CAPSTONE REPORT
Dental carries were a health problem first identified in 1930’s by Beltrani and also termed as the black teeth of very young. It also assigned various terms like “nursing bottle mouth, nursing bottle syndrome, night bottle mouth, and baby bottle tooth decay . The common meaning among all these various terms is suggestive of the negative impact of baby bottle in the pathology and etiology of carious lesions .
Oral health condition is a critical component of preschool children’s health and overall well-being. Early childhood caries has been associated with many factors such as prolonged/ recurrent nocturnal bottle feeding, breastfeeding, oral hygiene practices, dietary patterns, and the timing for child’s first dental visit . Parent’s knowledge regarding oral health and attitude affect the oral health of children. A study shows the effect of mothers’ attitude and awareness about oral hygiene of their preschool children the Makkah Al- Mukarrama in Saudi Arabia .
Prevalence
A study reports a high incidence of dental carries in the age group of 5, in both developed and developing nations . Highest prevalence of maxillary anterior caries is observed in Southeast Asia and Africa . A research study conducted on 322 randomly chosen pre-school children, investigated in the kindergartens of Al-Ahsa region in Saudi Arabia . The average score of decayed missing and filled teeth and overall carries prevalence in the preschool children is relatively higher as compared with children from developed countries. About 62.7 % of the children examined (202 out of the 322), were found to be positive for caries. Yet another study conducted in the Riyadh kingdom of Saudi Arabia reported a 94.4 % recurrence of caries and the observed mean decaying, missing and filled score was 6.3 . The consensus opinion of the teachers was that maintenance of appropriate dental hygiene and regular dental check-ups were crucial for a good dental health. Factors contributing to the poor dental hygiene were high sugar consumption, inappropriate oral hygiene (97.4 %). Another study reported an overall prevalence of 73% in 987 preschool children examined in six public and nursery schools in Jeddah .
2. Risk factors and Protective factors
Risk Factors
Factors contributing to the etiology of dental caries are demographic factors, general diet, host factors such as oral hygiene behaviors and microbiological status such as the type of bacteria . Environmental factors that override the interaction between these factors include demographic factors, socioeconomic status, poverty, culture, stress ad health care system .
Demographic Factors:
Race, ethnicity and socioeconomic status are important demographic parameters. Research analyses from various sources indicates high risk of early childhood carries (ECC) in ethnic minorities. This finding may be attributed to the occurrence of considerable barriers to dental care, which includes expenses of care and availability of necessary medical resources . Recent evidence from Middle east underscores the significant impact of social class on oral health condition. People from lower socio-economic strata encounter financial, material and social shortcomings that hinder their accessibility to necessary health care services. The availability of dental insurance is restricted in these areas .
Diet:
Several investigational reports have highlighted the strong association between frequency of sugar consumption and caries. Also, children drinking sweetened bottle milk or other sweetened drinks have a high risk of suffering from maxillary anterior caries compared to those containing only water or milk.
Protective factors
Tooth brushing
Developing a habit of regular tooth brushing and better oral hygiene is linked to a lower risk of caries in preschool children.
Knowledge of caregivers and parents
Many studies have positively implicated the appropriate dental knowledge of use of bottle, limiting sugar consumption and regular tooth brushing in protecting from caries.
Objectives
The primary objectives of the field work include enhancing practical knowledge and awareness in the field of private pediatric dental care in Jeddah, to aid the parents in interpretation of dental care knowledge and to offer dental services to low income individuals. Another goal involves establishment of an e-book that may facilitate the knowledge of children’s oral health care.
There is a dearth of knowledge about the significance of the first dental visit in Saudi Arabia. It is observed that most pediatricians do not refer patients until the age of 3 or until there is severe early childhood caries. Data collated from the interviews of 30 families with their children demonstrated that only one patient had a neonatal tooth and was recommended by a breast- feeding specialist. Rest of the patients were seen as emergency visits and very few were attended as recall. Considering that this was a private dental clinic and patients had to sped out of their pocket to be seen. Nursing caries is a grave problem in Saudi Arabia owing the religious practice of breast-feeding a child until 2 years of age, which is against the AAPD recommendation. A systematic review analysis investigating the association between caries and breastfeeding in Saudi Arabia showed a significant connection between breastfeeding frequency, nocturnal feeding, late weaning, feeding on demand and dental caries in preschool children. These findings, however, entail corroboration in larger sample size and more rigorous standardization and deep analyses .
