hellosmileLEARN by farhad attaie

TABLE of CONTENT the LEARNING FRAMEWORK the hellosmile CURRICULUM the CLINICAL LEARNING MAP the PAYER LANDSCAPE the CLINICAL MODULES the PATIENT AUDIT CHECKLIST the RESOURCE PLANNING GUIDE PPO IINSURANCE MEDICAID INSURANCE HEALTHPLEX/DORAL INSURANCE Guide 0-‐3 years Old Guide 3-‐6 years Old Guide 6-‐12 years Old TOOTH ANATOMY NEW PATIENT PROCESS CLAIM AUDIT

Tuesday, February 22, 2011

the Learning Framework

TRANSFORMATION SPIRITUAL MEDICAL HX

SOCIAL CLINICAL BASICS

IMPRESSIONS EMOTIONAL

INVENTORY

KNOWLEDGE VALUES

JUDGEMENTS

HUMAN

DISTINCTIONS

INSURANCE

communicaQon conversaQon language

FINANCIAL

TECHNOLOGY OPENDENTAL BLOG PHONE SYSTEM

GOOGLE MOODLE

LAB CASE ADMIN TREATMENT BASICS

COMMUNITY

Tuesday, February 22, 2011

PROTOCOLS

DENTAL HX

the hellosmile curriculum

We are commiCed to crea+ng a company culture that establishes las+ng rela+onships with our employees, our partners, and the families in our community. We ac+vely seek individuals that believe in making our world a beCer place and are eager to become changemakers in their communi+es. We look to hire entree level employees who are part of the neighborhoods we serve. These individuals understand the history and context of the communi+es and are therefor best suited to empathize with the families, mothers, fathers and children in these neighborhoods. Trainees that join our team are advantageously posi+oned to grow to be company and community leaders within 3-‐5 years. We enable this transforma+on by providing the necessary training, mentorship, and coaching through an in-‐house blended learning program, that combines online, one on one, and group sessions.

Tuesday, February 22, 2011

Our educa+onal programs are grounded in a model of transforma+ve learning rather than just informa+ve learning. Informa+ve or addi+ve learning increases what people know, adds to their skills, and brings new knowledge to an exis+ng worldview, paradigm or frames of reference. By comparison, transforma+onal learning gives people an awareness of the basic structures in which they know, think, and act in the world. From that awareness comes a fundamental shiA that leaves people more fully in accord with their own possibili+es and those of others. This shiA in paradigm is the single most powerful aCribute of hellosmile programs. Trainees find themselves able to think and act beyond exis+ng views and limits in their personal and professional lives, rela+onships, and their communi+es. Standard educa+onal methods oAen leave you having to remember the concepts you were taught or trying to figure out how to apply them. hellosmile's method leaves you applying what you learned naturally. Similar to what happens when you first ride a bicycle, in our programs you learn by direct personal discovery:a moment occurs when a new ability is yours.

the CLINICAL LEARNING MAP

TOUCH POINTS what conversa/ons are taking place? what occurs during this ac/vity ? where does the ac/vity take place? who performs the ac/vity (staﬀ role)?during this what should be an/cipated

Member Coordination Map member journey

Kids Health Center clinical flow

interaction categories

ac/vity? clinical instruments ? computer interac/on ?

member (patient) inventory use scenarios

situation orientation new member

check-up computer input treatment

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DENTAL HISTORY FOODS & DRINKS member interaction docs

MEDICAL

WELCOME

How often does your child have these foods, snacks drinks? 1. Almost everyday 2. A few times a week 3. A few times a month

Tiene alguna preocupación acerca de los dientes de su hijo hoy?

Siente su hijo algún dolor en sus dientes hoy?

YES

St.

R TR

AIN

Sta tio

Ave. 38th

37th Ave.

TYPE OF VISIT DATE

DOCTOR

Ave.

l use 718-838-9823 cal anytim

TYPE OF VISIT

7 TRAIN

Using the right amount of fluoridated tooth paste is very important for a good clean brushing.

NO Tiene su hijo caries que no se han tratado? SI

Si la ultima visita fue en los últimos seis meses:

38th

Han habido algunas rupturas o heridas en los dientes de su hijo?

Ave.

il Ra

Member

37th

d an

YES

Floss teeth daily, especially where teeth are in contact.

FACT #1

BRUSH 2 times a day 2 minutes at a time 2 teeth at a time

FACT #2

7 TRAIN 61st St.

Woodsid

lt ave

Rooseve

e Station

kids DENTAL & BRACES 39-05 61st STREET WOODSIDE, NY

DATE

DOCTOR

PASSPORT

TYPE OF VISIT

www.hellosmile.com DATE

FACT #3

FACT #4

DOCTOR

FACT #5

FACT #6

FACT #7

Le sacaron algunas radiografias en esa visita?

F G

Tiene Usted caries que no han sido tratadas?

Es esta su primera visita al dentista?

Hearing Loss or Hearing Problems Sinusitis Frequent Ear or Throat Infections (more than twice a year)

Psychological / Neurological / Developmental

Ear / Nose / Throat (ENT)

Attention Deficit Hyperactivity Disorder (ADD/ADHD) Oppositional Defiant Disorder (ODD) Specific Phobias or other Anxiety Disorders Depression Speech Delay other Developmental Delay Cerebral Palsy Pervasive Developmental Delay (PDD) Autism, Asperger Syndrome Mental Retardation (MR) Seizure Disorder or Epilepsy Vision / Eye Problems Growth Hormone Deficiency

Tuesday, February 22, 2011

F Has your child been diagnosed with any of the following conditions? Respiratory / Cardiovascular / Hematogoic

staff scheduling

about your child's health or medical condition?

