Snapshots: Smart Mouths Smart Kids
Across Ages, Stages & Demographics
Patty Braun, MD, MPH
Mary Kay Meintzer, LPC, CACII
Deidre Callanan, RDH, DC, MPH

Meet the presenters!

• Identify specific behavioral and physical characteristics that impact the oral health of children ages 0 to 5, 6 to 12, and 13+.
• Describe what is “ normal/expected ” for children in those age groups, and “ red flags ” for their oral health.
• Think with a “ whole child ” mindset.
• Identify available oral health prevention interventions.

Physical Development & Overall Health
• Growth
• Fine motor
• Gross motor
• Language (cognitive)
• Adaptive (social)

Growth, Influential Factors & Problems
• Growth
– Birth weight doubles by 4-5 months, triples by 12
– Birth length increases by 50% by age 1, doubles by 4 years
• Influential factors
– Nature: birth weight, gestational age
– Nurture: nutrition, illness, medical conditions
• Problems
• Medical conditions
• Non-nutritive grazing
• Nutritional supplements

-Rolls (4 mo)
-Sits (6 mo)
-Crawls
(9 mo)
0-1 1-2
-Walks (12 mo)
-Runs (15 mo)
-Throws ball (18 mo)
-Rides tricycle
-Up stairs one foot at a time
2-3 3-4
- Skips
- Climbs
- Catches toothpaste with both hands
-Skates
-Swims
4-5

-Moro
-Grasp
-Raking (6 mo)
-Pincer (9 mo)
0-1 1-2
-Uses spoon and spills
(15 mo)
-Doesn’t spill (18 mo)
-Copies vertical line
2-3 3-4
- Copies a circle
-Cuts with scissors
4-5

Da
Dada go
Me brush my teeth
I brush my teeth at school every day.
Why do I have to brush my teeth? I don ’ t want to.

• Medical and/or environmental conditions
– affect weight gain (e.g FTT)
– result in daily medications (e.g. Fe+)
– delay cognitive development (special needs)
– delay motor development (cerebral palsy)
– impact the introduction to solids (feeding problems)
– distracting caregiver to focus on other things
– contributing to complacency around oral health

0-2 years: Sensorimotor
• Knowledge of world is limited to child ’ s sensory perceptions and motor activities. Object
permanence develops.
2-7 years: Pre-operational Thought
• Language development is a hallmark of this period.
Children in this stage do not yet understand concrete logic, cannot mentally manipulate information, and are unable to take the point of view of other people, which he termed egocentrism. Other important concepts for this stage: centration, animism, and
artificialism.

Poor oral health:
• Trouble concentrating and learning
• Poor testing results
• Poor school attendance

Early Childhood Caries (ECC)
First Dental Visit
Thumbs, Fingers, and Pacifiers

• Severe decay in the teeth of infants or young children
• Common bacterial infection, of epidemic prevalence
• Highest rates (70%) in minority and rural populations
• Infectious and vertically transmissible

• Causes: Trauma (chipped or broken tooth) or tooth decay
• Complications if untreated:
• Tooth loss
• Blood infection (sepsis)
• Spread of infection to soft tissue, bone and other areas of the body

• By age 1
– Dental Home: comprehensive, ongoing, accessible, coordinated and family-centered
• 1 + 1 = ZERO
– ONE dental visit when there ’ s ONE tooth can equal ZERO cavities

• Non-nutritive sucking for pleasure, comfort and security
• Pacifier-vs-thumb: AAPD supports pacifiers
• Stop the habit: discourage after age 3 and decrease chance for orthodontic problems

Growth, Influential Factors & Problems
• Growth:
– 4-7 lbs/year
– ~ 3 inches/year
• Influential factors
– Nature: mid-parental height
– Nurture: nutrition, illness, medical conditions
• Problems
• Picky eater
• Problem feeder

- Skip
- Broad jump
-Ride a bike
5-6 6-8
-Dribble a ball
-Dress self without help
-Skate well
9 10
- Catch a fly ball
- Ski bumps
11-12

- Tie shoe
- Grip crayon
- Cut and paste
5-6 6-8
-Change clothes
- Brush teeth
-Knit/sew
-Build a model
9 10
- Floss teeth
- Play band instrument
11-12

• Medical and/or environmental conditions
– affecting their sleep (e.g. xerostomia)
– with undesirable side affects (e.g antihistamines)
– result in behavior problems (e.g. refusal)
– create concerns about weight gain (e.g. poor growth)
– contribute to complacency around oral health (e.g. should be old enough to do it him/herself)

6-7 years: Pre-operational Thought
7-11 years: Concrete Operations
• Children gain a better understanding of mental operations. They begin thinking logically about concrete events, but have difficulty understanding abstract or hypothetical concepts. Important concepts of this stage: conservation, reversibility, and associative thought.
11+ years: Formal Operations
• People develop the ability to think about abstract concepts. Skills such as deductive reasoning and
systematic planning emerge during this stage.

