ISSUES IN PEDIATRIC ORAL HEALTH
Concept of the Dental Home
Establishment of a dental home for a child by 12 months of age is an essential foundation for the prevention of dental disease, such as early childhood caries (ECC). Analogous to the American Academy of Pediatrics’ (AAP) concept of a “medical home,” the “dental home” has been defined by the American Academy of Pediatric Dentistry (AAPD) as “inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered” manner.
Achieving optimal oral health care for a child in a dental home environment requires a dentist who is knowledgeable about pediatric oral health (ie, a pediatric dentist) to partner with the child’s caregivers to develop a comprehensive preventive oral health care program based on an accurate assessment of the child’s disease susceptibility. Such a preventive plan includes anticipatory guidance and parental education on age-appropriate preventive measures such as oral hygiene techniques, a tooth-friendly diet, dental trauma prevention, and fluoride use.
Beyond its primary focus on preventive oral health, the dental home serves to provide comprehensive, routine, and emergency dental care, an ongoing assessment of growth and development, and referral to other dental specialists as needed. By providing continuously accessible dental care, the time and financial costs associated with emergency dental treatments are reduced for the individual child and for society. Also, the exposure of children to repeated dental check-up visits desensitizes them to the development of dental anxiety.
American Academy of Pediatric Dentistry. Policy on the dental home. Pediatr Dent 2016;38 (special issue):25–26.
Perinatal Factors and Infant Oral Health Care
The perinatal period offers a unique opportunity for oral health counseling by health care providers. Mothers may be unaware of the consequences of their poor oral health, including the impact on their systemic health, pregnancy, and the well-being of their children.
A mother’s caries status, oral hygiene, snacking habits, and socioeconomic status all have an influence on her infant’s colonization with Streptococcus mutans (MS), the key organism implicated in the caries process. Cariogenic bacteria can be transmitted vertically from mother to child, and horizontally between siblings, the father, and children in daycare settings, with significant colonization occurring after first primary molar eruption. The goal of prenatal dental counseling is to educate mothers on appropriate dietary practices, the importance of regular dental visits, the role of fluoride in maternal and child oral health, and methods to reduce maternal MS levels to delay infant colonization as long as possible.
Infant oral health care is the foundation on which preventive dental care is built. Ideally, this begins before caries develops so that preventive measures can be implemented. The primary goals for an infant oral health program are: (1) to establish with parents the goals of oral health; (2) to inform parents of their role in ...