ISSUES IN PEDIATRIC ORAL HEALTH
Concept of the Dental Home
Analogous to the American Academy of Pediatrics’ (AAP) concept of a “medical home,” the American Academy of Pediatric Dentistry (AAPD) has promoted the concept of a “dental home,” which is established by referring an infant/age one patient to a dentist who is knowledgeable about care for infants and young children (ie, pediatric dentist). The primary goal of a dental home is to assist children and their parents in the quest for optimum oral health care in a family-centered, continuously accessible, and culturally appropriate environment. In partnership with the caregivers, the dentist develops a comprehensive, personalized preventive oral health care program based on an accurate risk assessment for dental disease. Parents are provided with anticipatory guidance and education on age-appropriate oral hygiene techniques and a tooth-friendly diet. Other functions of the dental home include provision of comprehensive routine and emergency dental care, assessment of growth and development, and referral to other dental specialists as needed. Continuity of care is associated with fewer emergency visits and reduced treatment costs. A child is less likely to develop dental anxiety if a number of positive experiences precede a less pleasant appointment.
AAPD: Policy on the Dental Home. Pediatr Dent 2014;36 (special issue):24–25.
Perinatal Factors & Infant Oral Health Care
The perinatal period offers a unique opportunity for oral health counseling from various health care providers aimed at women’s oral health as well as future childcare. Mothers may be unaware of the consequences of their own poor oral health or that of their children. Cariogenic bacteria can be transmitted vertically from mother to child by licking a pacifier or sharing eating utensils or horizontally between siblings of similar age, from the father, and from children in day care centers. Colonization of the infant’s mouth with Streptococcus mutans (MS) is more likely when maternal salivary MS levels are high. The mother’s oral hygiene, snacking habits, and socioeconomic status all have an influence on the infant’s colonization with MS. Anticipatory guidance and dental treatment of the expectant mother can significantly reduce the child’s risk of acquiring MS. Prenatal dental counseling include education on the importance of regular dental visits and the role of fluoride in maternal and childhood oral health, counseling on appropriate maternal diet, and advice on reduction of MS colonization. Maternal MS levels and the risk of transmission to infants can be reduced if the mother rinses twice daily with chlorhexidine digluconate 0.12% for 2 weeks followed by chewing 100% xylitol gum for 5 minutes 3–5 times/d (total dose of xylitol 6–10 g/d) for several weeks.
Delayed dental development is characteristic of preterm infants and is also seen in infants with global developmental delay. It is important to advise expectant mothers that postnatal environmental tobacco smoke exposure increases susceptibility to childhood caries, an association that is independent of ...