Asthma or other breathing problems Heart Murmur or other Heart Condition Anemia (Sickle Cell, Aplastic, Hemolytic, Thalessemia) Von Willebrand disease, Hemophilia, or other Clotting Disorders Hepatitis (A, B, C) or other Liver problems HIV / AIDS Cystic Fibrosis

I AM THE CHILDS (PARENT / GRAND PARENT / GUARDIAN / ... )

or been Hospitalized?

E Is there anything else we should know

Kidney Disease, Bed-wetting, Urinary Tract Infections (UTI) Gastroesophageal reflux disease (GERD), Crohn's Disease Lactose Intolerance or frequent Diarrhea or Constipation Adrenal Insufficiency

YOUR FIRST NAME

D Has your child ever had surgery

Urinary / Gastrointestinal

AGE

has your child ever had a bad reaction to any drugs/medicines/antibiotics?

Leukemia or other Cancer Diabetes Childhood Obesity Cleft Lip or Plate Other Syndromes

CHILD’S FIRST NAME

C Does your child have any allergies or

Other Chronic / Acute Conditions

As a parent or guardian I commit to having an active role in the health and wellbeing of my child. I know there is a charge for a missed appointment and I have read and understand the terms of joining hellosmile.

YES

FACT #10

Isl

Thank you for bringing your child to a hellosmile kids dental health center!

member interaction docs ng

drugs, vitamins or supplements?

Like a friendly neighborhood doctor, we believe it is important to have an active role in the life of a child - from early childhood all the way up until they are young, independent adults. This is the most important journey your child will ever make, and this is why we are here to guide and to coach your child to stay healthy and happy throughout this early adventure of their life.

lab case admin

YES

B Is your child currently taking any medications,

FACT #9

inventory admin

A Does your child have a primary pediatrician?

FACT #8

Este formulario nos ayudara a entender las necesidades de su hijo, para que podamos estar seguros de proveer el cuidado necesario y hacer un plan de entrenamiento para la salud de su hijo y futuras visitas.

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NO SI NO

Le hicieron algún tratamiento en esa ultima visita? SI (( %&'%

Se cepilla sus propios dientes su hijo? SI

J SI

Sweets as snacks are best taken at breakfast, lunch, or dinner. Not in between meals.

SI NO

Se acuerda cuando fue la ultima vez que visito al dentista?

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Esta su hijo usando el biberón todavía?

Sabes el nombre o la SI información de la oficina NO del proveedor dental anterior? Has your child ever been treated for cavities?

SI NO

Fue esa visita una buena experiencia para su hijo?

SI NO

Usa tu hijo/a la seda dental o enjuague de boca antes o después de cepillarse los dientes?

SI NO

Se chupa el dedo, el chupete/ bobo, la almohada o alguna otra cosa favorita su hijo? SI

Germs that cause cavities can be passed on through saliva from Mother to child AND between friends.

Most children can not brush their teeth PROPERLY until they can tie their own shoes.

Drinking from a bottle containing juice or milk at night time can cause SEVERE dental cavities.

A child should be seen by a dentist by their first birthday.

Protecting baby teeth are important since most of them don’t fall out until age 10-12.

Replace sugary and unhealthy snacks with cheese, nuts, fresh fruits and vegetables.

the CALL CENTER WHY? Cost of technology -> no longer barrier to entry Besides, we want to be awesome!!!

Extended Hour HealthCoaching Line hellosmile call center and our Heath Coaches are key to our member loyalty/rewards programs. Our belief is that the telephone is one of the best tools for communica/on and engagement. For the ﬁrst /me in history phones we have the opportunity to u/lize mobile technology to establish deeper rela/onships with the parents and children we serve. Being available to our community through the phone we have our members undivided aFen/on for 5 to 10 minutes, and if we get this experience right, what we’ve found is that our members remember the experience for a very long /me and they tell their friends about it.. It also allows our HC’s to create more eﬃciencies in our clinics by addressing simple inquiries over the phone (Situa/onal Triage). Many health care organiza/ons feel that their call centers are an expense to minimize. We believe that it’s a huge untapped opportunity for us, not only because it results in word of mouth conversa/on about hellosmile products and services but because of its poten/al to increase the health and happiness of the parent/child. We believe that through the phone we will be able to create what we refer to as PEC personal emo/onal connec/ons that will move, touch and inspire our families towards healthier happier lifestyles and dis/nguish hellosmile as a premier service provider.

Tuesday, February 22, 2011

the hellosmile MENU New PaQent Exam / Re-‐Care / Primary PrevenQon Category

Secondary PrevenQon Category

Dental Disease Invasive Treatment -‐ (involves cuUng tooth structures)

Emergency Visit 0-‐2 Well Oral Health Check Up 2-‐3 Well Oral Health Check Up 3-‐6 Oral Health Check Up 7-‐9 Oral Health Check Up Pre-‐Adolescent Oral Health Check Up Adolescnet Oral Health Check Up

Sealants Preven8ve Visit pointers & procedures: Fluoride Varnish Space Maintenance pointers and procedures Early Orthodon8c Evalua8on & Therapies & Referrals

Minor treatment visits pointers & procedures Major treatment visits pointers & procedures Nitrous Minor visit pointers and procedures Nitrous Major visit pointers and procedures Passive Stabiliza8on (papoose) Pointers and Procedures Dental Treatment Under General Anesthesia (with Nap8me Dental)

Tuesday, February 22, 2011

the PAYER LANDSCAPE Insurance Strategy hellosmile believes in strategically opening oﬃces in both underserved and middle income neighborhoods in order to diversify the payer mix of pa/ents. This will enable hellosmile to meet its mission of serving all children and providing quality care at a low cost. It will also protect hellosmile ﬁnancially if federal insurances where to adjust fee schedules and regula/ons.

