Oral Health Risk Assessment Tool · experience enamel hypoplasia. Protective Factors Dental Home According to the American Academy of Pediatric Dentistry (AAPD), the dental home is
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CLINICAL FINDINGS
a Whitespotsorvisible decalcificationsinthepast12 months n Yes n No
a Obviousdecay n Yes n No
a Restorations(fillings)present n Yes n No
• Visibleplaqueaccumulation n Yes n No
• Gingivitis(swollen/bleeding gums) n Yes n No
• Teethpresent n Yes n No
• Healthyteeth n Yes n No
Caries Risk:n Low n HighCompleted:n AnticipatoryGuidancen FluorideVarnishn DentalReferral
Self Management Goals: n Regulardentalvisits n Weanoffbottle n Healthysnacksn Dentaltreatmentforparents n Less/Nojuice n Less/Nojunkfoodorcandyn Brushtwicedaily n Onlywaterinsippycup n Nosodan Usefluoridetoothpaste n Drinktapwater n Xylitol
RISK FACTORS
a Motherorprimarycaregiverhad activedecayinthepast12 months n Yes n No
• Motherorprimarycaregiverdoes nothaveadentist n Yes n No
• Continualbottle/sippycupuse withfluidotherthanwater n Yes nNo
• Frequentsnacking n Yes n No
• Specialhealthcareneeds n Yes n No
• Medicaideligible n Yes nNo
ASSESSMENT/PLAN
PROTECTIVE FACTORS
• Existingdentalhome n Yes n No
• Drinksfluoridatedwaterortakes fluoridesupplements n Yes n No
Treatment of High Risk ChildrenIfappropriate,high-riskchildrenshouldreceiveprofessionallyappliedfluoridevarnishandhavetheirteethbrushedtwicedailywithanage-appropriateamountoffluoridatedtoothpaste.Referraltoapediatricdentistoradentistcomfortablecaringforchildrenshouldbemadewithfollow-uptoensurethatthechildisbeingcaredforinthedentalhome.
Oral Health Risk Assessment ToolTheAmericanAcademyofPediatrics(AAP)hasdevelopedthistooltoaidintheimplementationoforalhealthriskassessmentduringhealthsupervisionvisits.ThistoolhasbeensubsequentlyreviewedandendorsedbytheNationalInterprofessionalInitiativeonOralHealth.Instructions for UseThistoolisintendedfordocumentingcariesriskofthechild,however,tworiskfactorsarebasedonthemotherorprimarycaregiver’soralhealth.Allotherfactorsandfindingsshouldbedocumentedbasedonthechild.
Oral Health Risk Assessment Tool GuidanceTiming of Risk AssessmentTheBrightFutures/AAP“RecommendationsforPreventivePediatricHealthCare,”(ie,PeriodicitySchedule)recommendsallchildrenreceiveariskassessmentatthe6-and9-monthvisits.Forthe12-,18-,24-,30-month,andthe3-and6-yearvisits,riskassessmentshouldcontinueifadentalhomehasnotbeenestablished.ViewtheBrightFutures/AAPPeriodicitySchedule—http://brightfutures.aap.org/clinical_practice.html.
Risk Factorsa Maternal Oral Health Studieshaveshownthatchildrenwithmothersorprimarycaregiverswhohavehadactivedecayinthepast12monthsareat greaterrisktodevelopcaries.This child is high risk.
Maternal Access to Dental CareStudieshaveshownthatchildrenwithmothersorprimarycaregiverswhodonothavearegularsourceofdentalcareareatagreaterrisktodevelopcaries.Afollow-upquestionmaybeifthechildhasadentist.
Continual Bottle/Sippy Cup UseChildrenwhodrinkjuice,soda,andotherliquidsthatarenotwater,fromabottleorsippycupcontinuallythroughoutthedayoratnightareatanincreasedriskofcaries.Thefrequentintakeofsugardoesnotallowfortheaciditproducestobeneutralizedorwashedawaybysaliva.Parentsofchildrenwiththisriskfactorneedtobecounseledonhowtoreducethefrequencyofsugar-containingbeveragesinthechild’sdiet.
Special Health Care NeedsChildrenwithspecialhealthcareneedsareatanincreasedriskforcariesduetotheirdiet,xerostomia(drynessofthemouth,sometimesduetoasthmaorallergymedicationuse),difficultyperformingoralhygiene,seizures,gastroesophagealrefluxdiseaseandvomiting,attentiondeficithyperactivitydisorder,andgingivalhyperplasiaorovercrowdingofteeth.Prematurebabiesalsomayexperienceenamelhypoplasia.
Fluoride Varnish in the Last 6 MonthsApplyingfluoridevarnishprovidesachildwithhighlyconcentratedfluoridetoprotectagainstcaries.Fluoridevarnishmaybeprofessionallyapplied.Foronlinefluoridevarnishtraining,accesstheChildOralHealthandFluorideVarnishModulesintheSmilesforLifeNationalOralHealthCurriculum,www.smilesforlifeoralhealth.org.
Tooth Brushing and Oral HygienePrimarycareclinicianscanreinforcegoodoralhygienebyteachingparentsandchildrensimplepractices.Infantsshouldhavetheirmouthscleanedafterfeedingswithawetsoftwashcloth.Onceteetheruptitisrecommendedthatchildrenhavetheirteethbrushedtwiceaday.Forchildrenundertheageof2determinedtobeatmoderateorhighriskforcaries,itisappropriatetorecommendasmearoffluoridatedtoothpasttwiceperday.Childrenolderthan2yearsoldshoulduseapea-sizedamountoffluoridatedtoothpastetwiceaday.ViewfluorideresourcesintheAAPProtectingAllChildren’sTeethCurriculumFluorideModulehttp://www.aap.org/oralhealth//pact/ppt/Fluoride.ppt.