Infant Oral Health Care

St. Barnabas Hospital Department of Pediatric Dentistry • 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 GUIDANCE Proactive 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 development diet and nutrition fluoride adequacy oral habits injury prevention oral hygiene

HEALTH SUPERVISION The longitudinal partnership between dentist and family individualized to focus on health outcomes for that family and child Departure from “every 6 months” Asses risk Anticipatory guidance Necessary treatment/ prevention Outcomes are the measures that indicate success physical ( decrease inflammation) congnitive (understanding of caries process) behavioral (d/c of bottle habit) First Dental Visit Dentist will: • Check: – Face and Jaws – Gums, Tongue, Tissues – Teeth and Bite • Ask questions • Give information

Courtesy University of Washington School of Dentistry First Dental Visit

• 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 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 - Bacteria

Passed 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 & Time Watch 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