Medicaid

SCHIP Managed Care administrator

PPO

Union

Private Patients

administrator

Fee For Service Sliding Fee Minimum Fee

Tuesday, February 22, 2011

the Clinical Modules Radiographs / X-‐RAYS / Oral Assays / DiagnosQcs Take Bite-‐wing (BWG), Peri-‐apical (PA) and Occlussal Radiographs Take and Panoradiographs Teke Cephalometric Radiographs Develops Radiographs with automa=c developer / digital Radiography Mounts film X-‐Rays properly; Processes (in Digital Management Sobware) Labeling X-‐ray w/ correct pa=ent informa=on Download digital radiographs & PT photos into pt files on PC Upload Radiograph items in PC into pt files Ability to Evaluate Radiographs at Basic levels 1 Ability to Evaluate Radiographs at Basic levels 2 Ability to Evaluate Radiographs at Basic levels 3

RadiaQon Health and Safety (RHS) Iden=fy major anatomical landmarks of the teeth, jaws, oral cavity, and adjacent structures of the skull Recognize basic radia=on biology concepts Prac=ce radia=on safety procedures for both the operator and pa=ents Manipulate key components of radiographic exposure equipment Iden=fy and correct common intraoral and extraoral radiographic exposure errors Manipulate key components of radiographic processing equipment and digital equipment Iden=fy and correct common radiographic processing errors Mount and label dental radiographs Apply eﬀec=ve infec=on control techniques Iden=fy necessary Quality Assurance procedures

CLINICAL DATA COMMUNICATION & PT CARE New Pa=ent Process Hand Off Form Dental Hx Process Medical Hx Process Insurance Process Char=ng & Tx Planning Process Perform Clinical Schedule Audit Are able to correctly and efficiently check out pa=ent with direct consulta=on and confirma=on with a,ending den=st

OPERATORY SETUP AND PREPARATION

Clinical Supply Categories

Fill Water Bo,les with Tab water for delivery carts Turn on Vacuum, Suc=on and Water Filter Unit from Front Turn on Nitrous Oxide from Front & Open Tanks in closet Turn on Nitrous main switch in Front Turn Large Autoclave ''ON" if filled with dis=lled water and ready to go from end of last day Stock treatment rooms with basic consumable supplies (non restora=ves) Clean and set up chairs in treatment Rooms and set up suc=on, water syringe, pt bib for basic exam/ prophy/cleaning Fill Ultra Sonic 1 bright shield and 1 Enzyme cleaner Set up basic instruments for exam and cleaning w/ floss and tooth brush and Dr's Gloves on tray Have Pa=ent Miror and glasses in place Turn on Pt Light and posi=on light and Provider's Chair as needed Clean/wash/decontaminate instruments, cold sterilize, bag and autoclave instruments, re-‐stock kitchen and treatment rooms with instruments Wipe and clean all equipment, cabinets, counter tops, and floor as needed in the clinical areas Empty and change all garbage bags: under counter, baskets, taped on wall Plug in aroma dispencer Turn On Back Computers, Open Open Dental, Picasa, Pandora, Familiar w/ OSHA standards of pa=ent safety and infec=ous controls regula=ons Set Up operatory for various procedure /treatments (Nitrous, Major,Minor filling, Sealents, extrac=on, space maintenance, orthodon=c bandind and bonding, ortho evalua=on) Turn on Each Chair Unit, Plug in Isolite, Turn on Digital Radiography Scanner, Pano/Ceph On & Correct Posi=on

Goals Objec,ves

Tuesday, February 22, 2011

At the conclusion of this course, the learner will be able to: 1.

Understand the Inventory Ordering Process

Request needed items to be ordered

IdenCfy what materials and supplies are used for speciﬁc procedures

List the various categories of supplies used in the pracCce

Enter payments into inventory data sheet

Know the common supply waste mistakes

Know the best pracCces to increase supply eﬃciency

CATEGORIES OF SUPPLIES General Supplies/Disposables Fillings Metal Instruments Cement Sana=zers Prophy Sterilizing Anesthesia X-‐Rays Oﬃce Supplies Kids Barriers Misc

Patient Audit Check List commlog -‐check commlog for communica8on hx insurance

-‐eligibility -‐for medicaid pts check ins for 1 year anniversary date remind pa8ent -‐for healthplex pt is assigned treatment plan review -‐fee schedule is properly checked in insurance window -‐fee schedule is updated in tx plan window -‐well care visits have had 6 months prior to their last visit -‐tx plan properly broken down for invasive tx dental hx -‐has been to den8st Yes No -‐If Yes when-‐> less than 6 months -‐> where -‐> what tx was done -‐> papoose used? -‐> xrays taken? Meidcal hx -‐chart noted with any problems or NSF no signigigant facts -‐make sure PCP is in the referral box Tuesday, February 22, 2011

