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  • Important and regular part of anticipatory and preventive care
  • Position: Child in the caregiver's lap straddling and facing the caregiver with the examiner's knees touching those of caregiver. The child's head is lowered onto the examiner's lap, and the examiner lifts the child's lip for inspection.

Bottle Weaning

  • Encourage infants to drink from a cup near age 12 mo; completely wean from bottle by age 18 to 24 mo.

Oral Hygiene

  • Begins before eruption of first tooth.
  • Use a pacifier, not a bottle, as the infant's means of non-nutritive sucking (no dipping in sweetener; goal wean from pacifier by age 24 mo; affects alignment of teeth after age 36 mo).
  • Limit or exclude high-sugar juices (maximum, 1 cup of juice daily), carbonated beverages, and refined carbohydrates; no bottle in bed or immediately before sleep.
  • Wipe the infant's gums with a moist cloth twice daily before the eruption of the first tooth.
  • Flossing should be done daily after contact occurs between adjacent teeth.
  • Toothbrushing with American Dental Association–approved fluoridated toothpaste (Morbid Mortal Wkly Rep 2001;50(RR-14):1).

Dental Home

  • Established by age 1 year or 6 mo after first tooth erupts for low-risk patients; earlier for high-risk patients (children with special healthcare needs, any condition impairing salivary production or flow).
  • Subsequent visits biannually for low-risk patients.

Tooth Whitening

  • Bleaching may cause temporary irritation and sensitivity, and may damage the enamel when used in excess.
  • Full-arch cosmetic bleaching for children with mixed dentition (primary and secondary) not recommended.

Intraoral and Perioral Piercing

  • Complications: pain, infection, scar formation, tooth fractures, metal hypersensitivity reactions, localized periodontal disease, speech impediment, bleeding, edema, airway obstruction.


  • Children with optimal fluoride consumption through adolescence have 50% to 75% less decay (sources: fluoridated community water, oral supplements, fluoridated toothpaste).
  • Slightly over half of the U.S. water supply is fluoridated (at varying amounts).
  • Optimal community water supply fluoridation is 0.7 to 1.2 ppm.
  • Determine the fluoride level of the local community water (local water utility or see
  • Adequate daily intake of fluoride: 0.01 mg/d for age 0 to 6 mo, 0.05 mg/kg/d for children older than 6 mo and adolescents.
  • Children age 6 mo and older may need oral supplementation, depending on the community water supply (Pediatrics 1995;95(5):777).
  • On average, 0.3 mg of fluoride is ingested with each brushing by young children using regular fluoridated toothpaste; a pea-sized drop of regular fluoridated toothpaste contains 0.4 to 0.6 mg of fluoride.
  • Fluorosis: Excess fluoride consumption may result in mild, permanent cosmetic effects (streaking, pitting, gray staining) on unerupted teeth; the most vulnerable period between ages 2 and 4 yr. Usually only occurs at amounts exceeding twice the recommended adequate intake (mildest form may occur >0.1 mg/kg/d fluoride ...

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