 5 or 6 teeth. They have spent the time in the bathroom and they report the deed is done, but an adult really needs to assist.

As far as flossing on their own? seriously? there are many adults who don’t even feel the need of this 1-2 minute activity warrants doing. A child left to their own devices may use a floss pick or floss and get a percentage of the spaces. If you actually watch them, they get one spot, skip 2 spots and so on. If this part of home care is a nightmare- consider a child’s waterpik flosser or GumChucks (much easier for a parent to use on a child).  Those tight spaces are where many cavities form.

Give some thought to yourself – did you ever have cavities? if so at what age did you have the most dental treatment? If you have never had decay – fantastic. Congratulations. You won’t have to spend time and money over your life having the dental fillings placed when you were a child drilled out and replaced several times over. Once a tooth has been cut with a dental drill and a filling placed, it is destined for future dental treatment. Fillings don’t last forever, especially the white resin fillings. All of this can be PREVENTED.

As a dental hygienist, my children are not immune to tooth decay, so I knew it had to be done, and I considered it a chore. It is important to me that I prevent what I know can be prevented. Why was I then cursed with a child who hated having his teeth brushed?

I know why. I was a dental assistant before I became a dental hygienist. I assisted a dentist with operating room privileges. We treated children under general anesthesia in a hospital. It was difficult to see such small, young children laying on an operating table – their feet going nowhere near the foot of the bed, and their eyelids taped shut during the procedure.This was not a children’s hospital – so these were adult hospital beds.  Usually, treatment involved several injections of anesthetic, pulpotomies (this is basically the equivalent to a root canal treatment but on a baby tooth), stainless steel crowns cemented to hold intact what was left of the decayed teeth, several fillings, and some extractions if the teeth were so badly decayed. As I suctioned and watched eyelids try to flutter I cast judgment on these children’s parents. In my mind I questioned to myself – “who would let their children’s teeth become decayed like this, and why don’t parents brush their kids teeth?”   This is why my son gave me grief – and of course, that is when I realized just how difficult it is to carry out dental home care at times. Often it’s not that brushing isn’t happening, it’s that it isn’t happening well. Today’s typical diet is inducive to dental decay. Let your children, or your grandchildren or any children you know be the exception.

So I sympathize with new parents, parents of multiple kids, tired and overworked parents – but please, as tired as you are, please get through this chore at night before bed – at least, and monitor what it is in contact with their teeth throughout the day. Do what you feel is in the best interest of your child.

Early Childhood Cavities – why be concerned?

Feds spend $1M to fly Inuit children south for dental surgery

Cavities on the increase for kids

Sedatives Cited in Toddler’s Dental Office Death 

Anesthesia in young kids may carry developmental risks

If you live in Calgary or Claresholm, bring your kiddies in for a no charge first visit.

If you have young children at home, or children who you feel would do better in their home environment – a mobile dental hygienist is a great option – they bring their equipment to you.

Don’t Let Language Be The Barrier

ÖWelcome to Lifetime Smiles Dental Hygiene Clinic in Calgary. We would like to introduce you to one of our dental hygienists – Jane Ma.   Jane speaks Mandarin and is happy to help patients who have difficulty accessing dental care in Calgary because of the language barrier. She is happy to discuss any dental issue you or your family member are having in Mandarin, and explain procedures and dental treatment. Jane can also refer you to a dentist if need be. Would you like your children to speak Mandarin at their dental cleaning appointments? Being a parent herself, Jane is very relaxed and happy to treat children of all ages. Do you have a senior parent who speaks Mandarin and communicating in their language would be easier?

Would it be easier to discuss the cost of dentistry and dental insurance policies in Mandarin?