Radiograph Review -current bitewings for tx -PA for major tx or n2o Pano can substitute -check for Pano patients that are 6-9-12 only take pano if 6 year molars are visible -radiographs must be organized properly in the open-dent image module Behavior hx -for all patients under 12 years old beh. hx added to the notes for every visit ++/-+ +-/--for NP anesthesia -for tx quick notes are used to indicate type amount and site of anesthesia Sealants -patients with 6 year molars and 11/12 year molars checked for sealant authoriazation -whenever tx plans for sealants are made pano must be tx planned

passport communication -communicate how many more visits till passport prize Sibling review -always audit siblings accounts when communicating with patients (repeat audit for all siblings)

Resource Planning & Scheduling Tool Location: Dropbox hellosmile shared folder Team Members understand pa/ent flow as it relates to overall financial goals. Team members understand op/mal resource management that will empower ever member to fully aware of their personal /me management. Understanding the importance and correla/on of collec/on rate to overall prac/ce performance. Determining the most op/mal pa/ent flow .

Op,mal TEAM Scheduling Woodside KIDS Dental clinic Clinical Team

Pa,ent Coordinator

SCHEDULING GOALS -3 NP or WC per 30 min -1 major per hour -1 minor per hour -6/8 total Pts per hour -$600 hour Dec -$625 hour Jan -$650 hour Feb -$675 hour Mar

Tuesday, February 22, 2011

◦

Medicaid: Medicaid is the joint federal-state program established in 1965 to provide health insurance to lowincome populations. Medicaid programs may be operated as traditional fee-for-service, capitation or a combination of the two. Although Medicaid program design and fee levels vary from state-to-state, Medicaid generally is viewed differently by private dental offices than by safety net dental clinics. Relative to their alternatives of full-fee patients and indemnity insurance patients, most private dentists do not consider Medicaid reimbursement to be desirable. Consequently, most private dentists do not choose to participate in Medicaid. On the other hand, safety net dental clinics often find Medicaid to be their prime source of reimbursement compared with sliding fee schedule discounts and minimum pay patients, which do not cover overhead cost. In 2001, Congress established a new Medicaid prospective payment system (PPS) for Federally Qualified Health Centers, which differs from the prior Medicaid cost system.

Learning ObjecQves Eligibility Coding EOB-‐ explana=on of beneﬁts Denials Referral (To and From) Payments Payer Mix

Tuesday, February 22, 2011

MEDICAID AUDIT CODES "MEDICAID AUDIT REASON” 162 919 705 142 1197 1313 715 712 1172 135 68 1608 1357 140 144 204 932 746 2050 142 186 717 62 175 68 935

RECIPIENT INELIGIBLE ON DATE OF SERVICE INVALID COMBINATION OF TOOTH SURFACE CODES SERVICE PAID CURRENT OR PREVIOUSLY CONFLICTING CLAIM RECIPIENT DOB DIFFERS FROM NYS MASTER FILE SERVICE CONFLICT IN COMBINATION PRIOR SERVICE/CLAIM; PAY/RECORD FOR NO IMPROPER TOOTH FOR PROCEDURE INDICATED PROCEDURE CONFLICTS WITH PREVIOUS SERVICE PROCEDURE CODE EXCEEDS SERVICE LIMITS PRE-‐PAID CAP RECIPIENT-‐SERVICE COVERED WITHIN PLAN (DENY) PROCEDURE CODE UNACCEPTABLE FOR PROVIDER SPECIALTY SERVICE DATE NOT WITHIN 90 DAYS OF RECEIPT DATE NUMBER OF EXCEEDS MAXIMUM OF 25 FOR DOCUMENT Provider ID and servicing/a,ending ID are iden=cal RECEPIENT ID NOT ON FILE recipient sex differs from nys master file procedure not available on date of service no service authoriza=on on file INVALID NPI AND MMIS BILLING PROVIDER ID COMBINATION RECIPIENT DOB DIFFERS FROM NY CITY MASTER FILE PROCEDURE REQUIRES PRIOR APPROVAL AND IT IS NOT ON INVOICE PROCEDURE CONFLICTS WITH PREVIOUS SERVICE SERVICE PROVIDER ID INVALID SERVICE PROVIDER ID NOT ON MASTER NYS FILE Needs to submi,e claim with a 90 days le,er..We can do it by paper or by Epaces.. improper # of surfaces

Tuesday, February 22, 2011

STEP 1 Determine what pt is being referred for (i.e.: endo, omfs, etc.); Explain to pt parent that we must submit a request for referral to insurance (healthplex) and wait approximatly 3-4 weeks; STEP 2

Fill out Section I (with all of the patients information): Write patient name, relationship to employee, "self", patients dob in mm/dd/ccyy format, STEP 3

