St. Barnabas Hospital Department of Pediatric Dentistry Infant Oral Health Care
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St. Barnabas Hospital
Department of Pediatric Dentistry
Infant Oral Health Care
• First visit when?
•Within 6 months of erupting teeth
•AAP, ADA, AAPD
Goals of Infant Oral Health
• Break the cycle of Early Childhood Caries– The concentration of disease in certain populations suggests that diet, microflora
and even prenatal factors may be contributory– Children with ECC remain at risk throughout childhood
• Disrupt the Acquisition of Harmful Microflora– Children are inoculated with caries-initiating bacteria by parents and caregivers– Prevention of transmission by treating parents/caregivers– Prenatal counseling/maternal oral health/ infant oral health (chain of prevention)
• Manage the Risk/Benefit of Habits– Permit the dentist to enter a habit continuum– Outcome: gentle waning of habit without need to intervene to remedy side effects
• Establish a Dental HOME for Health or Harm– Care is begun with nonthreatening preventive services– Parents know where to turn if there is an emergency– If treatment is needed a firm foundation of trust has been established
• Impart Optimal Fluoride Protection– Optimal fluoride exposure is the tenet of early intervention
• Use Anticipatory Guidance to Arm Parents in the Therapeutic Alliance– Parent is a co-therapist
Infant dental visits• 1986 AAPD adopted a position on infant oral health recommending that
the first visit occur within 6 months of the eruption of the first primary tooth
• Based on the recognition that many children by age 3 have already experienced dental caries, and those who had remained prone to recurrent decay
• For many years prior to adoption of that policy and to this day, physicians claim responsibility for the oral health of children younger than 36 months, unfortunately physicians’ knowledge and inclination to practice preventative dentistry have been shown to be lacking
• While the incidence of permanent tooth decay has declined over the last three decades, that of primary tooth caries has not
• The infant oral health visit is not without problems, some dentists are still reluctant to see these children because of expectations of negative behavior, lack of understanding of preventive opportunities and concern about reimbursement for procedures
Concepts of Infant Oral Health
Risk Assessment• Identification of factors know or believed to
be associated with a condition or disease for the purposes of further diagnosis, prevention or treatment
• Infectious disease• trauma• injury• orthodontic problems• compliance issues
• Helps insure total health
Oral Examination and Assessment of Clinical Risk
Factors
• Use of dental chair is unnecessary
• Parent participates as learner
• and immobilizer
• Teaching about the oral cavity
• Child may cry which is desirable and useful
•
CAT TOOL
ANTICIPATORY GUIDANCEProactive counseling of parents and patients
about developmental changes that will occur in the interval between health care supervision
•Visits that includes information about daily caretaking specific to that upcoming interval•Addresses protective factors•Aimed at preventing oral health problems•Areas include:
oral developmentdiet and nutritionfluoride adequacyoral habitsinjury preventionoral hygiene
HEALTH SUPERVISIONThe longitudinal partnership between
dentist and family individualized to focus on health outcomes for that
family and childDeparture from “every 6 months”
Asses risk
Anticipatory guidanceNecessary treatment/ prevention
Outcomes are the measures that indicate successphysical ( decrease inflammation)
congnitive (understanding of caries process)behavioral (d/c of bottle habit)
First Dental VisitDentist will:
• Check:– Face and Jaws
– Gums, Tongue, Tissues
– Teeth and Bite
• Ask questions
• Give information
Courtesy University of Washington School of Dentistry
• Be familiar with milestones from birth to age 3
• Advise families of need for evaluation if non has been done
• Allow you to relate to anticipatory guidance with parent
First Dental Visit
Developmental Milestones From Ages 6 months to 3
Years
Oral Conditions of Infancy
•Candidiasis (thrush)
•Herpes
•Cysts
•Eruption cysts
•Natal or Neonatal teeth
•Early Childhood Caries (tooth decay)
Candidiasis (thrush)
Associated with:
• Antibiotic usage
• Compromised immune system
• Any condition resulting in reduced salivation
Herpes
• Herpes Simplex Virus Type 1• Painful ulcerations can involve
the tongue, gingiva, lips and oral mucosa
• May be accompanied by malaise and low grade fever
• Usually lasts 10-14 days• Supportive therapy,
hydration, antipyretics, if necessary
Herpangina
• Usually caused by Coxsackie A virus
• Characterized by fever, malaise, painful ulcerations in the oropharynx
• Supportive treatment, hydration, antipyretics if necessary
Cysts
Natal / Neonatal teeth
• Usually in lower incisor area
• Present at birth or within 30 days after birth
• Up to 85% are part of normal primary dentition (not supernumerary)
• Try to retain unless hyper-mobile or causing excessive
irritation to breast-feeding mother
Epstein’s Pearls
• Found on mid-palatal raphe of hard palate
• Formed during closure of palatal shelves
• Asymptomatic – usually disappears during first few months of life
Bohn’s Nodules
• Remnants of salivary glands
• Located on buccal or lingual surface of alveolar mucosa
• Asymptomatic –usually disappear in 1st year of life
Dental Lamina Cysts
• Located on crests of alveolar ridges.
