Child health care professionals should develop the knowledge to perform oral risk
assessments on children beginning at 6 months of age (American Academy of Pediatrics).
In addition, children at moderate to high risk for caries should receive an aggressive
anticipatory guidance and intervention program.
Child health care professionals are encouraged to:
• Assist parents/caregivers in establishing a regular source of dental care (a “dental
home”) for the child and for themselves. The first visit should occur when the child is
12 months of age or when the first tooth erupts.
• Provide counseling and anticipatory guidance to parents and other caregivers
concerning oral health and protective behaviors during well-child visits.
• Impress upon the parents/caregivers the importance of the child’s primary dentition.
• Assess the risk for oral diseases in the child beginning at 6 months of age by identifying risk indicators such as:
Inadequate or inappropriate fluoride exposure.
Past or current caries experience in child, siblings, parents and other caregivers.
Restorations placed in a child within the past two years.
Insufficient or lack of age-appropriate oral hygiene efforts by parents/caregivers.
Frequent and prolonged exposure to sugary substances especially between meals including bottle or sippy cup use.
Use of at-will and night-time bottle or sippy cup containing anything other than water.
Frequent use of medications that contain sugar or cause xerostomia (inhibit saliva flow) (e.g., anticholinergics, asthma, seizure and attention-deficit hyperactivitymedications or antibiotics with added sugary syrup).
Clinical findings of heavy accumulation of plaque or any signs of decalcification
(white spot lesions).
Low socioeconomic status.
Special health care needs (developmental delays or disabilities).
• Facilitate appropriate referral for management of children assessed to be at increased
risk for oral disease or in whom carious lesions or white spot lesions are identified.
• Obtain or develop and maintain a list of community oral health referral sources that
will provide services to young children and children with special health care needs.
• Encourage drinking optimally fluoridated tap or bottled water. If not possible,
prescribe fluoride drops or tablet supplements.
• Advise parents about the most appropriate type of water to use to reconstitute infant
formula. While occasional use of water containing optimal levels of fluoride should
not appreciably increase a child’s risk for fluorosis, mixing powdered or liquid infant
formula concentrate with fluoridated water on a regular basis for infants primarily fed
in this way may increase the chance of a child’s developing enamel fluorosis.
• Advise parents (and demonstrate as needed) that the following actions may reduce the
risk of caries in children:
Wipe an infant’s teeth, especially along the gum line, with a soft cloth after feeding
from the breast or bottle.
Brush the child’s teeth using a pea-sized (the size of a child’s pinky nail) amount
of toothpaste, especially before bedtime. Children older than 2 should use fluoride
toothpaste; children younger than 2 should use a smear of fluoride toothpaste on the
brush only if they are at moderate to high risk of caries.
Help children with brushing until they are about 7 years old.
Give each family member their own toothbrush.
Never put the child to bed with a bottle or sippy cup containing anything other than
water. The last thing to touch the child’s teeth before bedtime should be a toothbrush
or water.
Begin weaning children from at-will bottle and sippy cup use (such as in an effort to
pacify a child’s behavior) by about 12 months of age.
Feed the child foods containing fermentable carbohydrates (e.g, crackers, cookies,
dry cereals) at mealtimes only and limit the amount.
Avoid saliva-sharing behaviors, such as kissing the baby on the mouth, sharing a
spoon when tasting baby food, cleaning a dropped pacifier by mouth, or wiping the
baby’s mouth with a cloth moistened with saliva. For older children, avoiding the
sharing of straws, cups or utensils.
Avoid saliva-sharing behaviors between children via their toys, pacifiers, utensils, etc.
Lift the lip and look in the child’s mouth for white or brown spots on the teeth.
Visit an oral health professional beginning when the child is 12 months of age, or
when the first tooth erupts.
Apply fluoride varnish applications two to three times a year for children at
moderate to high risk of caries.
• Educate pregnant women and new parents about care that will improve their own
oral health:
Brush teeth twice daily with a fluoride toothpaste and floss daily, especially
before bedtime.
Eat foods containing fermentable carbohydrates at mealtimes only and in
limited amounts.
Avoid sodas and other sugary beverages of any type, especially between meals.
Choose fresh fruit rather than fruit juice to meet the recommended daily fruit intake.
Obtain necessary dental exam and treatment before delivery when possible.
Chew sugarless or xylitol-containing gum or other xylitol-containing products, four to five times a day, after eating.
Do not smoke or use tobacco products.
Oral Health 2010. Sacramento
