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The condition of children’s teeth and the associated tissues are critical to their well-being. A child with poor dentition may be suffering with chronic pain and thus may have difficulties achieving proper nutrition. He or she may also be at risk of malocclusion and life-threatening infection. Further, dental problems such as early childhood caries can affect the secondary dentition if not addressed, with consequences extending through the life span. Caries are the most common dental problem encountered; the National Health and Nutrition Examination Survey of 1999–2004 showed that 42% of children from ages 2 to 11 have some evidence of decay in their primary teeth, and 21% of children from ages 6 to 11 have evidence of decay in their secondary dentition.2 Unfortunately, a large proportion of these children have untreated caries.1 At higher risk of caries are children living in low-income and moderate-income households, children of color, and children with special health care needs.2,3 However, decay can and does occur in children of all backgrounds. As the health professional most likely to encounter new mothers and their infants at a young age, the pediatric clinician has a unique opportunity to provide anticipatory guidance that may help to prevent or slow the development of caries. Therefore, it behooves the provider to evaluate a child’s current dental status from an early age, to advise the child and the primary caregiver about positive and negative practices that may bear on future dentition, and to assist the family in establishing a dental home.

The evaluation of a child’s current dental status begins with age-appropriate history gathering regarding the child’s current practices. Data should be accumulated to assess risk for caries (see Table 13-1).4 Fixed events such as known decay, special health care needs, low socioeconomic status, and familial history of caries raise the child’s overall assessed risk for developing decay and should be noted in early life. However, mutable practices such as the use of a dental home, exposure to fluoride, exposure to simple sugars, and frequency of brushing are potentially modifiable by behavioral intervention and are critical to assess with every health supervision visit. In addition, sucking habits, including bottle, pacifier, and thumb, should be addressed to evaluate for the risk of malocclusion.

Table 13-1. AAPD Caries-Risk Assessment Tool (CAT)

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