• Asymptomatic – usually disappear as teeth erupt.
Eruption Cysts
Growth & Development of the Teeth
At birth the primary (baby) teeth have already formed
Permanent teeth are developing or beginning to mineralize (harden)
Eruption Patterns
Importance of Primary (Baby) Teeth
Smiling & self-esteem
Chewing and eating
Speech development
Aid proper jaw and face formation
Guide permanent teeth into place
Early Childhood Caries or ECC (Tooth Decay)
1 or more decayed teeth
Child under age 6
Previously known as:
Baby bottle tooth decay
Bottle mouth
Nursing decay
Sippy cup decay
ECC
Severe ECC
Results of ECC
Pain and infection
Difficulty eating and sleeping
Affects nutrition and growth
Results of ECC
Courtesy Proctor & Gamble
Causes of ECC
Diann Bomkamp, RDH, BSDH, Missouri
ECC Causes - BacteriaPassed from
caregiver to child
food/drink
utensils
toothbrushes
Blowing on or pre-chewing food
More likely if mother has decay
Early spread increases decay risk
ECC Causes - Diet
Food type
Starchy foods
Added or natural sugar
Pacifier dipped in sweetener
Liquid medicine
Courtesy Proctor & Gamble
ECC Causes - Time
ECC Causes - Time
Frequency and length of feeding
Bedtime bottle
“At will” nighttime nursing
“Carry along” bottle or no-spill training cup
Frequent snacking
Courtesy Proctor & Gamble
ECC Causes - Teeth
Enamel Hypoplasia
Deformed, weak
enamel
Causes:
•Fever or virus
•Low birth weight
Lack of fluoride
Enamel is more vulnerable to acids
Courtesy Diann Bomkamp, RDH, BSDH, Missouri
ECC Prevention - Dental Visits
12 months old or 6 months after 1st tooth
Early morning appointment
Build excitement
Be calm
Courtesy University of Washington School of Dentistry
ECC Prevention
Diet
Reduce bacteria
Oral hygiene
Treat mother
Protect the teeth
Regular dental visits
ECC Prevention – Reduce Bacteria
Check mother’s (or primary caregiver’s) oral health
Treat decay
Xylitol gum or mints
No saliva-sharing activities
ECC Prevention – Reduce Bacteria
Courtesy Proctor & Gamble
ECC Prevention – Reduce Bacteria
Courtesy Proctor & Gamble
ECC Prevention – Diet &
TimeWatch sugar/starch exposure
Limit night beverages
Provide healthy snacks
Avoid pacifier dipping
Wean from bottle/breast by one year
Ask for sugar-free medication
ECC Prevention – Protect Tooth
Fluoridated water
Fluoride drops?
Fluoride toothpaste
Only use before age 2 if no fluoride in water, or baby has ECC
Only use a tiny smear across width of brush
Repair hypoplasia (enamel defects)
AAPD Guideline on Infant
Oral Health
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