Fill out Section II: (Referred by Dr. ) Ali Attaie (Referred to Dr. ) i.e.: Kenneth Liao (Address) i.e.: 37-14 28th Ave, Astoria, NY 11103 (Service Requested) i.e.: root canal therapy for tooth #30 (Provider Office #) our site number goes here A6472 (Specialty) i.e.: Endodontist (Telephone number) 718278-5858 (signature of patient) PATIENT PARENT MUST SIGN!!!! Non-Emergent Tx needed: 1. Determine what pt is being referred for (i.e.: endo, omfs, etc.); 2. Explain to pt parent that we must submit a request for referral to insurance (healthplex) and wait approximatly 3-4 weeks; 3. Fill out Section I (with all of the patients information): Write patient name, relationship to employee, "self", patients dob in mm/dd/ccyy format, . (Employee/Subscriber Name) Enter patient first, middle and last name, Employees/Subscriber Social Security number) Enter pt Healthplex Insurance Id as it appears on healthplex website. (Name of Group Dental Program) i.e.: Amerigroup, (Group No.) i.e.: GG-466-CHP 1 4. Fill out Section II: (Referred by Dr. ) Ali Attaie (Referred to Dr. ) i.e.: Kenneth Liao (Address) i.e.: 37-14 28th Ave, Astoria, NY 11103 (Service Requested) i.e.: root canal therapy for tooth #30 (Provider Office #) our site number goes here A6472 (Specialty) i.e.: Endodontist (Telephone number) 718278-5858 (signature of patient) PATIENT PARENT MUST SIGN!!!! Mail claim referral form to: HealthPlex Pre-Auth Department 333 Earle Ovington Blvd., Suite 300 Uniondale, New York 11553-3608

Tuesday, February 22, 2011

STEP 1

Tuesday, February 22, 2011

Preferred provider organization (PPO): Preferred Provider Organization (PPO) is a subscription-based medical care arrangement. A membership allows a substantial discount below their regularly-charged rates from the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network. They negotiate with providers to set fee schedules, and handle disputes between insurers and providers. PPOs can also contract with one another to strengthen their position in certain geographic areas without forming new relationships directly with providers. This will be mutually beneficial in theory, as the insurer will be billed at a reduced rate when its insured utilize the services of the "preferred" provider and the provider will see an increase in its business as almost all insureds in the organization will use only providers who are members. In PPO's, the policyholder must pay a deductible if the insurance requires one which it does in most cases. The deductible is the portion of any claim that is not covered by the insurance provider. It is the amount of expenses that must be paid out of pocket before an insurer will cover any expenses

Learning ObjecQves Eligibility Coding EOB-‐ explana=on of beneﬁts Denials Referral (To and From) Payments Payer Mix Tuesday, February 22, 2011

PPO

Tuesday, February 22, 2011

Guide 0-‐3 years Old Teething A baby’s first set of teeth normally appear in the mouth some=me between five and eight months aber birth, although it can be as late as 12 months. Teeth will con=nue to appear un=l the child is around three years old and all 20 milk (primary) teeth are in place. Teething can make your baby’s gums inflamed and sore as the teeth push through. You might no=ce your baby is more bad-‐tempered than usual, or has trouble sleeping. He or she might start to chew on their toys or fingers and dribble more than usual. However, if your child has a fever or is nauseous, do not assume this is down to teething and make sure you take them to the doctor. If your baby seems uncomfortable or in pain, there are ways you can help. To soothe your baby, try giving him or her something safe to bite on such as a teething ring (preferably cooled in the fridge first). You can also clean your baby’s mouth several =mes a day with a clean, damp gauze pad to help limit bacteria around the swollen gums and new teeth. • Baby BoFle Syndrome is a destruc=ve pa,ern of tooth decay that can occur in babies and young children. It is caused when a child’s teeth are regularly exposed to sugary liquids for long periods, such as juice or milk (even breast milk). In par=cular, problems arise when children are allowed to fall asleep with a bo,le of milk or juice. The teeth are then bathed in the liquid overnight, allowing the decay-‐causing bacteria on the teeth to feast all night long. The best solu=on to this is not to use a feeding bo,le as a pacifier or allow children to go to bed with anything but water in a bo,le. For the same reason you should also avoid giving your baby a pacifier that has been dipped in anything sweet. Pacifiers and thumb-‐sucking, provided their use is limited, should not pose a problem for the first few years of a child’s life before the permanent teeth erupt. Sucking is a basic and natural ins=nct of babies and most health prac==oners agree that it should not cause a problem, provided the pacifier is kept clean, free from cracks, is designed not to cause airway obstruc=on and is never =ed around your child’s neck. However, the longer a child sucks on a pacifier or finger, the more likely that it could cause problems in the development of their adult teeth, and might push them out of posi=on. If you are concerned about your child’s sucking habits, you should consult your den=st or doctor. It can oben be confusing to know exactly what you should be doing for your baby’s oral health and when you should be doing it. Star=ng a good oral health regime early will set your children up for life and give them the best chance of having healthy teeth and gums into old age. Oral hygiene You should start to clean your baby’s teeth and gums as soon as the first teeth start to show. Not only does this remove food debris and bacteria, but it also helps to establish tooth brushing as a normal part of your child’s daily rou=ne. • Gently clean your baby’s teeth and gums morning and night, using a moist gauze, sob, moist cloth or sob baby toothbrush. Firmly wipe away liquid and food debris, paying par=cular a,en=on before bed=me to ensure the teeth are not leb dirty overnight (see above: Baby Bo,le Syndrome).

lose tooth 6-7 years old

lose tooth 7-8 years old

•

With babies and young children, it is oben easier to clean their teeth from behind, with the child’s head in your lap. You can make a game of looking at each other’s face upside down.

•

Before the age of two, a toothbrush is not strictly necessary. Once your child’s back teeth have come through, however, you should ensure you are using a sob baby toothbrush to keep them clean. This will also help your baby get used to having a toothbrush in his or her mouth, meaning you are less likely to have problems brushing their teeth later on.

