Paterson Dental Clinic

Changing Children’s Lives ... One Smile at a Time

Mission
The mission of PPS Office of Dental Services is to provide underserved children with access to comprehensive dental care and educate children & their families about the importance of dental hygiene. The goal of the Office of Dental Services at Paterson Public Schools (“PPS Dental”) is to work with families and providers of medical care (pediatricians, family physicians)  to improve the oral health of Paterson’s children by increasing their access to preventive oral health services and integrating early oral health as the medical standard of care for children. We envision a future where every child has access to a dentist and preventable dental diseases are eradicated.
The Paterson Public Schools (PPS), Office of Dental Services providing free comprehensive dental care to uninsured and underserved infants, children, adolescents and special needs patients’ ages 0-17, who are residents of Paterson. 

Staff

Dr. Aparna Kaimulayil

After graduating from New York University College of Dentistry with a doctorate in dental surgery, I completed my general practice residency at the St. Joseph Regional Medical Center. I specialize in providing comprehensive, personalized dental care with a patient-centered approach. I previously worked in private practice and I am a member of American Dental Association, the New Jersey State Dental Association, and the Passaic County Dental Society. When I am not at work, I enjoy spending time with family and gardening.

Yana Zaydel, RDH

I have worked in the dental field for almost 20 years as a dental assistant, dental hygienist, and now a teacher and dental coordinator for our district. Out of the many different offices and environments I have had the privilege of working in; the most rewarding part of my career has been caring for the dental needs of the children in my community. I am very excited to be able to continue to do this as the dental coordinator of our clinic. As for teaching dental assisting, there is nothing more inspiring to me than educating and helping young students build a successful future in a field I hold so close to my heart. 

Nesime Dokur, CDA

Nesime or patients call her Sima started her career in dentistry in 1981 in Us Army. She came to PPS Office of Dental Services in 1999 after working in St. Joseph Dental Clinic for 15 years. Sima is a Certified Dental Assistant, and she assists the dentist in every treatment procedure.

Miriam Martinez, CDA

Miriam is a Certified Dental Assistant with over 20 years of experience. She joined PPS Dental in 2003 as a clinical assistant. Now she is responsible for front desk and the outreach programs.

 

 

Board / Support

Dr. Napoliello, DDS – President of the Delta Dental Foundation of NJ
Yana Zaydel – Coordinator of the PPS Dental Office of Dental Services
Dr. Ephros, DMD, MD - Department chair of oral and maxillofacial surgery in St. Joseph Medical Regional Center
Dr. Waba, MD – Director of Pediatric Clinic in Paterson Health Department
Support
Delta Dental Foundation of NJ
St. Joseph Medical Regional Center
America's ToothFairy: National Children's Oral Health Foundation  

 

 

 

 

 

