"Early Oral Health" and what parents need to know discusses some of the ways to help your children's oral health, even before they are born. Presented for the first time at Isis Maternity in Needham, MA by Dr. Femina Ali.

1. Early Oral Health Isis Maternity Expert Speaker Series Femina Ali, D.M.D.

4. Community means a lot

6. Younger siblings

7. Met with preschoolers

9. Prevention is key Brush twice a day How to floss video Floss daily Eat a healthy diet Use recommended prenatal vitamin with Folic Acid Continue regular check-ups at the dentist Ask for a screening for any gum disease, treat it Get necessary X-rays before pregnancy Take care of elective work before pregnancy

10. Getting pregnant Bacteria present in periodontal disease may affect reproduction success and outcome of fertility treatment Fertility treatments can affect gum health – a 2004 study showed that women receiving ovulation inducting medicines for three or more menstrual cycles had higher levels of gingival inflammation and bleeding

11. The Mother's Health During Pregnancy

12. What to expect Hormonal changes – increased progesterone and estrogen causes gums to react differently to bacteria in plaque Dietary changes – cravings and snacking Morning sickness Change of routine – feeling tired Fear, anxieties, and questions

13. What you can do Eat healthy, balanced diet Milk, cheese, and yogurt for Calcium Choose foods high in Vitamin C – strawberries, melons, broccoli, papaya, bell peppers Phosphorous – chicken, eggs, legumes, dairy If you have the urge to snack Carbohydrate rich foods can be an invitation to tooth decay Brush your teeth after snacking when possible Floss daily Get a dental cleaning once every 3 months during pregnancy, some insurance plans even pay for the extra cleanings

14. If you need dental work X-rays for dental emergencies are okay if used to diagnose major issues like infection Untreated dental infection can be a risk to the fetus It’s a myth that calcium is lost from mother’s teeth during pregnancy

15. Gingivitis/Periodontal Disease Especially common during months 2 – 8 Occurs in 60-70% of pregnant women Links between pre-term, low birth weight babies and gingivitis 12 % of babies in the US are born preterm (before 37 weeks) Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small*

16. What gingivitis looks like Symptoms include red, swollen, bleeding gums

17. Treating gingivitis Deep cleaning (scaling and root planing) may be recommended Periodontal therapy reduced pre-term birth and low birth weight infants by 68% in women with pregnancy associated gingivitis

18. Pregnancy Tumors Growths or swelling between the teeth Plaque response Most prevalent during second trimester Often removed after baby is born

19. Fetal Development Teeth begin to develop between the third and the sixth month of pregnancy Need calcium for tooth development 20 primary teeth are present in jawbone at birth

20. Mother’s Health Post Pregnancy

21. Bouncing back Congratulations! You’ve had a baby! Hormones returning to pre-pregnancy levels Gums, if kept healthy during pregnancy, should be less problematic Routine hygiene visits and daily brushing and flossing still very important

22. Fathers and Caregivers Decay causing bacteria, mutans streptococci, are transmitted soon after the first tooth erupts Reducing a parent’s or caregiver’s mutans streptococci count can help Avoid sharing food utensils

23. Setting a good example Study that shows children whose parents are regular at the dentist have less problems Seeing you brush and take care of your teeth is good Routine is key

24. Children's Dental Health This is National Children’s Dental Health Month

25. Infant Dental Development What you need to know to help your baby

26. First Teeth First teeth usually arrive in the front, 6 – 12 months May notice a change in behavior Droolingand chewing Teething rings

27. Cleaning infant gums After each feeding, wipe baby’s gums with a clean gauze or cloth Even before the first tooth, begin a daily routine of twice daily cleaning When first tooth comes through, use soft bristle toothbrush or finger brush to clean Use water or a non-fluoridated cleansing gel Children get used to you trying to clean their mouth

28. Breast feeding Breast milk is a complete form of nutrition for the infants. Recommended for all except for those where breastfeeding is determined to be harmful Frequent feeding should coincide with frequent cleaning of gums

29. Bottle feeding Clean the baby’s mouth and teeth after feeding a baby with bottled milk or formula Liquid concentrate or powdered formula should be mixed with non-fluoridated water to not over fluoridate

30. Baby bottle decay Never let a baby fall asleep with a bottle If your baby needs comfort, provide a pacifier instead of bottle Bacteria in mouth uses sugar as foods, which creates acid that attacks teeth Fruit juice should never be put in a bottle

