Neonatal and Pediatric Medicine
Open Access

Parents are often not well educated about basic oral hygiene for their infants and young children. Several oral health problems such as dental caries, fluorosis and dental infections begin in young age and can be prevented by regular dental care and guidance. As pediatric primary care physicians routinely see infants and toddlers, they play a major role in prevention of dental issues, screening for dental caries and referral to pediatric dentist if essential. A thorough knowledge of preventive measures will help maintain excellent dental hygiene of children [1].

Pediatric primary care physicians must initiate dental screening examination as the first tooth erupts. American Academy of Pediatrics (AAP) recommends dental health assessment at 6, 12, 18, 24, 30 months and 3, 4, 5 and 6 years of age if the child has not started following up with a dentist [2]. All children must receive referral for a dentist at 1-year age.

The pediatric physicians should offer dental anticipatory guidance at all well child visits. This will appropriately educate parents to take informed decisions regarding their child’s dental health.

Twice daily brushing with fluoride toothpaste along with flossing is the first step to good dental health. Flossing should be initiated once there is less space between two teeth. Children up to 8 years of age are not capable of proper tooth brushing coordination, so parental support is warranted according to the child’s capabilities. Normal recommendations are to use a “smear” of toothpaste up to 3 years of age and then no more than “pea sized” at age more than 3 years [3]. It is important to educate parents regarding the adequate use of toothpaste quantity. Parents should also be instructed to clean their infant’s gums daily with a clean, wet washcloth.

Educating parents regarding diet plays an important role in preventing caries. Fruit juices contain enormous amount of sugars and have high potential for dental caries. AAP recommends juice should not be introduced prior to age 1 year and then limit daily intake to 4 ounces in ages 1-3 years and 4-6 ounces for ages 4-6 years [4]. In older children, juices/milk must not be allowed in bed, instead it should be offered in a training cup and must not be sipped throughout the day. Several research articles show prolonged breastfeeding of more than 12- 24 months increase the risk of dental caries [5,6]. Foods and beverages that contain combination of sugars and starches are cariogenic. Salivasharing activities like sharing utensils, cleaning pacifier in mouth must be avoided as cavity-causing bacteria can be passed from mother to child.

Professional fluoride varnish application by pediatric physicians/ dentists performed every 6 months in pre-school children has shown to reduce the rate of caries. For children at high risk for caries, it must be applied four times in a year. Research has shown that preventive dental care is cost saving in addition to improving oral health [7]. Fluoride supplementation may be recommended based on the fluoride intake and caries risk. The United States Public health recommends community drinking water concentration of 0.7mg/L to prevent dental caries [8]. But due to confusion regarding fluoride supplements among physicians and parents, and non-compliance among parents regarding daily administration, fluoride supplements are not the first line measure for preventing caries [1].

Use of dental sealants to seal pit and fissures of primary and permanent teeth is an effective method for preventing and arresting caries [9].

Anticipatory guidance for pediatric dental care helps improve oral hygiene of children and reduce the chances of caries. Pediatric primary care physicians play a major role in providing appropriate education and preventive measures towards oral health of infants and young children.