Little Patients, Big Smiles

 

 

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Retaining the form and function of oral structures over a lifetime is vital not only to overall health, but also to quality of life. As such, ensuring that children have the tools and education necessary to maintain their oral health is important. But which factors have the greatest impact on children's oral health? In this Sunstar E-Brief, three pediatric oral health experts share their opinions on what wields the greatest influence on children's oral health. And while their viewpoints might vary, as panelist Steven P. Hackmyer, DDS, points out, what matters most is that no single factor stands above another—all should be considered of equal importance.

FLUORIDE RECOMMENDATIONS

Steven P. Hackmyer, DDS, associate professor and chair of the Department of Pediatric Dentistry and Community Oral Health, University of Tennessee Health Science Center, College of Dentistry in Memphis: "We are finding that fluoride's greatest benefit comes from its topical effect as an additive in toothpastes, mouthrinses and water. While too much fluoride exposure can be problematic, when fluoride is used appropriately, overdose is not an issue. For example, parents and/or caregivers need to be informed that their 2-year-old should not be solely responsible for dispensing toothpaste and brushing his or her own teeth. A very young child has yet not acquired these skills or the ability to expectorate. This puts the child at increased risk of swallowing toothpaste and ingesting too much fluoride."

Michael W. Roberts, DDS, MScD, Henson Distinguished Professor in the Department of Pediatric Dentistry, University of North Carolina School of Dentistry in Chapel Hill: "After reviewing all other sources of dietary fluoride exposure, systemically administered fluoride should be considered for children at caries risk who drink fluoride-deficient water (defined as concentrations less than 0.6 ppm). The American Academy of Pediatric Dentistry has established guidelines for fluoride supplementation to maximize its caries-preventive effects, while minimizing the possibility of fluorosis. And if fluoride supplements are prescribed, these guides should be carefully followed."

Lori Rainchuso, RDH, MS, assistant professor at the Forsyth School of Dental Hygiene, Massachusetts College of Pharmacy and Health Sciences in Boston: "Determining whether a child's primary water source is fluoridated is important, and if it's not fluoridated, systemic fluoride therapy should be advised for infants age 6 months who are considered moderate to high caries risk. Clinicians can check the local public health department or the U.S. Centers for Disease Control and Prevention's (CDC) oral health data system, 'My Water's Fluoride,' to find information about fluoridation of public water systems. Never assume well water is not fluoridated. A patient's private well should be tested for fluoride content prior to prescribing fluoride supplementation.

"Topically, a thin smear layer of fluoride toothpaste is recommended as early as the first tooth erupts for infants who are considered moderate to high caries risk. For children age 2 and older, a pea-size dab on a child-size toothbrush is recommended. Twice-daily brushing—after breakfast and before bed—is also recommended."

SELF-CARE REGIMENS

Hackmyer: "Providing education about proper self-care is vital. Long-term brushing with the wrong type of bristle can create 'notching' in the teeth. Effective toothbrushing technique needs to be taught and reviewed because it's not something that comes naturally."

Roberts: "Regular cleaning of the teeth at home following consumption of food is basic to good oral health. This should begin as soon as the first baby tooth erupts. The use of a soft, moistened cloth is a good 'first toothbrush,' but a size-appropriate toothbrush should be used as more primary teeth begin to appear."

Rainchuso: "Tips for brushing methods and effectively accessing a child's mouth should be discussed with parents and/or caregivers, and even practiced at the first dental appointment. I inform parents/caregivers that difficulties with brushing and child positioning are common. This prevents them from feeling discouraged when the approach they are using isn't successful. Adult supervision is recommended until the child is 8 years old. Depending on the child's dexterity and ability to brush, parents/caregivers should allow brushing autonomy when appropriate. For an older child, I advise parents/caregivers to be there in the beginning for fluoride toothpaste placement, and to come back two minutes later for a post-brushing inspection. Flossing is advised when proximal surfaces begin to touch."

DIETARY GUIDANCE

Hackmyer: "Dental professionals can play an integral role in dietary counseling. Diet is especially relative to the onset of type 2 diabetes, which has serious effects on oral health, including an increased risk of periodontal disease. Dental team members need to join other health care professionals in reinforcing the importance of a healthy diet."

Roberts: "A balanced diet low in sugars and other fermentable carbohydrates is basic to good health for a child, both generally and dentally. Bacteria in the mouth thrive on food products that can be converted into acids that destroy enamel and dentin—but avoiding sugars and fermentable carbohydrates helps stop the process of decay. Children from ages 1 to 6 should not consume more than 4 ounces to 6 ounces of fruit juice per day from a cup, and never from a baby bottle or 'sippy cup.'"

Rainchuso: "A dietary analysis can be helpful not only for the child, but for the entire family as well. Parents or caregivers should be advised against putting a child to bed with a bottle containing anything other than water. Mothers who are breastfeeding should also be instructed to avoid putting an infant with an erupted tooth (or teeth) to sleep while nursing. These goals can be difficult to achieve, so it is important for dental hygienists to not only give caregivers suggestions and rationale for improved oral health, but to also share strategies. For example, a sugar-induced reward system can be hazardous to a child's oral and overall health. As an alternative, use a park excursion or other healthy activity as a reward. Also, recommendations for food and beverage 'grazing' should be discussed, especially during the child's sippy-cup stage. To help prevent caries, healthy snack options should be suggested, such as fruit, raw carrots, snap peas or cucumbers."

PROFESSIONAL DENTAL HOME

Roberts: "A professional dental home should be established for infants by their first birthday. The initial visit should include a medical and dental history review, oral examination, age-appropriate toothbrushing demonstration, teeth cleaning and application of fluoride varnish, if indicated. Counseling for dental and oral development (anticipatory guidance) should also be provided to parents or caregivers."

Rainchuso: "The recare schedule should be determined according to the child's individual needs. Children at high risk of caries are often placed on a quarterly appointment interval."

EDUCATION

Hackmyer: "When a child is born, parents are not given a set of instructions. As health care professionals, we need to serve as a conduit of education. And rather than just treating disease, we need to educate young children—as well as their parents or caregivers—about what they can do to maintain oral health. We have to get parents and caregivers to take ownership of their role in the child's oral health."

REGULAR PREVENTIVE SERVICES

Roberts: "A child should receive regular, professional dental care, which typically means every six months for a periodic oral examination and regular preventive services. Sealant placement on primary and permanent teeth with pits and fissures that are predisposed to plaque retention is an important caries prevention strategy. Sealants should be monitored, and repaired or replaced as needed."

From fluoride use to preventive recare intervals, dental professionals hold the keys to helping maintain the oral health of patients young or old. Providing effective education on the importance of oral health—and strategies for maintaining it—are integral to improving the oral health of our smallest patients.

 

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