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A Pediatric Guide to Children's Oral Health Reference Guide

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A Pediatric Guide to Children's Oral Health Reference Guide !"#$%&'()&*"+,&%$"(- ./&0%)$123"4)'0"5$'0(/ !"#"$"%&"'()*+" 7DEOHRI&RQWHQWV 7RRWK6WUXFWXUH .................................................. 1 $QWLFLSDWRU\*XLGDQFH ............................................ 2 0DQDJHPHQWRI2UDO,QIHFWLRQDQG3DLQ .............................. 4 'HQWDO7UDXPD7RRWK,QMXU\ ....................................... 6 )UDFWXUH ....................................................... 8 7UDXPD2UDO6RIW7LVVXH ......................................... 10 ,QMXU\3UHYHQWLRQ ............................................... 11 &RQJHQLWDO2UDO$QRPDOLHV ....................................... 12 &KLOGUHQ:LWK6SHFLDO1HHGV ...................................... 14 $&.12:/('*0(176 3ULPDU\$XWKRUV Rama Oskouian, DMD A Pediatric Guide to Children’s Oral Health is a Giusy Romano-Clarke, MD, FAAP collaborative project of the Oral Health Initiative coordinated by the American Academy of $GGLWLRQDO&RQWULEXWRUV Pediatrics (AAP) and the federal Maternal and Lauren Barone, MPH Child Health Bureau. Suzanne Boulter, MD, FAAP Melinda B. Clark, MD, FAAP We request the following citation be used when David M. Krol, MD, MPH, FAAP Wendy Nelson, ACCE referencing this document: Diona L. Reeves American Academy of Pediatrics. A Pediatric Guide Rebecca Slayton, DDS, PhD to Children’s Oral Health. Elk Grove Village, IL: American Academy of Pediatrics; 2009 7KHIROORZLQJLQGLYLGXDOVDQGRUJDQL]DWLRQV SURYLGHGSKRWRJUDSKVIRUWKLVUHVRXUFH For information about the AAP Oral Health American Dental Association Initiative, contact ANZ Photography American Academy of Pediatrics Suzanne Boulter, MD, FAAP 141 Northwest Point Blvd Noel Childers, DDS, MS, PhD Elk Grove Village, IL 60007-1098 David A. Clark, MD E-mail: [email protected] Melinda B. Clark, MD, FAAP Web site: www.aap.org/oralhealth Content Visionary Yasmi Crystal, DMD Joanna Douglas, BDS, DDS Donald Greiner, DDS, MSc Martha Ann Keels, DDS, PhD Rama Oskouian, DMD The recommendations in this publication do not indicate Rocio B. Quinonez, DMD, MS, MPH an exclusive course of treatment or serve as a standard of Giusy Romano-Clarke, MD, FAAP medical care. Variations, taking into account individual circumstances, may be appropriate. A special thanks to AAP staff and advisory committee members who helped in the production of this resource. Products are shown or mentioned for informational purposes only and do not imply an endorsement by the AAP. The AAP does not recommend any specific brand of This project is supported in part by Grant No. U93 MC products or services. 00184 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Copyright © 2010 American Academy of Pediatrics. Administration, Department of Health and Human Services All rights reserved. and the American Dental Association Foundation. 7RRWK6WUXFWXUH &URZQ The portion of the tooth visible above the gums. (QDPHO The outside layer on the tooth that covers the crown, enamel is a hard, thin, translucent layer of calcified substance that envelops and protects the dentin. Enamel is the hardest substance in the body. The enamel’s properties allow it to protect the softer underlying dentin during chewing, grinding, and crushing food. Decay typically starts at the enamel surface and then spreads to the other layers. 3XOSFKDPEHU The softest part of the tooth, the pulp extends from the tooth root to the crown. The pulp contains the tooth connective tissue, blood vessels, and nerves. Its function is to provide the tooth with nutrients. If the pulp of a tooth becomes damaged beyond repair, the tooth dies. Damage to the pulp can be a result of a cracked tooth, a deep cavity, or trauma. 5RRW The part of the tooth below the crown, the root is covered by cementum rather than enamel, and attached by the periodontal ligament to the alveolar bone. It is like an anchor because it helps hold our teeth within the alveolar bone. 'HQWLQ A hard, thick substance that is the main component of the tooth structure, dentin is found under the enamel in the crown and under the cementum in the root. The dentin provides the tooth with the ability to flex and absorb tremendous functional loads without fracturing. Normal dentin is composed of millions of tubules that change as you move from the periphery toward the pulp chamber. These tubules contain tiny projections of the nerve and are, thus, sensitive to exposure to air, acid, and touch. $OYHRODUERQH The portion of bone in the maxilla or mandible that surrounds and supports the teeth. &HPHQWXP The thin layer of calcified (tough calcium deposits) tissue covering the dentin of the root, cementum is 1 of 4 tissues that support the tooth in the jaw. The principal inorganic components of cementum are hydroxyapatites, which are thin, platelike crystals similar to those in bone. 3HULRGRQWDOOLJDPHQW Made up of bundles of connective tissue fibers that anchor the teeth within the jaws. Used with permission from the American Dental Association 1 $QWLFLSDWRU\*XLGDQFH $*( 5,6.