•

If appropriate, take your child to visit your local dental health prac==oner as soon as possible, preferably around the age of one, so that they can assess your child’s emerging teeth and give you more informa=on about how best to care for them

Diet recommenda,ons Healthy ea=ng habits can help to maintain healthy teeth and gums. • Don’t put anything apart from milk or water into your baby’s bo,le. Juice, or even weak squash, is acidic and sugary, which can damage your child’s teeth. •

Be a role model – babies don’t know about sweets and ﬁzzy drinks; they learn from people around them. Chances are that if you eat well yourself, your children will copy you.

•

Of course, it is impossible (and very boring!) to avoid all poten=ally damaging foods; balance is the key. Enjoy treats as part of your meals, not in between, and limit the worst oﬀenders such as s=cky, sugary foods. Most children need snacks to meet their nutri=onal needs as they grow, but you should try to avoid them grazing all day long. When your child is old enough, ensure you give him or her nutri=ous and healthy snacks such as vegetables, yoghurt and fruits, which are also be,er for their oral health. In par=cular, dairy products contain calcium, which is essen=al for building strong teeth.

Tuesday, February 22, 2011

lose tooth 9-11 years old

lose tooth 10-12 years old

Guide 3-‐6 years Old By the age of three, your child should have all 20 of their primary (baby) teeth in their mouth. During this time, their permanent teeth will be developing in the jaw below the gums and the first adult teeth will be getting ready to emerge in the mouth around the age of six. Why are primary teeth important? As primary teeth fall out, it is a common misconception that they do not matter, as long as the permanent teeth are well looked after when they come through into the mouth. This is not true. The primary teeth have a number of important roles to play: Primary teeth are essential in the first step of digesting food: chewing, biting and grinding. Primary teeth act as guides for the permanent teeth; by keeping proper spaces in the mouth, they help ensure permanent teeth enter the mouth in the correct places. If primary teeth are lost early through decay there is more chance of them affecting the position of permanent teeth, so they may become crooked or even blocked by other teeth. Primary teeth can also influence the development and growth of the face and jaw muscles. Tooth decay Your child's teeth are vulnerable to decay (particularly if the child is eating sweet and sticky food), as the enamel on milk teeth is not as hard as it is on adult teeth. If you are keeping your child’s teeth clean by twice daily brushing with fluoride toothpaste they are far less likely to suffer tooth decay. However, if you think your child might have tooth decay (e.g. you can see stains on the teeth) or if he or she is in any pain, you should take him or her to visit your local dental practitioner if possible. Tooth decay and disease present in primary teeth can be passed on to the permanent teeth as they erupt. Primary molars remain in the mouth until around 10 to 12 years, with lots of opportunity to pass decay on to their new permanent neighbours. If it spreads to the root, an infection in a primary tooth can actually damage the permanent tooth lying directly underneath. Thumb-sucking If your child is still sucking his or her thumb towards the end of this period, you may want to think about gently persuading them to stop. This can be tricky, so try not to make it too traumatic. You could start by drawing attention to the habit and help them stop when they are ready to do so. If your child is regularly sucking his or her thumb when the permanent teeth come through, it can sometimes cause problems with tooth positioning. Seek advice from a dental health professional if you are worried about this. My child won’t let me brush his or her teeth. If your child doesn’t like having his or her teeth brushed, you’re not alone. The following tips might help: Make it less of a battle by inventing games around tooth brushing. Brush your teeth with your child so that they can see you do it too. Explain gently to your child what you’re doing and why. Give reasons that will make sense to your child and appeal to them – super-strong teeth can be exciting to children obsessed with superheroes! Make sure that brushing is a regular part of your child’s routine, not something that stops and starts. Why not try our Brushing Contract and Toothometer to encourage the twice daily brushing routine?

Tuesday, February 22, 2011

My child hates the taste of toothpaste Make sure you are using toothpaste specifically designed for children. These generally have a more gentle taste to appeal to children. If your child doesn’t like the taste of your normal toothpaste, try shopping around for different flavours to tempt them. If that doesn’t work, you could try brushing their teeth with water, but reintroduce toothpaste as soon as possible, as the fluoride it contains is vital for strengthening teeth. Don’t despair: some children just take a while to get used to it – seeing a sibling, cousin or friend around the similar age enjoying the toothpaste can sometimes be enough to make it taste better! Oral hygiene The most important thing you can do is brush your child’s teeth at least twice a day with fluoride toothpaste: in the morning and last thing before bed. By this age, children are generally able to grasp their own toothbrush and participate in brushing. However, they don’t have the dexterity to clean their teeth effectively, so will still need your help. You can help your child with a small soft toothbrush specifically designed for children, as they have a smaller head to fit in your child’s mouth. It is best to use toothpaste specifically designed for children as it contains the appropriate amount of fluoride and will have an appealing, gentle taste. Use no more than a pea-sized amount of toothpaste. Get your child to help clean their own teeth and explain to them what you are doing. You should ensure, however, that you also clean them thoroughly. Clean the teeth gently but firmly, and don’t forget to brush the gums. You can also use your child’s toothbrush to clean their tongue. Lots of plaque and bacteria live on the tongue, so it is well worth gently brushing it on a regular basis. Diet recommendations Healthy eating habits can help to maintain healthy teeth and gums. Be a role model – children don’t automatically want sweets and fizzy drinks; they learn from people around them. Chances are that if you eat well yourself, your children will copy you. Of course, it is impossible (and very boring!) to avoid all potentially damaging foods: balance is the key. Enjoy treats as part of your meals, not in between, and limit the worst offenders such as sticky, sugary foods and fizzy drinks. Most children need snacks to meet their nutritional needs as they grow, but you should try to avoid them grazing all day long. When your child is old enough, ensure you give him or her nutritious and healthy snacks such as vegetables, yoghurt and fruits, which are also better for their oral health. In particular, dairy products contain calcium, which is essential for building strong teeth.

