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ORAL HEALTH Pocket Guide Bright Futures in Practice: ORAL HEALTH Pocket Guide Bright Futures in Practice: Oral Health Pocket Guide Paul Casamassimo, D.D.S. Katrina Holt, M.P.H., M.S., R.D. Editors Supported by Maternal and Child Health Bureau Health Resources and Services Administration U.S. Department of Health and Human Services Published by National Maternal and Child Oral Health Resource Center Georgetown University Cite as Casamassimo P, Holt K, eds. 2004. Bright Futures in Practice: Oral Health—Pocket Guide. Washington, DC: National Maternal and Child Oral Health Resource Center. Bright Futures in Practice: Oral Health—Pocket Guide © 2004 by National Maternal and Child Oral Health Resource Center, Georgetown University. Library of Congress Control Number: 2004112811 This publication was made possible by grant number H47MC00048 and purchase order number 03-0271P from the Health Resources and Services Administration’s (HRSA’s) Maternal and Child Health Bureau (MCHB) to Georgetown University. The publication was developed by the National Maternal and Child Oral Health Resource Center (OHRC) working in collaboration with the Bright Futures Education Center. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services, HRSA, or MCHB. An electronic copy of this publication is available from the OHRC Web site at http://www.mchoralhealth.org. Permission is given to photocopy this publication. Requests for permission to use all or part of the information contained in this publication in other ways should be sent to the address below. Those wishing to use materials not produced by OHRC that are included in this publication must request permission from the original source. National Maternal and Child Oral Health Resource Center Georgetown University Box 571272 Washington, DC 20057-1272 (202) 784-9771 (202) 784-9777 fax E-mail: [email protected] Web site: http://www.mchoralhealth.org TABLE OF CONTENTS Introduction........................................................... 1 Appendices .......................................................... 81 Tooth Eruption Chart ............................................ 82 Components of Oral Health Supervision.............. 7 Systemic Fluoride Supplements: Oral Health Supervision ...................................... 17 Recommended Dosage ...................................... 84 Pregnancy and Postpartum ................................... 18 Glossary ................................................................ 85 Infancy .................................................................. 24 Resources .............................................................. 88 Early Childhood..................................................... 34 Middle Childhood ................................................. 46 Adolescence .......................................................... 58 Risk Assessment ................................................... 67 Risk Assessment Tables .......................................... 68 Caries-Risk Assessment Tool (CAT) ......................... 76 iii INTRODUCTION INTRODUCTION Recognizing oral health as a vital compo- nent of health, HRSA’s MCHB sponsored the The Bright Futures project was initiated in development of Bright Futures in Practice: 1990 by the Health Resources and Services Oral Health. The information contained in Administration’s (HRSA’s) Maternal and Bright Futures in Practice: Oral Health—Pocket Child Health Bureau (MCHB). The mission Guide is excerpted from Bright Futures in of the Bright Futures project is to promote Practice: Oral Health, the cornerstone docu- and improve the health and well-being of ment Bright Futures: Guidelines for Health infants, children, and adolescents. This is Supervision of Infants, Children, and Adoles- achieved through the development of edu- cents, and other sources. The pocket guide cational materials and through fostering is designed to be a useful tool for a wide partnerships. Bright Futures provides com- array of health professionals including den- prehensive, culturally effective, family- tists, dental hygienists, physicians, physician centered, community-based child health assistants, nurses, dietitians, and others to supervision guidelines consistent with the address the oral health needs of infants, needs of families and health professionals. children, and adolescents. The Bright Futures guidelines provide the This pocket guide offers health profes- foundation for a coordinated series of edu- sionals an overview of preventive oral cational materials for health professionals health supervision for five developmental and families. periods—pregnancy and postpartum, 2 rather than as a comprehensive description of pediatric oral health. The information does not prescribe a specific regimen of care but builds upon existing guidelines and treatment protocols such as those rec- ommended by the American Academy of Pediatric Dentistry, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Dietetic Association. Optimal oral health for infants, children, and adolescents can be achieved through an effective partnership between families, infancy, early childhood, middle childhood, oral health professionals (e.g., dentists, and adolescence. Although age groupings dental hygienists), and other health pro- are designed to take advantage of naturally fessionals (e.g., obstetricians/gynecolo- occurring milestones, many oral health gists, pediatricians, family physicians, issues cut across multiple developmental physician assistants, nurse practitioners, periods. The information presented in the nurses, dietitians). Health professionals pocket guide is intended as an overview need to help families understand the 3 causes of oral disease, especially tooth child’s or adolescent’s individual needs and decay, and how to reduce or prevent oral susceptibility to disease. disease and injury in their infants, chil- When an oral examination by a dentist is dren, and adolescents. not possible, an infant should begin to Resistance to tooth decay in infants, chil- receive oral health risk assessments by age dren, and adolescents is determined partly 6 months by a pediatrician or other quali- by physiology and partly by behaviors. fied health professional. Infants within one The younger the child when tooth decay of the risk groups listed below should be begins, the greater the risk of future entered into an aggressive anticipatory decay. Therefore, delaying the onset of guidance and intervention program admin- tooth decay may reduce long-term risk for istered by a dentist as soon as possible. Risk decay. For this reason, the time to begin groups are as follows: preventing oral disease, especially tooth • Infants with special health care needs decay, is when teeth begin to erupt. • Infants of mothers with a high rate of The first oral examination should occur tooth decay within 6 months of the eruption of the first primary tooth, and no later than age 12 • Infants with demonstrable tooth decay, months. Thereafter the child or adolescent plaque, demineralization, and/or should be seen according to a schedule staining recommended by the dentist, based on the • Infants who sleep with a bottle 4 • Late-order offspring • Anticipatory guidance about growth and • Infants from families of low socioeco- development issues (e.g., teething; nomic status thumb, finger, or pacifier habits; feeding practices) All infants, children, and adolescents need a dental home. A dental home is a compre- •A plan for emergency dental trauma hensive, continuously accessible, and management affordable source of oral health care under • Information about proper care of teeth the supervision of a dentist. The first visit and oral soft tissues establishes the dental home. This visit pres- • Information about proper nutrition and ents an opportunity to implement preven- dietary practices tive health practices and reduce the risk for • Comprehensive oral health care in accor- preventable oral disease. dance with accepted guidelines and A dental home should be able to provide periodicity schedules for pediatric oral the following: health • An accurate risk assessment for oral dis- • Referrals to other dental specialists, such eases and conditions as endodontists, oral surgeons, ortho- • An individualized preventive dental dontists, and periodontists, when care health program based on risk assessment cannot be provided directly within the dental home 5 If the infant, child, or adolescent does American Dental Association not have a dental home, help parents find 211 East Chicago Avenue a source of care by doing the following: Chicago, IL 60611-2678 • Provide a referral to a dentist in your (312) 440-2500 community. Contact your state or local http://www.ada.org pediatric dental society or dental society To find a dentist: or pertinent national organizations for a http://www.ada.org/public/disclaimer.asp list of such dentists. The following national organizations may be helpful in •Work with local agencies to determine an locating dentists: infant’s, child’s, or adolescent’s eligibility for public assistance programs such as American Academy of Pediatric Dentistry Medicaid or the State Children’s Health 211 East Chicago Avenue, Suite 700 Insurance Program or other source of Chicago, IL 60611-2663 funding for oral health care, and help (312) 337-2169 families enroll in these programs or To find a pediatric dentist: obtain such funding. http://www.aapd.org/finddentist
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