$66(660(17 $17,&,3$725<*8,'$1&( %LUWKWR Do mom or siblings have Encourage good oral hygiene of 0RQWKV cavities, a toothache, or parent or caregiver. bleeding or sensitive gums, or If there is not a family dentist, have they had cavities filled in encourage and assist parents in the past year? identifying one to help facilitate a Do mom or siblings have a dental home. dentist? Review infectious nature of tooth Does tap water supply contain decay. fluoride? Encourage cleaning baby’s mouth with Is fluoridated tap water used soft cloth after feeding. for drinking and cooking? Instruct parents not to clean the baby’s Is this a baby with special pacifier by putting it in their mouth. health care needs Advise no napping or sleeping with a (eg, low birth weight, bottle or sippy cup. premature, congenital anomalies)? Provide information about teething. 0RQWKV Review previous questions. Review information from prior visits. Is fluoridated tap water used Start using fluoridated water to to prepare formula and baby’s prepare formula. food? Consider fluoride drops if water supply Does the baby fall asleep with does not contain fluoride and child is a bottle that has formula or a at high risk for caries. liquid other than water? Do not put the baby to bed with a Does the baby nurse on bottle that contains anything other than demand through the night? water. Do not pre-chew baby’s food or share eating utensils. WR Review previous questions. Review information from prior visit. 0RQWKV Is fluoridated tap water used Teach parents to check their baby’s for drinking and preparing teeth and mouth by “lifting the lips.” formula and baby’s food? Recommend that adults use a smear Does the baby sip on a cup or of fluoridated toothpaste to brush the bottle with milk, juice, or other teeth of children at high risk for caries. sweet drinks between meals? Teeth should be brushed twice a day (morning and night) by 1 year of age. Does the baby snack on candy, cookies, or other starchy foods between meals? 2 $QWLFLSDWRU\*XLGDQFHFRQWLQXHG WR Does the baby fall asleep with Teach about mouth and tooth injury 0RQWKV a bottle that has formula or prevention. FRQWLQXHG juice, or does the baby nurse Review feeding habits, discuss healthy on demand through the night? snacks, and discourage grazing. Has a parent or another Discuss the dental home. adult started brushing the baby’s teeth with a “smear” of fluoridated toothpaste? WR Review previous questions. Review information from prior visits. 0RQWKV Stop use of the bottle. Prolonged exposure to milk or juices causes harm to teeth because bacteria in the mouth convert the sugars to acid. The acid attacks the enamel and can lead to dental caries. WR Review previous questions. Review information from prior visits. 0RQWKV Does an adult brush the child’s Evaluate change in fluoride needs. teeth twice a day with a “pea- Reinforce brushing with small pea- sized” amount of fluoridated sized amount of fluoride toothpaste. toothpaste? Reinforce injury prevention and response. Be sure the child has a dental home. '2&80(17$7,21 Record fluoride varnish application in the child’s medical record. For handwritten charts, use stickers to document the examination and any oral health findings. Aprintable version of this sticker chart is available online at www.aap.org/ oralhealth/chart-sticker.doc. 3 0DQDJHPHQWRI2UDO,QIHFWLRQDQG3DLQ 7227+$%6&(66 A collection of purulent fluid caused by a bacterial infection. The most common cause is extension of the dental caries process into the pulp of the tooth. It can also be caused by trauma to the tooth that allows for mouth bacteria to enter the pulp of the tooth. ,1)250$7,21)253$5(176 Anaerobic organisms are the most common causative agents in dental abscesses. An abscess may be associated with facial cellulitis. 75($70(175()(55$/237,216 Treat with amoxicillin or penicillin if fever or infection extends to face and regional nodes. Clindamycin should be prescribed if child is allergic to penicillin. Pain may be managed with nonsteroidal anti-inflammatory 7RRWK$EVFHVV drugs or an acetaminophen/narcotic combination. An infection can be life-threatening and must be addressed emergently. Refer immediately to a dentist for definitive care. 25$/&$1',',$6,67+586+ An infection of the mouth caused by Candida fungus (yeast) that presents as adherent white plaques, usually on the tongue and inner cheeks. It may also be present on the roof of the mouth, the gums, the tonsils, or the throat. ,1)250$7,21)253$5(176 Oral candidiasis may occur in newborns, immune-
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