Guide 6-‐12 years Old These following six years mark a period of mixed tooth sizes, with both primary and permanent teeth in the mouth together. Primary teeth will loosen and fall out throughout this period. The roots are gradually reabsorbed until the tooth is loose enough to fall out (or be gently pulled out). Permanent teeth will arrive in the mouth throughout this period. It is very important that these new teeth are kept as clean as possible, as they are not fully mature and more vulnerable to decay. The ‘6-year molar’ is the first permanent tooth to arrive. It erupts at the back, behind the baby teeth, so it’s more difficult to reach and easier to ignore! It is vital that this tooth is kept clean and healthy, as it is the one most likely to suffer from cavities. By the age of 12, the last primary tooth has usually been lost and from this point on children have a set of 28 adult permanent teeth. The final four teeth (also known as ‘wisdom’ teeth) may come through sometime between the ages of 18 and 25 (if at all). Tooth decay It is particularly vital to keep the mouth clean and healthy during this stage. The irregular mix of primary and permanent teeth in the mouth makes children’s teeth particularly vulnerable. Decay is more likely if the child is eating sweet and sticky foods. If your child is keeping his or her teeth clean by twice daily brushing with fluoride toothpaste they are far less likely to suffer tooth decay. However, if you think your child might have tooth decay (e.g. you can see stains on the teeth) or if he or she is in any pain, you should take him or her to visit your local dental practitioner if possible. Tooth decay and disease present in primary teeth can be passed on to the permanent teeth as they erupt. Primary molars remain in the mouth until around 10 to 12 years of age, with lots of opportunity to pass decay on to their new permanent neighbours. If it spreads to the root, an infection in a primary tooth can damage the permanent tooth lying directly underneath. My child won’t brush his or her teeth: If your child doesn’t like brushing his or her teeth, the following tips might help: Make it less of a battle by inventing games around tooth brushing. Brush your teeth with your child so that they can see you do it too. Explain gently to your child why it’s so important to brush their teeth, with reasons they can relate to, according to their age. Super-strong teeth can be motivating for six-year-olds keen on superheroes, while an attractive appearance and fresh breath may be more important to older children who are becoming more aware of themselves. Make sure that tooth brushing is a regular part of your child’s routine, not something that stops and starts. Why not try our Brushing Contract and Toothometer to encourage the brushing twice daily routine? My child hates the taste of toothpaste If your child doesn’t like the taste of your normal toothpaste, try shopping around for different flavours to tempt them. The fluoride in toothpaste plays a vital role in strengthening teeth and is particularly important as your child’s permanent teeth start to arrive.

Tuesday, February 22, 2011

Oral hygiene The most important thing is to ensure that your children brush their teeth at least twice a day with fluoride toothpaste – once in the morning and again last thing before bed. By this age, children are capable of brushing on their own. Although you might not be brushing their teeth, they still need your help to establish the brushing twice daily habit for life. You should encourage your children to brush their teeth morning and night, as it is particularly vital to keep the mouth clean and healthy during this stage. The irregular mix of primary and permanent teeth in the mouth makes children’s teeth vulnerable. Decay is more likely if the child is eating sweet and sticky foods. Use a toothbrush especially designed for children as they will have a smaller head to fit in a child’s mouth. Use a normal-sized amount of toothpaste. You can now use an adult toothpaste; however, if your child doesn’t like the taste of adult toothpaste, you can use toothpaste designed specifically for children of this age as this will not only contain the appropriate amount of fluoride but also have an appealing gentle taste. Explain to your child how to clean their teeth and why it’s important that they do it regularly. You should check that they are doing a thorough job and might suggest using plaque disclosing tablets to show them the areas they are missing. Help your child to clean their teeth gently but firmly, and don’t to forget to brush the gums. Help your child to move around the mouth systematically. Start with the last tooth and move towards the front teeth brushing first the outside, then the inside tooth surfaces. They should work their way through the mouth quarter-by-quarter. Remind them to brush the biting surfaces of the teeth, as these can be particularly vulnerable to decay – it’s difficult to keep these clean when tooth sizes are uneven. You should also encourage your child to use their toothbrush to clean their tongue. Lots of plaque and bacteria live on the tongue, so it is well worth gently brushing the tongue on a regular basis. Speak to your local dental health practitioner for more information on how best to keep your child’s teeth clean. Diet recommendations Healthy eating habits can help to maintain healthy teeth and gums. Be a role model – children may want to eat the same things as their friends, but you can still be a good influence. Chances are that if you eat well at home, your children will learn to think of this as ’normal’. Of course, it is impossible (and very boring!) to avoid all potentially damaging foods: balance is the key. Enjoy treats as part of your meals, not in between, and limit the worst offenders such as sticky, sugary foods and fizzy drinks. Most children need snacks to meet their nutritional needs as they grow, but you should try to avoid them grazing all day long. When your child is old enough, ensure you give him or her nutritious and healthy snacks such as vegetables, yoghurt and fruits, which are also better for their oral health. In particular, dairy products contain calcium, which is essential for building strong teeth. Your child will often be eating away from home, particularly during the day. Explain to your child why it’s important not to eat and drink too many foods and liquids that could damage their oral health, and to brush their teeth at least twice a day, so that they can have healthy teeth and gums.