Our Programs

Community Service Learning Program (CSLP)
We pride ourselves on incorporating interactive, age-appropriate, English & Spanish education throughout our dental home. Our waiting room is equipped with the TV and DVR, and children can watch the “Wiggly Tooth” and “The Legend of Tooth Kingdom” videos. At the end, there are quizzes & brain games to reinforce dental hygiene tips presented throughout the story. Upon the child's next visit, a new story will become available to teach him/her about specific dental procedures they may receive.
The next stop for children at PPS Dental is the Toothbrush Station, where a dental assistant counts down two minutes of brushing, offering feedback about proper brushing technique.
Parents and caregivers are welcome (and encouraged) to join their children during the appointments. Whether kids are at the dental home for a simple cleaning or for more extensive treatments, our assistants & dentist make it a point to discuss how healthy diet affects oral health, stressing the link of oral health to overall health & wellness.
Our educational program for parents and caregivers includes following:
1. Educate expecting mothers about early childhood caries and ways to prevent it. Oral health education including impact of maternal health on the developing fetus; caries disease transmission from the care givers to infants and toddlers; effects of early childhood caries; inappropriate use of baby bottle and sippy cup; age/ developmentally appropriate daily oral care for infants and toddlers; initial dental visit by age one; benefits of fluoride varnish and fluoride supplements for children living in non-fluoridated area and importance of good nutrition. Pregnant women, new mothers and care givers are provided with available community resources to access recommended dental care in a timely manner.
2. Educate caregivers that a child's teeth are susceptible to decay as soon as they begin to erupt (baby bottle caries).
3. Educate caregivers about importance of primary teeth.
4. Educate caregivers about health problems associated with dental disease.
5. Educate caregivers about preventive oral care for infants and toddlers.
6. Educate caregivers about importance of scheduling first dental visit within six months of eruption of the first tooth.
Oral Health Program (OHP)
Provides preventative and diagnostic dental services and comprehensive oral health education to children and families at-risk. Prevention and Early Intervention services include on-site visits to Early Childhood Programs serving children 0 - 17 years, and pre and postnatal women Paterson NJ; Head Start Program and all Public schools in Paterson.
Examination and preventive care with prophylaxis, topical fluoride treatment with application of fluoride varnish provided to children with written parent consent for such services. Children diagnosed with moderate to severe dental caries are referred for follow-up care; Completion of recommended follow up treatments is verified through PPS Dental Health Data tracking system. Education provided to children, parents and care givers  address importance of early intervention, prevention, practice of oral hygiene in school and at home, periodic dental checkups; benefits of using fluoride tooth paste, fluoride rinse, topical application of fluoride by dental professionals and use of systemic fluoride when indicated. Emphasis is also placed on healthy eating/ feeding habits to reduce incidence of dental caries. Children are given an age-appropriate free kit with tooth brush, tooth paste, dental floss and oral health education brochures Tooth Fairy.
Prevention
The best way to eradicate dental disease is to never contract it in the first place! Combined with oral health education, preventative treatments like the following can avoid the accumulation of dental decay and caries/cavities before they begin:
Prophylaxis (teeth cleaning), Fluoride application to strengthen teeth's defense against decay, Diagnostic oral examination by dentist, Caries Risk Assessment to determine unique, personal factors affecting oral health, X-rays to detect possible intraoral decay, Sealants on emerging permanent teeth to protect enamel crevices susceptible to decay.
Intervention
PPS Dental dentist have extensive experience dealing with early, moderate, and advanced dental disease in children. We provide: Cavity fillings, Tooth extractions, Pulpotomy (mini root canal), and Mouth guards. Our dentists make referrals to orthodontists, endodontists and other specialists as needed.
The American Academy of Pediatric Dentistry (AAPD) and the American Dental Association recog­nize that caries-risk assessment and management protocols can assist clinicians with decisions regarding treatment based upon caries risk and patient compliance and are essential elements of contemporary clinical care for infants, children, and adolescents. This guideline is intended to educate healthcare providers and other interested parties on the assessment of caries risk in contemporary pediatric dentistry and aid in clinical decision making regarding diagnostic, fluoride, dietary, and restorative protocols.

The Ultimate Oral Health Guide for Parents

Tooth decay is the single most common chronic childhood disease in the United States. Over 40% of children are affected by tooth decay by the time they reach kindergarten, and 53% of children 6 to 8 years of age have experience with cavities (untreated cavities, filled teeth, or missing teeth as a result of a cavity).

While tooth decay and gum disease have substantial oral health repercussions in their own right, they’re also linked to even more serious chronic illnesses such as heart disease, diabetes, and respiratory diseases.

The good news is that tooth decay is generally preventable for those who practice good oral hygiene, limit sugary drinks and snacks, and make regular trips to the dentist for checkups and cleanings.

From birth through the teenage years, this guide takes a comprehensive look at the risks, challenges, and positive steps to take through each stage of your child’s development. Additionally, we will discuss the difficulties and offer helpful guidance and resources for two of the most at risk demographics: low-income families and families with children who have special health care needs.

Oral Health During Pregnancy

Due to hormone shifts and diet changes, pregnant women face a higher risk of oral health problems including gum disease and tooth decay. Along with taking steps to prevent oral health problems, it’s important for pregnant women to get any cavities treated right away, as strong evidence points to mothers as a primary source of the bacteria that causes tooth decay in infants and toddlers.

In addition to problems after birth, poor oral health can have consequences for the pregnancy itself. Gum disease has been linked to preterm birth, low birth weight babies, low birth weight babies being born prematurely, and the development of preeclampsia (a pregnancy complication that can lead to serious or even fatal outcomes).

Gingivitis and Gum Disease

According to the Illinois Department of Health, gingivitis occurs to some degree in 60 to 75% of all pregnant women. One reason for this is that they tend to have a more severe reaction to the plaque bacteria due to increased levels of the hormone, progesterone.

While it’s common and can be managed with good dental hygiene, when left untreated it can affect the tissue that holds the teeth in place, even resulting in tooth loss if the problem becomes severe.

The main symptoms of gingivitis are red, swollen gums and bleeding, If you start to notice a greater degree of sensitivity in your gums or bleeding during brushing, pay extra attention to your oral health habits. Brushing twice a day and flossing is always a good practice, but it’s especially important when you are experiencing symptoms of gingivitis.