Mouth guards
Orthodontics

• 50-80% of dental injuries involve front teeth of the upper jaw
• Most common injures: secondary to falls, traffic accidents, violence and sports
• Protect teeth and reduce the force of blows that can cause concussions, neck injuries and jaw fractures
• Three types: preformed, mouth-formed and custom-fabricated

Dental injuries are also prevalent in non-contact activities and exercises: gymnastics and skating

• Age 6-7: permanent teeth and orthodontic problems
• Orthodontic treatment uses appliances, tooth removal, or surgery
• Functional appliances use muscle action from speaking, eating, and swallowing
• Fixed orthodontic appliances are sets of wires and brackets cemented to the teeth

Wires, brackets and bands may become dental caries hubs with poor oral hygiene

Pre-adolescents/adolesents
Age 13+

Growth, Influential Factors & Problems
• Growth
– Puberty
• Girls: 9-14 years
• Boys: 10-15 years
• Getting earlier
• Influential factors
– Nature: family size
– Nurture: self-image, self-serve, nutrition, illness
• Problems
• Obesity
• Eating disorders

13 14 15 16 17

• Medical and/or environmental conditions
– impact receipt of health care (e.g. stop going to healthcare provider)
– result in dental trauma (e.g. don’t use mouth guards)
– result in invincibility (e.g. won ’ t happen to me)
– produce anxiety (e.g. learning about diseases)
– contribute to complacency around oral health (e.g. who cares?)

• 11+ years: Formal Operations
• Consider Ethical Development here

Gingivitis/Periodontal Disease
Tobacco, Cannabis, etc.
Oral Piercing

• Mildest form of periodontal disease
• Inflammation of the gingiva surrounding tooth
• Immunosuppression and hormonal changes lead to an altered response to bacterial plaque
• If untreated, can lead to periodontitis
Contributions by Morgan Lauer,University of Colorado, School of Medicine, MS-IV

• Chronic exposure to bacterial plaque = chronic inflammation
• Destruction of the periodontal ligament, loss of supportive bone and tooth loss

2x as likely to suffer from heart disease.
May make it more difficult for diabetics to control their blood sugar.

• 1 in 4 high school students report using some type of tobacco
• If current tobacco use patterns continue in the US:
– 6.4 million persons now under 18 years will die prematurely from a tobacco-related illness

• 3 main forms of cannabis: marijuana, hash, and hash oil
• Delta-9-tetrahydrocannbenol (THC)
• Cannabis smoke is carcinogenic
• Increased risk of xerostomia (dry mouth)
• Complications with adrenaline-containing local anesthetics

• ENDS have the look and feel of tobacco:
– E-cigarettes and Vaping
• Cartridge filled with liquid nicotine: flavored and varying strengths
• Upon inhalation, heat vaporizes the liquid, bringing a mist to the user
• Medical Hx– ask about tobacco and marijuana use

• Marijuana can be sold and consumed in vaporizers
• Vape pens – Can be sold pre-loaded with highly concentrated marijuana
A major public health concern

• Waterpipe used to smoke tobacco and marijuana
• Myths:
– Harmless- tobacco smoke goes through water
– Less addictive/nicotine in a water pipe is less addictive than smoking cigarettes

• Intraoral piercing as a body art has been gaining popularity
• Complications:
• Infection
• Prolonged bleeding
• Swelling and possible nerve damage
• Blood borne disease transmission

Inflammation of the heart valves or tissues is a risk of oral piercing.
Oral piercing can provide opportunity for bacteria to enter the bloodstream and travel to the heart.

• Inability or difficulty to brush and floss
• Poor diet
• Difficulty clearing food from the mouth
• Medications can lead to increased risk of dental disease

• Tooth eruption: Delayed, accelerated, or inconsistent
• Malocclusion: Poor fit between the upper and lower teeth, and crowding of teeth
• Developmental defects: Pits, lines, or discoloration
• Tooth anomalies: Variations in the number, size, and shape

• First Dental Visit by Age One
• Cavity Free at Three
• Community Water Fluoridation
• Fluoride Varnish
• Sealants