Sunday, June 10, 2012

Oral care for kids

Nursing & Pediatric Oral CareBy educating parents and kids on oral health, nurses can help spare children from surgical tooth extractions in the OR. Poor oral health is occurring amongst young children at an alarming rate.

By A. Trevor Sutton

Rumor has it that the Tooth Fairy pays less for teeth with cavities. If this rumor is true, then the infamous winged collector of primary teeth has been saving a lot of money lately.
In a recent study, the CDC noted an increase in the number of preschool aged children with cavities. This is the first rise in pediatric caries in more than 40 years.1
"There are tremendous impacts that result from childhood tooth decay," said Donna Hallas, PhD, PNP-BC, CPNP, PMHS, FAANP, clinical associate professor at New York University's College of Nursing.
"Children with decayed teeth do not want to talk, and they tend to be less social hoping that others will not see the decay," she said. "On a more basic level, serious tooth decay poses problems for chewing food properly."

Small Teeth, Big Problems

Pediatric cavities, like adult cavities, require professional dental intervention such as fillings and crowns. If the decay is too extensive a tooth extraction may need to be performed.

"There are a significant number of children in area hospitals on an OR waiting list to have teeth pulled," Hallas said. "These lists can be filled for months with children awaiting dental sedation to have extractions performed."

Poor oral health is occurring amongst a wide variety of young children, Hallas noted, pointing to data from the National Institute of Dental and Craniofacial research, which reveals 42 percent of children ages 2-11 have had dental caries in their primary teeth.2

In the study, Black and Hispanic children, and those living in families with lower income, had more decay at 43.34 percent and 55.4 percent, respectively.2

Creative Partnerships
"About 7 years ago NYU developed a formal partnership between our College of Nursing and our College of Dentistry," Hallas noted. "This partnership has grown and developed considerably since its inception."
With this creative partnership, there were a numerous opportunities to address several important challenges in healthcare. Among them were:
  • interprofessional education and practice;
  • access to evidence-based preventive oral-systemic healthcare; and
  • reduction in health disparities.
"Our goal was to explore how nurses and nurse practitioners could improve oral health outcomes in children under 5 years old," Hallas said. "We began by simply having our pediatric nurse practitioner students accompany our dental students as they examined teeth in dental clinics."

While this new paradigm of a college of nursing within a college of dentistry challenged the historic models of health education and healthcare delivery, the intent is to:
  • incorporate the best practices of each discipline;
  • explore overlapping dental and nursing curriculum; and
  • discover opportunities for co-practice by dentists, nurses and nurse practitioners.
"The partnership that we have with the College of Dentistry is very unique," Hallas noted. University administrators "are looking to carry this idea to the national level by helping to implement oral health curriculum in other nursing schools." she added.
Education Impacts Outcomes
In one of the research studies on pediatric oral health at NYU, Hallas had nurses teach a group of about 100 new mothers some simple oral healthcare techniques for infants.
"When education is done early, new mothers are eager to learn how to care for their children," she said, adding the new parents in the study quickly put into practice what the NYU nurses taught them.

"The results were very encouraging. Of the mothers who came back for follow-up examinations, no cavities were present," Hallas noted.

"Even if we had only a 10 percent improvement, it would be worth the 8-minute DVD that we used to explain oral healthcare to new mothers.
Many new parents do not know some of the most basic pediatric oral health techniques, however, although nurses can help change that.
"For instance, new mothers need to know about the vertical transmission of cavity causing organisms," Hallas said.

"These organisms are transferred from mother to baby by simple things like a mother wiping off a pacifier with saliva or testing the spoon before giving it to the child. These seemingly harmless activities can be promoting cavities," she explained.
Another aspect of proper pediatric oral health is ensuring children's teeth are adequately brushed.
"Many parents do not realize that they have to brush their children's teeth until age 7 due to dexterity issues," Hallas noted. "Just because children are putting the brush in their mouth, it does not mean they are doing an adequate job. Parents should let the child brush his or her teeth first, but an adult should be the one to finish the job."
Nurses should also educate parents on the impact of a poor diet or dietary changes on their child's oral health. "There is a strong correlation between poor oral health and a poor diet," Hallas said. For example, "foods that are high in sugar tend to stick to the teeth more than other foods."
Oral Health Checks
The Surgeon General has declared: "Oral health is essential to the general health and well-being of all Americans."1
Many people wrongly operate with the assumption that their oral health has nothing to do with their overall health. Through early intervention, nurses can do much to correct this misnomer.
"As a child moves into adulthood, he or she will continue the poor oral habits developed in childhood. Beginning good oral care habits early on makes the difference when permanent teeth come into place," said Hallas.
"Oral health is part of a routine assessment of care," she concluded. "When you do assessment of a child, you have to take time to do an oral health check and teach parent and child what they need to know."
Interprofessional collaboration is gaining a great deal of popularity within the healthcare profession.

For example, although nurses and dentists have not had a long history of collaboration, NYU's College of Nursing is doing something to positively change the status quo.

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