In addition to normal oral health habits, it’s helpful to brush and rinse your mouth after every meal and snack. Be sure to contact your dentist as he or she may recommend extra professional cleanings as well.

Cavities and Tooth Erosion

Pregnant women have a higher risk of developing cavities due to several main factors such as increased acidity in the mouth for those with frequent vomiting and dry mouth due to hormonal changes for some. On top of that, more frequent snacking on less healthy foods because of cravings increases the risk of tooth decay, and some pregnant women find it harder to stay consistent with oral hygiene due to a heightened gag reflex causing nausea and vomiting when trying to brush their teeth.
Symptoms of cavities include:

• A toothache
• Tooth sensitivity
• Mild to sharp pain when eating or drinking something sweet, hot, or cold
• Visible holes or pits in a tooth
• Brown, black or white staining on any surface of a tooth
• Pain when biting down

Tooth decay is treatable and preventable if you are consistent and proactive.

If you suspect that you may have a cavity, schedule an appointment with your dentist as soon as possible to prevent further decay. As mentioned earlier, the bacteria that cause tooth decay are often transmitted from a child’s mother, so it’s important to take care of the problem sooner rather than later.

While pregnant women are at a higher risk of tooth decay, it’s still preventable if you stay on top of brushing and flossing. In addition to the normal twice-a-day-routine, brushing and rinsing after all snacks and meals is an added step you can take to protect your teeth. If you find yourself craving unhealthy foods, substituting healthier snacks (low or no sugar) will help to cut down on potential oral health problems.

While it may seem advantageous to brush your teeth immediately after vomiting, it’s actually counterproductive unless you first rinse your mouth with a mixture of water and baking soda to neutralize the stomach acid from your vomit.

If you find it challenging to brush your teeth due to a strong gag-reflex, don’t give up! Instead, change up your routine by trying things like using a small, soft toothbrush designed for children, brushing later in the morning when you don’t gag as much, and concentrating on your breathing as you brush your back teeth.

Pyogenic Granuloma (“Pregnancy Tumors”)

While the name sounds alarming, “pregnancy tumors” aren’t cancerous and typically don’t lead to any serious medical complications. They appear as small, red or fleshy colored lumps of tissue located between the teeth or along the gum line. They are relatively uncommon as they only develop in up to 5% of pregnancies.

If the lump is small and doesn’t bother you, you may not need to treat it – they often go away after pregnancy on their own. If it does bother you, it may be removed under local anesthetic. Consult your dentist.

Safety Concerns for Oral Health Treatment in Pregnant Women

Not all medications related to oral health treatment are safe.

Among others, Nitrous Oxide (or laughing gas) is considered to be risky for pregnant women. Always be sure to consult your doctor or pharmacist before taking any medication.

Oral x-rays are considered to be safe during pregnancy.

As long as proper shielding of the stomach and thyroid is in place, it’s safe to get x-rays of your mouth when you are pregnant. Leaded vests are used to shield the fetus from the small dose of radiation in x-rays.

Oral Health for Infants and Young Children

While tooth decay for young children is generally preventable, it’s a huge problem in America. Over 40% of children are affected by tooth decay by the time they reach kindergarten, and 53% of children 6 to 8 years of age have experience with cavities (untreated cavities, filled teeth, or missing teeth as a result of a cavity).

Infants

Establish a dental home by age 1.

The American Academy of Pediatric Dentistry (AAPD) recommends that all infants have a dentist home established by age one. However, a lack of education is a primary concern – a majority of pediatricians and general dentists aren’t advising parents to take their child to see a dentist by age one, and about half of all pediatric dentists don’t see infants by their first birthday.

Prevent the sharing of decay-causing bacteria.

Since the bacteria that cause tooth decay are transmittable from one person to another, the AAPD recommends that parents refrain from sharing spoons, bottles, pacifiers, etc. Also, be sure to thoroughly wash sippy cups and bottles between uses.

Painkillers and chilled teething rings can help to soothe gums during teething.

While not all infants and young children experience discomfort during teething, there are several good solutions for those who do. Painkillers such as infant acetaminophen or ibuprofen and chilled teething rings (or frozen washcloths) are recommended by the AAPD. However, over-the-counter teething gels (topical anesthetics) are not recommended due to “potential toxicity of these products in infants.”

Toddlers

Positive oral health habits should start with the arrival of a child’s first tooth.

