Maternal and Child Oral Health Advocacy and Promotion

Maternal and Child Oral Health Advocacy and Promotion

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 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
[email protected] If you would like a copy of
today’s PowerPoint presentation, you can email me, Teddy Owusu, at
[email protected] And Beth’s email is
[email protected] 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.


  1. Dolly Pham
    5 facts from the video:
    1) Dental Caries: is a common chronic condition caused by a bacterial infection in the mouth.
    2) Multiple Factors: Tobacco use, Excessive alcohol use, Diet choices, Access to and availability of services, Awareness of need for care, Cost of care, Fear of dental procedures.
    3) Baby teeth play a significant role in speech development, support kids nutrition, and support space in jaw for permanent teeth to reside.
    4) To help keep children's mouth healthy, toothbrushing should start as soon as the first tooth appears in a baby's mouth.
    5) Having a teeth cleaning during the 12 months before pregnancy is a core measure of preconception health.

  2. Vanessa Garcia, California Baptist University
    1.Good oral health improves our overall health, ability to speak, smell, touch, smile, smell, taste, chew, swallow and make facial expressions to show feelings and emotions.
    2.Dental cares (tooth decay) is a common chronic disease and it is preventable.
    3.Cavities are caused by multiple factors: tobacco use, excessive alcohol use, and poor diet choices.
    4.Factors that limit preventative or oral treatment include: access to and availability of services, awareness of the need for care, cost of care, and/or fear of dental procedures.
    5.The ADA recommends to start brushing a child’s teeth as soon as the first tooth appears, usually around 6-10 months of age. Use a smear of toothpaste for children under three and a pea-size amount of fluoride toothpaste for children 3-6.

  3. Roxanne Beye
    California Baptist University
    1. Tobacco use, alcohol use, and diet choices all contribute to dental caries
    2. Losing natural teeth can affect nutrition, enjoyment of food, speech, and self esteem

    3. Dental X-rays and local anesthesia are safe during pregnancy

    4. Having a teeth cleaning during the 12 months before pregnancy is a core state measure of preconception health
    5. It is important for primary teeth to remain intact until it is appropriate for them to fall out in order to prevent malocclusion of permanent teeth

  4. Genesis Rivera, California Baptist University
    1. Tooth loss is not a normal part of aging.
    2. The first set of teeth that children have are important because they affect nutrition, speech, and keep space for the adult teeth.
    3. Dental caries are most common in children ages 3 to 5, but can affect anyone, even infants.
    4. Toothbrushing should begin as soon as the baby’s first tooth appears.
    5. A smear of fluoride toothpaste is recommended for children under age 3, while a pea-sized amount is recommended for children ages 3 to 6.

  5. Sofia Ayala
    California Baptist University

    1.     Dental
    carries are a common chronic condition and it is preventable through basic &
    inexpensive through oral hygiene.

    2.     Dental
    carries are caused by a bacterial infection in the mouth.

    3.     Some
    of the risk factors for dental carries include; tobacco use, excessive alcohol
    use, diet choices, access to and availability of services, awareness of the
    need for care, cost of care, and fear of dental procedures. Cavities can lead
    to severe toothaches & infections can lead to tooth loss.

    4.     Goals
    for reducing the proportion of young children includes tooth brushing with
    fluoridated toothpaste and seek professional treatment is key to good oral
    health. Toothbrushing should start as soon as the first tooth appears in a baby’s

    5.     Secondary
    prevention occurs when the focus shifts to preventing the progression of the that
    certain disease, effects of the disease can still be minimized but it requires
    early recognition and treatment.

  6. Amber Leigh Morris
    California Baptist University

    1.    Oral health plays a key role in overall health.
    2.    Cavities can be caused by tobacco use, alcohol use, poor dietary choices, as well as poor access to or awareness of the importance of dental care.
    3.    Tooth loss is NOT a part of aging!
    4.    Adults should supervise and help children brush their teeth until they are 7-8 years old, about the time they can tie their shoes.
    5.    OBGYNs have a great opportunity to educate women on the importance of oral health as they see their patients frequently throughout the lifespan.

  7. Jenna Talbert; California Baptist University
    1. Saying that baby teeth are not important because they just fall out is a myth

    2. Tooth-brushing should begin using fluoride toothpaste as soon as the first tooth comes in 
    3. Children who receive good oral help during their younger years have a better view of dental professionals as they grow.

    4. Expect oral health changes when you’re expecting. Estrogen and progesterone can exaggerate the way our gums react to bacteria in our mouth.