Development and Testing Interventions
One of the first steps is to psychologically prepare children for their first dental visit and develop oral health educational data for parents. American Dental Association urges health care professionals and public to be aware that a child’s teeth are prone to decay as soon as the they start to erupt. It is of crucial importance that parents schedule a visit to their dentist within 6 months of the eruption of first tooth and no later than 12 months of age
The fieldwork would provide an opportunity for teaching simple dental practices to the parents. Appropriate dental practices are necessary to ensure good dental hygiene of the children. The mother or the nursing care provider should follow basic caring practices to guarantee clean and healthy gums and teeth. Children should be taught simple dental care practices to ensure good oral hygiene, before the development of secondary permanent teeth. The soft gums of the baby should be effectively cleaned using soft cloth, and sometimes soft gauze, in order to eliminate the plaque and clean the gums before the formation of the primary milk teeth. Sharing of spoons and utensils with other babies should be avoided by parents and the babe care providers. Saliva usually transmits bacteria from the adults to the children, which may contribute to the process of tooth decay. Kissing is another way in which bacteria can be transferred from the adults to the children. Therefore, good dental hygiene of the children is effectively maintained by ensuring the family members and child care providers have good oral health and engage in proper dental habits like continuous brushing and flossing of the teeth .
During field work, it would be essential to educate the parents that infants and young children should not go to sleep at night with a bottle of milk or any sweetened drinks with a high sugar content. The sugary fluids contain acids, which cause the decay of the teeth of children and also adults. The feeding bottle should be immediately removed after feeding of the baby. Breastfeeding to sleep, however, may be important and do not result in the negative consequences of tooth decay . Babies should be offered a cup for drinking at approximately the age of 4 to 6 months. The mothers of the children should properly discuss the fluoride needs of their children with the pediatric dentist. Pediatric dentists know when a child needs more or less fluoride intake. Children with less fluoride levels should consume more quantities of fluoride supplements. But, excess fluoride intake or consumption can be detrimental to the health of the teeth of the child through staining and increasing toxicity. Importance of goof oral hygiene should be highlighted to the parents. To have healthy gums and clean teeth the children should be given sufficiently healthy drinks and foods. The nutritious content is important in improving the teeth strength and also minimizing instances of teeth decay. Foods and drinks that are rich in sugar or processed carbohydrates should be avoided; for example, refined food like pastries and white bread. The children should be refrained from using mouthwashes with high alcoholic content. If the child experiences cavities and is more than 6 years, the mother should enquire from the dentist if it is important to use mouthwash, which has fluoride content. While playing, these children can harm a tooth or injure the gums. Parents should protect children against physical harm, and also understand the appropriate measures to take when the child is injured during a dental emergency. Children should be prohibited from sucking the thumb or fingers; this prevents destruction of the gums .
Ensuring Widespread Adoption
The primary objective of this project is to urge companies to aid in publishing of this book. It would be of utmost importance to target vulnerable populations instead of individual. The principle focus should be on primary determinants of health leading to dental problems, such as lack of knowledge of parents regarding first dental visit, brushing of kids and significance of dietary counselling.
Limitations of Field Work Experience
Families from certain background and ethnicities have cultural inhibitions like having their children examined only by doctors, or preference for a male or female doctor. Sometimes children are in pain or extremely uncooperative, which makes it challenging to communicate with parents and provide anticipatory advice. Financial problems or busy schedules of parents contributed towards many missed appointments. One of the major drawbacks was the recall procedure for parents where the dental visits are often less chaotic and peaceful for discussions, education and appropriate comprehensive diagnosis.
References
Al-Malik. (2002). Erosion, caries and rampant caries in preschool children in Jeddah, Saudi Arabia. Community Dent Oral Epidemiology, 30: 16-23.
Al-Zahrani, A. M. (2014). Knowledge and attitude of Saudi mothers towards their preschool children’s oral health. Pak J Med Sci, 30 (4): 720-724.
Bagher, S. M. (2013). The Relationship between Breastfeeding and Dental Caries in Preschool Children in Saudi Arabia: A Systematic Review. Journal of King Abdulaziz University - Medical Sciences, 20 (3).
Reisine, S. (1998). Psycosocial and behavioral issues in early childhood caries. Coomunity Dent Oral Epidemiol, 26 (1): 32-44.
Statement on Early Childhood Caries. (2000). Retrieved from American Dental Association: http://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-early-childhood-caries
WebMD. (2015). Retrieved from http://www.webmd.com/oral-health/tc/basic-dental-care-infants-and-children
Wyne, A. (2002). Caries prevalence in Saudi primary schoolchildren of Riyadh and their teachers' oral health knowledge, attitude and practices. Saudi Med J, 23 (1): 77 - 81.
Wyne, A. H. (2002). Caries prevalence, severity and pattern in pre-school children. Saudi Med J, 23 (5): 280- 284.