Starting when the first tooth emerges, parents should begin brushing their children’s teeth after breakfast and before bed using a small headed, soft toothbrush. Under age three, it’s recommended that no more than a smear or rice-size bead of toothpaste containing fluoride be used. As soon as two teeth touch, start gently flossing between them once a day.

It’s also important to schedule and keep regular cleaning and evaluation appointments with a pediatric dentist. The typical frequency recommendation is every six months.

Start establishing healthy eating habits by 12 months of age.

If you want to lower your child’s risk of cavities (and other health problems), it’s important to start a healthy diet young since eating habits start to form as early as one year of age. Habits that increase the risk of tooth decay and other oral health problems include nighttime bottle feeding with juice, repeated use of a sippy or no-spill cup (without washing between uses), and frequent sugary snacks or drinks between meals.

Examples of snacks to limit include cookies, granola bars, soda, and even fruit juice – the AAPD recommends limiting juice intake to 4-6 ounces per day, and it should not be a substitute for whole fruit or used throughout the day to calm a fussy child.

The use of pacifiers and thumb sucking should stop by age four.

While many children gradually quit sucking on pacifiers or their fingers and thumbs between the ages of two and four, some children may need help breaking the habit. Prolonged thumb sucking can interfere with the proper growth of the mouth, and it can cause problems with the proper alignment of the teeth.

The American Dental Association (ADA) recommends the following steps:

• Don’t scold. Instead of scolding the child for thumb sucking, offer praise for not doing so.
• Focus on the root of the problem. Children often suck their fingers when feeling insecure. Focus on correcting the cause of the anxiety and comfort the child.
• Use rewards. Reward the child when he or she avoids thumb sucking during a difficult period, such as being separated from family members.
• Consult your doctor or dentist for extra help. If your child still can’t overcome the thumb-sucking habit, consult your pediatrician or dentist. There are medications and apparatuses designed to break kids of the habit.

Young Children

Start teaching your child to be responsible for their oral health.

While most children are ready to brush their teeth without supervision by age seven or eight, each child is different. Other than the obvious concern of being able to brush your teeth without swallowing toothpaste, children are ready to brush their teeth when they have the motor skills and discipline to brush all of the surfaces on their teeth (as opposed to just a few strokes on the front teeth).

Here are some tips for helping your child to develop excellent oral health habits:

• Be consistent yourself. Kids tend to emulate what they see their parents do. If you consistently brush and floss your teeth, it will be much easier to insist that they do it as well.
• Make it enjoyable. While you are still assisting your children in brushing their teeth, consider ideas like reading a 2-minute book or dancing to their favorite song. You can also try rewarding your child with a sticker chart.
• Insist on consistency. The more brushing and flossing becomes second nature, the better your kids long-term oral health. Try not to skip brushing even on long days or vacation.
• Be thorough. Your dentist can assist in demonstrating the proper method of brushing your child’s teeth. Be sure that they are following the general guidelines: two minutes of brushing front, bottom and back of all teeth. “Smart” toothbrushes can make this process easier by vibrating when it’s time to stop brushing and keeping track of how long they brushed their teeth.
• Don’t forget the tongue. A good routine includes brushing your tongue to ensure fresh breath and kill germs
• Flossing is a vital piece of the routine. Flossing once a day before brushing is important. Floss picks (or other devices) may be easier for some kids to use if they struggle with traditional floss.

Be consistent with dental cleanings and checkups.

As a general rule, kids should be seen by a dentist for a checkup and cleaning every six months. Additionally, you should talk to your dentist about scheduling an appointment between cleanings if your child exhibits any of the following symptoms:

• White spots on the teeth
• Visible cavities that are brown or black
• Pain in the area around a tooth
• Sensitivity to sweet, hot, or cold foods and drinks

Limit sugary snacks.

As with toddlers, a good diet is a large part of preventing cavities and other oral health problems. Kids who eat a lot of sugary snacks and drink sugary drinks are at a higher risk of tooth decay.

Oral Health for Children and Teens

Tooth decay is a serious problem for American youth – almost one out of five (18.6%) have untreated cavities. Among more mundane risks (such as a sugary diet) teens can sometimes have a much higher risk of oral health problems if they:

• Smoke or chew tobacco
• Have mouth jewelry
• Use meth (meth mouth)
• Have an eating disorder

Oral Health Routines

Tweens and Teens should be responsible for maintaining the habit of brushing their teeth twice daily and flossing once a day. However, it’s wise to check in and make sure they are staying on track. It’s important to discuss the benefits of good oral hygiene, as well as the consequences of poor oral health habits.