31. Decay Early childhood decay is recognized as an infectious disease Rising tooth decay rates, now affects 28% of preschoolers

32. Weaning off bottles The A.D.A. recommends the introduction of training cups at age one – doing so may help make the transition easier than if it was postponed Discuss with your pediatrician how much milk your child continues to need and when you may introduce plain water to the diet

33. Flourosis Condition resulting from too much fluoride in child’s diet Causes brown spots or discoloration on teeth If you see this in your child, check with your dentist Monitor children’s fluoride intake

34. Fluoridation levels The optimal level for the prevention of dental cavities is .7 to 1.2 mg/L depending on how warm the climate is Local towns that supplement the water supply to bring it to an optimal level (1.0 mg/L): Needham, Westwood, Wellesley, Dedham, Newton, and Natick Local towns that are not supplementing: Dover and Medfield Find out more at http://www.cdc.gov/OralHealth/index.htm

35. Going to the dentist The American Academy of Pediatric Dentistry recommends all children see a dentist within 6 months of the first tooth or no later than the child’s first birthday.

36. Toddler Dental Development

37. Toothbrushing Begin brushing your child’s teeth when the first tooth comes through Use a small, soft-bristled toothbrush Non-fluoridated toothpaste or gel until child can spit Continue to clean and massage the surrounding toothless gums Begin flossing as you see contact between teeth Use of 2 minute sand timer makes things fun

38. Pacifier Use Use pacifiers instead of bottles if child requires that comfort There are different sized and shaped pacifiers May start to affect tooth position if used past age 3 – dentist can monitor changes in tooth positioning Positive intervention Encouragement

39. The Binky Flower Some parents have suggested planting the binky in a pot of soil with some seeds When the seeds sprout and start growing, children are excited to see that their binky turned into a flower or plant

40. Thumb Sucking Thumb sucking is usually not a problem unless it continues on for a long period of time If child is still sucking thumb at age 3, help may be required to help the teeth position correctly

41. As the children grow Age 3 and up 20 primary teeth

42. Brushing Toothbrushes – Oral B stages Power toothbrushes Disclosing tablets from dentist office

43. Flossing Disposable flossers Children need your assistance until about 7 years Daily, at night after brushing

44. Fluoride and Sealants Fluoride supplementation can be provided at the dentist office Most commonly given in a varnish or foam - varnish is painted on and children can eat and drink after Sealants protect baby teeth and molars from cavities – sometimes need to be done more than once

45. X-rays Start around age 3 Usually “Bitewings” Show permanent teeth beneath surface, cavities Digital x-rays emit less radiation Lead apron

46. Baby teeth are important They hold the space in the jaw for adult teeth Losing a baby tooth too early can lead to crooked or crowded teeth Adjacent teeth drift Extractions are not fun for children Prevention

47. Nutrition Nutrition plays an important role in healthy teeth and gums

49. Vegetables

50. Fruits

51. Milk

52. Meats and Beans

53. Raw Carrots

54. Apple Slices

56. Sticky sweets

57. Soda

58. Doughnuts

60. After eating… Have child brush after eating sticky foods After most meals if possible At least twice a day – once after breakfast and once before bed If child had citrus or acidic drink, wait an hour before brushing teeth

61. Teeth play a role Part of the digestive process, chewing Speaking Looking good Smiling

62. Costs of poor oral health The AAPD says that 51 million hours of school time are missed by children each year because of dental issues A 2007 report by the CDC says one in every 5 three-year- olds suffers from tooth decay Decay can lead to fillings or lost teeth – which may lead to orthodontics that otherwise would not be necessary Dental decay is entirely preventable

63. Finding a dental home Dentists can be a great resource as oral health doctors See issues as they arise Building trust between you, your child, and the dentist Many options Family dental office Pediatric Convenience

64. Open Communication Ask your dentist any questions you may have Your dentist may have questions for you, too It may take a while for your child to feel comfortable Don’t give up on dental visits if one goes poorly

65. Dental Resources www.WellesleyDentalGroup.com/blog American Academy of Pediatric Dentistry www.aapd.org American Academy of Periodontology www.perio.org Academy of General Dentistry www.knowyourteeth.com American Academy of Pediatric Dentistry www.aapd.org

66. Thank you very much! Please feel free to contact me if you have ANY questions 781-237-9071 www.WellesleyDentalGroup.com femina@wellesleydentalgroup.com