Jane is passionate about dentistry and is dedicated to her patients, and has been a registered dental hygienist since 2003. She is eager to communicate to her clients up-to-date oral health knowledge.  Her gentle and caring clinic manners have gained much praise from patients.  The greatest satisfaction for Jane comes from seeing patients smile and tell her about their improved oral health and general health.
She enjoys Canada’s natural beauty, and appreciates people’s generosity.  She loves reading, music and trying different foods from different cultures.
If you or someone else would like to communicate in Mandarin with Jane – please phone (403)457-2044 or email us (info@lifetimesmiles.ca).  It’s important that language is not a barrier to a healthy mouth and a long lasting pain free smile. When discussing an individuals dental health – it is important their are no misunderstandings due to language. Our goal is to provide high quality care in a culturally sensitive fashion. Come meet Jane in person 🙂
 牙齿卫生员简说普通话在卡尔加里

Autism In The Dental Hygiene Chair

autism ribbonApril is Autism Awareness month, and this week is National Dental Hygienists week, so I decide to blog about both. I dedicate this blog post to my friend Allison and all families who know Autism and Aspergers well. During my time as a dental hygienist I have been exposed to clients of all ages and backgrounds including those with unique needs. After recently meeting Allison I became aware that I did not have any experience with autistic children.

How is that possible? Did I in fact treat autistic children but didn’t know it? Would a parent not indicate that on a medical chart? Could I treat clients in a city with a population of 1 million and not see 1 autistic child when the stats from Centers for Disease Control and Prevention (CDC) identify that 1 in 88 children is diagnosed with autism? Was I so oblivious that I may have chalked up a child’s behaviour to “high maintenece” when really it was typical behaviour of an autistic child?

I don’t know the answer. I knew that after reading Allison’s blog post “Life with Liam“, about an orthodontic appointment for her 9 year old son that I was certain I may not know how to make a dental hygiene visit for an autistic child a positive one, an experience that both child and caregiver look forward to as opposed to viewing it as one more necessary but unpleasant life task. This was disturbing to me because I sincerely want to make dental hygiene visits a great, educational experience for both children and their caregivers. It is with children I feel hygienists have the opportunity to make the greatest impact – sharing  preventative dentistry knowledge – ensuring a life of “no drilling & filling”.

Of course I studied “special needs” in dental school, but how much could I recall of dealing with autism? not much. I was feeling very inadequate with my limited knowledge of the unique challenges associated with dental hygiene home care, best time of day for dental hygiene appointments, and management in the clinic. I was also certain my dated knowledge wouldn’t hold a candle to the reality of today for these families. Continuing education throughout life is a reality.

I have since learned that Autism is a general term, and there are various functioning levels – each individual is just that –INDIVIDUAL.  Autism Speaks Canada has an informative website and states that “Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. They include autistic disorder, Rett syndrome, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome. ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. ”

It is best for the caregiver to outline the functioning level of the child (where they are on the spectrum)- as well as details about sensory issues that may arise and discuss how to best handle them when at a dental hygiene appointment. If this conversation can happen prior to the child’s appointment that would be best. The dental hygienist will welcome any information that can facilitate an enjoyable visit. You know your child best, and know what sensory stimuli could be avoided or reduced. A dental hygiene clinic can have some advantages in terms of sensory stimuli when compared to a traditional dental clinic. There will be no dental drilling noises, smell of root canal mediciments, or dental materials like monomer being used in a hygiene clinic. Lighting may be an issue, so best to discuss this ahead of time. Caregivers can practice a visit at home before going to the clinic so the child has some familiarity with what may happen – practicing laying back, looking in the mouth, and counting teeth.

From the dental hygienists perspective be prepared to book a longer appointment so it isn’t rushed, the child has the time needed, you can answer all of the caregivers questions, and you can review techniques for oral home care. Repetition and routine can be very reassuring for autistic children. Establishing a relationship with one particular dental hygienist, rather than seeing someone different each visit can achieve this. Like appointments with all children, what works one day may not work the next, so be prepared with knowledge and do not hesitate to ask for recommendations from caregivers, and have patience. The first appointment may end up being a familiarity time, and perhaps no treatment carried out. Stretch your mind and skills and grow with the child & family.

Are you a dental hygienist looking for a resource to use? Dental hygienist and mother, Karen Raposa devoted six years of her life to writing “Treating the Dental Patient with a Developmental Disorder”. She cited her autistic son as her inspiration for writing the book. This book shares information on how to provide dental health services for patients with developmental disorders. You will also find the best information comes directly from parents and caregivers. Keep an open mind…. we are always learning.