Oral Health Screening Online Module

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Oral Health Screening Online Module

Section 5: Anticipatory Guidance for Oral Health & Prevention of Dental Caries

Objectives

Upon completion of this section, participants will be able to:

Describe anticipatory guidance for oral health
Describe dental caries prevention strategies
Describe fluoride varnish
Provide age appropriate anticipatory guidance to a child’s caregiver

Anticipatory Guidance

As a C&TC health provider you should provide anticipatory guidance to a child and his/her family to promote oral health, prevent disease and increase awareness about expectations for the next developmental phases. With this information, parents or caregivers can help prevent and reduce common oral health problems, infections and disorders in their children. See Table 1 for an anticipatory guidance timeline.

Providers should:

Customize and modify anticipatory guidance based on risk assessment, family questions and concerns and cultural appropriateness.
Provide information on oral health such as dental caries, risky behaviors and other related topics.
Make verbal referrals at each visit beginning at the time of eruption of the first tooth or no later than 12 months of age for regular, preventive dental care. Anytime abnormalities are noted, referral for oral health assessment and treatment from a dentist is critical.

Prevention of Dental Caries

Although dental caries is the most prevalent chronic disease of children in the nation, it is also the most preventable. Providers have opportunities to educate families and help prevent dental caries. Education and preventive dental care should start during pregnancy and continue throughout a child’s life. Prevention begins with good maternal dental practices during pregnancy to reduce vertical colonization of cariogenic Streptococcus mutans from mother to infant. Caregivers should begin cleaning the infant’s mouth and gums on a regular basis even before tooth eruption.

Strategies to prevent and treat dental caries include:

Fluoride supplementation when systemic fluoride exposure is suboptimal; up to at least 16 years of age.
Oral health screening and risk assessment
Parent/caregiver and patient education
Comprehensive dental care by age 1
Reducing consumption of fruit juice, milk at bedtime, soda pop, sports drinks and other sugary liquids
Increasing water and daytime milk consumption
Assessing need for sealants on caries-susceptible posterior teeth with deep pits and fissures; placed as soon as possible after eruption. Coverage for sealants is limited to recipients through age 18 on first and second permanent molars.

Fluoride is most effective in preventing dental caries when it is ingested and available to the tooth while the tooth develops. Since this route is not always possible, Fluoride varnish application (FVA) is another strategy primary providers can use to prevent dental caries. Studies have found fluoride varnish, in addition to caregiver counseling, reduces incidence of ECC. Fluoride varnish is a topical treatment containing 5% sodium fluoride that is applied to the surfaces of teeth. FVA protects the teeth for several months. It prevents new cavities from forming and hinders developing cavities. Primary care providers can apply the varnish in the clinical setting and be reimbursed for FVA as part of the C&TC visit. The child’s history, clinical findings and susceptibility to oral disease should determine the timing, selection and frequency. For more information on FVA and reimbursement see the Resources section of this module.

Table 1: Anticipatory Guidance Timeline
Anticipatory Guidance Timeline
6 to 12 months	Encourage good oral health of parent or caregiver Encourage use of soft cloth to clean mouth after feeding Encourage tooth cleaning after first tooth eruption Review nutrition and eating habits Encourage napping and sleeping without a bottle or sippy cup Encourage use of cup for drinking Discuss mouth and tooth injury prevention Provide counseling for nonnutritive oral habits (e.g. digit, pacifiers) Help evaluate fluoride needs Address speech/language development Refer to dentist upon first tooth eruption and no later than 12 months of age
12 to 24 months	Review applicable items from 6 to 12 months Encourage daily brushing and flossing Assess appropriateness of feeding practices Review fluoride status, including childcare arrangements that may affect systemic fluoride intake
2 to 6 years	Review applicable items from previous visits Encourage assisting child with tooth brushing until child is capable of tying his/her own shoes Encourage assisting child with flossing until child is capable of writing name in cursive Reinforce brushing with pea-sized amount of fluoride tooth paste Reinforce injury prevention Help evaluate change in fluoride needs
6 to 20 years	Review applicable items from previous visits Provide substance abuse counseling (e.g. smoking and smokeless tobacco) Provide counseling on intraoral/perioral piercing

Quiz

1. Which of the following is included in the Anticipatory Guidance for infants 6 months to 12 months? (Check all that apply)

2. Which of the following is included as a dental caries prevention strategy? (Check all that apply)

3. What is fluoride varnish? (Check all that apply)

4. Which of the following should be reinforced during 2 years to 6 years of age? (Check all that apply)

For questions about this page, please contact our Maternal and Child Health Section.

Minnesota Department of Health

Oral Health Screening Online Module

Child and Teen Checkups (C&TC) E-Learning Training Programs

Oral Health Screening Online Module

Section 5: Anticipatory Guidance for Oral Health & Prevention of Dental Caries