1426 McPhillips Street, Winnipeg, MB

PREVENTIVE PEDIATRIC
DENTISTRY THE
CONTINUED CARE MODEL
Dr. Charles Lekic DDM, MSc, PhD, FRCD(C)

Pediatric Preventive Dentistry

Dental caries presents a
major dental health
problem in children
Etiology of caries:

tooth susceptibility,
bacterial plaque,
carbohydrates, time, oral
sugar clearance,saliva flow
& pH

Pediatric Preventive Dentistry

Most important factors in caries prevention are:

Oral Hygiene, Diet, Fluoride therapy and Fissure sealants

Oral Health Education

Plaque removal & Diet

are the most important
factors in oral health
education

Oral Health Education

Plaque Removal
Use of Disclosing
Agents
Caries Activity Tests
Tooth brushing

Oral Health Education

Plaque Removal (Contd)

Flossing (once posterior
contacts close)
Oral Rinsing- removes only
soft debris, recommended in
patients with ortho
appliances

Oral Health Education

Plaque Removal (Contd)
Chemotherapeutic agentse.g. Chlorhexidine- short
term benefits
Chewing gums- Trident,
CDA approved

Oral Health Education

Toothbrushing
Roll method
Horizontal scrub- most successful for
children
Modified Bass

Oral Health Education

Diet
-Instruct Patient/Parent to write down what he/she
eats or drinks for 3 consecutive days.
-Analyze with the patient/parent and make
recommendations:

Reduce sucrose consumption

Sweets are not to be eaten between meals or at bedtime
Emphasize foods that require chewing, stay away from
soft/sticky foods
Brush teeth after meals and ALWAYS at Bedtime
Discuss the danger of hidden sugars such as starchy
foods (bread)

Fluoride Therapy

Systemic Fluorides
Provided by water fluoridation and by supplemental
therapy

Water Fluoridation
Concentration of 1 ppm of fluorides in drinking water
is considered optimal in reducing caries prevalence
Optimal fluoride concentration reduces caries up to
50%
Commonly use sodium fluoride, hydrofluosilic acid and
sodium silicofluoride

Fluoride Therapy

Water Fluoridation (Contd)

Effect of systemic fluorides is greater on smooth
enamel surfaces
Most effective method in caries prevention

Supplemental Fluoride Therapy

Before prescribing supplemental fluoride, must know:

The fluoride content in childs drinking water

Childs weight
Overall fluoride intake

Fluoride Therapy

Topical Fluorides
Delivered via gels, varnishes,
mouthrinses, prophy pastes and
dentifrices
No need for topical fluoride in
patients with low risk and/or
residing in optimally fluoridated
areas- use of a fluoridated
toothpaste should be sufficient.
Fluoridated dentifrices are not
recommended in small children
(<3 years)

Fluoride Therapy

Topical Fluorides (Contd)

Parents should always supervise brushing so that
the toothpaste and saliva are expectorated
Acidulated phosphate fluoride (0.5%) and stannous
fluoride (0.4%) are most common for topical use

Fluoride Toxicity

Chronic Toxicity
Only a pea-sized amount of
toothpaste should be used
Not recommended to use
fluoridated dentifrice in
children younger than 3 yrs.
Use the cup test to check if
the child could rinse and spit
without swallowing

Chronic Toxicity
Repeated ingestion of lesser amounts of fluoride may result
in chronic fluoride toxicity, the most common of which is
dental fluorosis
To prevent chronic fluoride toxicity, parents should: Make
sure their child thoroughly expectorates toothpaste after
brushing

Acute Fluoride Toxicity

Acute Toxicity

Results from the accidental ingestion of excessive

amounts of fluoride
Common symptoms include nausea and vomiting
Lethal dose for a 3 yr. old child approx. 500 mg of
fluoride ingested at one time
In the event of accidental ingestion of excessive
amounts, vomiting should be induced (2 teaspoons of
Ipecac Syrup)
Administer milk to slow absorption and form
complexes with the fluoride
Consider transporting the child to a poison control
centre

Pediatric Preventive Dentistry

Dental diseases are largely preventable and

increased emphasis on prevention should be the
goal of every dental practice

The role of Manitoba dentists in

promoting childrens oral health

It is important to
increase the general
awareness regarding
oral health and more
particularly for the
economically
disadvantaged
portion of the child
population.

The role of Manitoba dentists in

promoting childrens oral health

At a present time
there are very few
programs aiming at
increasing the
awareness regarding
childs oral health.

In dental offices
there is little
understanding if and
in what capacity
private practitioners
could be involved in
the implementation
of such programs.

The role of Manitoba dentists in

promoting childrens oral health

Therefore, it is important for every

dental practice to assess if and in what
capacity they could be involved in
reaching out to both the children and
their parents and guiding them toward
improved childs oral health.

Childrens Dental World Model of

Continued Care

Childrens Dental World has been

specifically interested in designing a
program, including a reward\motivation
system that benefits the child and a
somewhat of a counseling\guidance
system that will frequently remind and
help the caregiver maintain the childs
oral health.

Continued Care Model

Every child will after booking a recall

appointment be classified, in regard to
the completed restorative treatment,
into:
1. Low risk (0-1 rest. treat.)
2. Moderate risk (2-4 rest. treat.)
3. High risk (5 rest. treat.)

Continued Care Model

Childrens Dental World recall patients
are receiving, every 6 weeks, health
promotion material related to childs age
and the risk factors involved.
Parents are at the same time asked to
answer two to three questions and mail
them in the envelope provided.

Continued Care Model (0-1 yr)

Continued Care Model (1-3 yrs,

low risk)

Continued Care Model (1-3 yrs,

moderate risk)

Continued Care Model (1-3 yrs,

high risk)

Continued Care Model (3-6 yrs,

low risk)

Continued Care Model (6-12 yrs,

moderate risk)

Continued Care Model (>12 yrs,

high risk)

Continued Care Model

Following the first round of preventive
letters 25% of parents responded,
answering the questions.
We expect this percentage to increase
following the next rounds of letters and
more especially following the next recall
visit.

Continued Care Model

At the next recall

visit if the child
will present with
healthy teeth
he/she will earn
the membership
to the No Cavity
Club.

No Cavity Club
Club

Continued Care Model

The child will be

able to use this
card in Toys R
Us stores and the
cash value for
the first cavity
free recall visit
will be $15.00

No Cavity Club
Club

Continued Care Model

At the subsequent
recall visits if the child
continues to have
healthy teeth the cash
award will increase by
$5.00 and will raise up
to the full amount
reduced only for the
actual cost of the
recall visit.

No Cavity Club
Club

Continued Care Model

No Cavity Club membership and the

health promotion letters, that are to be
sent to the parents, are designed to
increase the awareness regarding oral
health and to award and motivate
children and parents in achieving and
maintaining health.

Continued Care Model

Continued Care Model is a true
investment in health and is a unique
model to North America.
Further research will provide evidence
regarding the effectiveness of the
program and the dental profession will be
given this information as soon as it
becomes available

Continued Care Model

At the end of the

day what is more
rewarding then a
healthy smile on a
pediatric dental
patient?

Thanks for your attention