tooth ANATOMY CENTRAL INCISOR PRIMARY DENTITION

LATERAL INCISSOR CANINE FIRST MOLAR

incisors

canines

MAXILLARY TEETH

MANDIBULAR TEETH

molars

SECOND MOLAR I J

SECOND MOLAR T

K S

premolars

O N

FIRST MOLAR CANINE LATERAL INCISOR CENTRAL INCISOR

Tuesday, February 22, 2011

SAMPLE Dental Health Certificate- Optional

The New York State Dental Association (NYSDA) has been the voice for the dental profession in New York State since its founding in 1868. With 14,000 members (76 percent of practicing dentists in the state), NYSDA is one of the largest state constituents of the American Dental Association. Visit the New York State Dental Association online at www.nysdental.org. As dentistry's premier philanthropic and charitable organization, the American Dental Association Foundation is a catalyst for uniting people and organizations to make a difference through better oral health. Visit the ADA Foundation online at http://www.ada.org/ada/adaf/index.asp. The New York State Dental Foundation is an active member of the New York State Oral Health Coalition. The Coalition has in turn established an agenda that will help the State implement, review and update the NYSOHP. Visit the NYS Oral Health Coalition at www.nysohc.org The goals of the Center for Best Practices for the Prevention of Childhood Overweight and Obesity are to increase the public’s awareness about the public health threat of early childhood obesity and to increase obesity screening and counseling among health care providers in our six target counties: Albany, Rensselaer, Saratoga, Schenectady, Warren and Washington. Visit the NYS Oral Health Coalition at www.healthykidsny.org The mission of the Foundation for Healthy Living is to increase and disseminate knowledge about health care and to improve the health of our communities.

Parent/Guardian: New York State law (Chapter 281) permits schools to request a dental examination in the following grades: school entry, K, 2, 4, 7, & 10. Your child may have a dental check-up during this school year to assess his/her fitness to attend school. Please complete Section 1 and take the form to your dentist for an assessment. If your child had a dental check-up before he/she started the school, ask your dentist to fill out Section 2. Return the completed form to the school's medical director or school nurse as soon as possible.

   

Last

Child’s Name: Birth Date:

/ Month

/ Day

First

Sex: Year

Male

Middle

Will this be your child’s first visit to a dentist?

Yes

School:



Have you noticed any problem in the mouth that interferes with your child’s ability to chew, speak or focus on school activities?

                  

Female

  

Name

Grade Yes

I also understand that receiving this preliminary oral health assessment does not establish any new, ongoing or continuing doctor-patient relationship. Further, I will not hold the dentist or those performing this assessment responsible for the consequences or results should I choose NOT to follow the recommendations listed below.

Parent’s Signature______________________________________________________________ Date

Section 2. To be completed by the Dentist I. The Dental Health condition of _______________________________ on _________________ (date of exam) The date of the exam needs to be within 12 months of the start of the school year in which it is requested. Check one: Yes, The student listed above is in fit condition of dental health to permit his/her attendance at the public schools. No, The student listed above is not in fit condition of dental health to permit his/her attendance at the public schools. NOTE: Not in fit condition of dental health means that a condition exists that interferes with a student's ability to chew, speak or focus on school activities including pain, swelling or infection related to clinical evidence of open cavities. The designation of not in fit condition of dental health to permit attendance at the public school does not preclude the student from attending school.

Dentist’s Signature

     

Optional Sections - If you agree to release this information to your child’s school, please initial here.

II. Oral Health Status (check all that apply). Yes Yes

Yes

No Caries Experience/Restoration History – Has the child ever had a cavity (treated or untreated)? [A filling (temporary/permanent) OR a tooth that is missing because it was extracted as a result of caries OR an open cavity]. No Untreated Caries – Does this child have an open cavity? [At least ½ mm of tooth structure loss at the enamel surface. Brown to darkbrown coloration of the walls of the lesion. These criteria apply to pits and fissure cavitated lesions as well as those on smooth tooth surfaces. If retained root, assume that the whole tooth was destroyed by caries. Broken or chipped teeth, plus teeth with temporary fillings, are considered sound unless a cavitated lesion is also present]. No Dental Sealants Present

Other problems (Specify):_______________________________________________________________________________

III. Treatment Needs (check all that apply) No obvious problem. Routine dental care is recommended. Visit your dentist regularly. May need dental care. Please schedule an appointment with your dentist as soon as possible for an evaluation. Immediate dental care is required. Please schedule an appointment immediately with your dentist to avoid problems.

Tuesday, February 22, 2011

I understand that by signing this form I am consenting for the child named above to receive a basic oral health assessment. I understand this assessment is only a limited means of evaluation to assess the student’s dental health, and I would need to secure the services of a dentist in order for my child to receive a complete dental examination with x-rays if necessary to maintain good oral health.

Dentist’s name and address (please print or stamp)

Visit the Foundation at www.foundationforhealthyliving.org Donated Dental Services helps those in need. Have you registered? Donated Dental Services, which has been endorsed by NYSDA, is a nationally recognized program run by dentists in our area donated charity care to those who need it. Care is given at your office. On your time, on your terms. To volunteer for the DDS program, go to www.nfdh.org, or call (303)534-5360.

Section 1. To be completed by Parent or Guardian (Please Print)

Tuesday, February 22, 2011