Due to the increase of sex hormones in teens, they are more susceptible to gingivitis (gum infection), which can generally be prevented by consistently practicing proper brushing and flossing techniques. Continue with regular dental cleanings and evaluations to be sure that their oral health is on track.

Diet

As tweens and teens begin to make their own decisions about the food they eat, it’s important to encourage them to make good decisions. Some teens face a higher risk of tooth decay due to regular consumption of sugary foods and acidic, sugary drinks such as soda.
The ADA recommends paying extra attention to the type and frequency of snacking, the amount of sugary drinks, and choosing sugarless chewing gum. Those who have braces should follow their orthodontist’s instructions and avoid foods that can cause brackets or wires to break.

Braces

If your child has a bad bite or teeth that are out of place, he or she may be at a higher risk of cavities or gum disease due to the difficulty in cleaning his or her teeth. Braces can help to correct these problems and decrease the risk of oral health problems in the future. They can also relieve the discomfort and difficulty when chewing that can come with a bad bite or misplaced teeth. On top of the tangible benefits of braces, they can also help to increase your child’s confidence by giving him or her the gift of a nice smile.

Depending on the needs of your child, metal braces typically cost between $3,000 and $7,000. Some insurance plans may cover a portion of the cost, so be sure to research the specifics of your plan.

While brushing and flossing is more difficult with braces, it’s even more important since all the brackets and wires create more places for plaque to collect. In addition to being consistent with oral hygiene while wearing braces, it’s also important for your child to follow through with the orthodontist’s instructions, such as wearing rubber bands. Failing to do so can delay his or her progress and require more time and expense before the braces can be removed.

Wisdom Teeth

A common dental issue for older teeth is problematic wisdom teeth. Wisdom teeth often grow incorrectly, or there may not be room in the mouth. Reasons for removing wisdom teeth include:

• Tooth pain
• Infection
• Cysts
• Tumors
• Damage to adjacent teeth
• Gum disease
• Tooth decay (if it is not possible or desirable to restore the tooth)

Oral Health for Children with Disabilities

11 million (or 15%) of American children have “special health care needs” (SHCN), which means that they have any “physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs.”

While a child’s disability and needs can sometimes take precedence over proper oral health habits, the negative impact of oral health diseases should not be overlooked. For instance, serious chronic illnesses (including heart disease, diabetes, and respiratory diseases) have been linked to poor oral health.

Challenges to Prevention and Treatment of Oral Health Problems

These children are at an increased risk for oral health problems due to factors such as:

• Regularly taking medications containing sugar
• Special diets
• The need to eat frequently
• Poor oral hygiene

---

Measure / Outcome

Measure

DMFT index measures the prevalence of dental caries/Teeth.
The components are:
D component: Decayed teeth
M component: Missing teeth due to caries
F component: Filled teeth due to caries

                   DMFT

 

Age Group	Number of Children	2016				2017				2018
		DT	MT	FT	DMFT	DT	MT	FT	DMFT	DT	MT	FT	DMFT
0-6	862	685	96	589	1370	602	74	528	1204
6-17	756	578	87	491	1156	513	83	430	1026

 

OUTCOME:
We see an improvement in oral health in children of all ages. We also see behavioral changes such as proper nutrition and restriction of sugary beverages and more frequent dental visits for children. 
Improved care results in increased:
•Oral evaluations by primary care providers
•Proportion of children who have received 4 fluoride applications by 4 years of age
•Health education for parents/caregivers
•Referrals to dentists starting at age 12 months
 Benefits:
•Healthier kids
•Entrée into dental care
•Dentally healthier kids entering dental care

 

Annual “Give Kids A Smile″ Oral Health Fair

In celebration of Children’s Dental Health Month, and Give Kids a Smile, PPS Dental in collaboration with Dental Assisting students of HARP Academy  holds a large oral health fair open to the Paterson  Public Schools. An oral exam, prophylaxis, fluoride varnish application, and presentations about oral hygiene and healthy nutrition are given to each child.

Fluoride Rinse Program (FRP)

As a preventative strategy PPS Dental provides supplies of Unit dose Fluoride Rinse to every school in the District. School nurses are in charge of providing fluoride treatment to every student on monthly basis.

 

Toothbrush to Every Student Program (TESP)
PPS Dental is working on establishing a hygiene closet at every PPS school where students can access needed dental health products.
Health Club
PPS Dental is working on establishing a “Health Club” to increase oral and overall health & wellness. Our plans include:

• Create a social media campaign with a special hashtag & information related to oral health in the community
• Design posters, flyers, & fact sheets on children’s dental health in the community
• Document schools nutrition information & how it may affect oral health