    5. Having a teeth cleaning during the 12 months before pregnancy is a core state measure of preconception health.

  8. Cassandra Mendoza, California Baptist University
    Five Facts:
    1. Insert Fact One
    To help establish and keep children’s teeth healthy it is best to start brushing their teeth as soon as the first tooth comes out.
    2. Insert Fact Two
    It is best for children to watch parents brush their teeth so they also want to do it and they will develop healthy oral hygiene habits throughout their life.
    3. Insert Fact Three
    Children that establish good dental health at an early age with their parents will react and cooperate better with dentists and dental visits.
    4. Insert Fact Four
    Oral health will change during pregnancy—gingivitis and dry mouth and can have tooth erosion from vomiting.
    5. Insert Fact Five
    Oral health is a vital component to general health—extractions are safe during pregnancy; it is important to intervene earlier than later because the complications can cause harm to the mother and the fetus.

  9. Katelin La
    California Baptist University

    1. Dental caries is a destructive disease that is caused by a bacterial infection in your mouth. The bacteria breaks down the sugar in food and produces acid which can wears the tooth down.
    2. The multiple risk factors for dental caries are tobacco use, excessive alcohol use, diet choices, access to and availability of services, and cost of care.
    3. The American Dental Association recommends starting to brush with fluoride toothpaste as soon as an infant’s first tooth comes into the mouth which is around 6 to 10 months.
    4. The estrogen and progesterone levels increase during pregnancy. These levels increase hormones which can exaggerate the way gum tissue reacts to the bacteria in our mouths. This condition is called pregnancy gingivitis.
    5. Having a teeth cleaning during the 12 months before pregnancy is a core state measure of preconception health. Among women ages 18-44 with a recent live birth, the estimate overall prevalence of having a teeth cleaning for 29 reporting areas was 51.3%.

  10. Dianne Abetong- California Baptist University
    1. Some risk factors of dental caries include tobacco use, excessive alcohol use, fear of dental procedures, diet choices, and access to/availability of services, and awareness of the need for care.

    2. Dental carries can affect anyone of any age or race, however, it is especially common in children, teens, and older adults.

    3. According to the ADA, they recommend that as soon as an infant’s first tooth emerges, typically between 6 and 10 months, tooth brushing with fluoride tooth paste should be encouraged.

    4. Some common oral health issues that occur during pregnancy include pregnancy gingivitis, dry mouth, and tooth erosion from morning sickness. Therefore, a teeth cleaning during the twelve months before pregnancy are a vital part of preconception health.

    5. Brushing twice a day and flossing once a day are essential and key factors to preventing tooth decay.

  11. Sabrina Dalan, California Baptist University

    1. Baby teeth are important as they facilitate speech, support nutrition, and preserve
    space in the jaw for permanent adult teeth.
    2. The key to good oral health is to begin brushing with fluoride toothpaste as soon
    as the baby’s first tooth erupts (6-10 months).
    3. It is important for health professionals to educate and screen for oral issues because they see them more than the dentist.
    4. Oral health affects my overall health and is important in all stages of life.
    5. The increase of estrogen and progesterone during pregnancy can change the way gum
    tissue reacts with bacteria in our mouths, leading to pregnancy gingivitis.

  12. Rebekah Mateo

    California Baptist University

    1. Many factors influence oral health, including tobacco use, excessive alcohol use, diet choices, access to and availability of services, awareness of the need for care, cost of care, fear of dental procedures, etc.

    2. To help keep children’s mouths healthy, adult-supervised toothbrushing should start as soon as the first tooth appears in a baby’s mouth – usually about 6-10 months old.

    3. Children who receive quality dental care early on in life are more likely to have a positive attitude toward oral health professionals and dental visits.

    4. Having a teeth cleaning during the 12 months before pregnancy is a core state measure of preconception health among women of reproductive age.

    5. It is important to maintain basic oral hygiene habits, eat healthily, and keep regular dental appointments to ensure good health.

  13. Vu-An Foster

    Rutgers School of Public Health

    3 things I learned

    There are
    multiple factors that affect oral health: Tobacco Use, Excessive alcohol use, diet
    choices, access to and availability of services, awareness of the need for
    care, cost of care, fear of dental procedures

    Baby teeth are

    Brushing teeth
    starts as soon as baby teeth appears

  14. Nicole Bohannon, California Baptist University

    1.     Kid’s baby teeth facilitate our speech and support kids’ nutrition.

    2.     Tooth loss is NOT a normal part of aging.

    3.     Preventive measures include establishing a dental home within six months of eruption of
    the first tooth and no later than 12 months of age.

    4.     Receiving oral health care during pregnancy is safe throughout pregnancy and is effective
    in improving and maintaining oral health.

    5.     Having a teeth cleaning during the 12 months before pregnancy is a core state measure
    of preconception health.

  15. Lisa Bangean, California Baptist University
    1. Good oral health improves our ability to speak, smile, smell, taste, touch, chew, and swallow, make facial expressions and show emotions.
    2. Adults should supervise and help children with brushing their teeth in order to ensure they are doing it correctly.
    3. Children who receive quality oral care early on in life are more likely to have a good attitude.
    4. “If I’m not in pain, I don’t need to see a dentist” is a myth.
    5. Having a teeth cleaning during the 12 months before pregnancy is a core state measure of preconception health among women of reproductive age

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