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Dental Education Australia

Counseling and Preventive Dental Care for Young Children and Infants

Pediatricians, as part of their routine pediatric health care, should offer and reinforce the importance of dental education and health as an important part of the overall health of a child. Prior to the eruption of the primary dentition, the pediatrician may talk about non-nutritive sucking and the teething process. The necessity for fluoride supplementation should be assessed prior to the 6-month evaluation in order that, if necessary, it may be initiated during the 6-month visit. The use of cups and bottles, feeding habits, and teeth cleaning become more essential as the primary dentition erupts.

Non-nutritive sucking — This is a normal part of early development; it includes self-soothing behavior and occurs in 70% - 90% of babies in different populations. The incidence of sucking on pacifiers or digits reduces with advancing age; by age 4 -5 years, nonnutritive sucking is usually substituted with additional coping mechanisms. When compared with sucking on a pacifier, sucking on digits is more likely to continue into the 4th or 5th year. If it continues into the time of eruption of permanent teeth, it can contribute to the development of malocclusion.

Teething — It is usual for babies whose primary teeth are erupting to become agitated, chew on objects, and drool excessively. Frequently, parents say that their teething babies suffer from diarrhea, fever, or additional systemic symptoms; however no proof exists that can relate those symptoms to teething. The management of teething symptoms is palliative. The advantage of topical gels in the management of teething pain hasn’t been demonstrated. Due to the risk of methemoglobinemia, over the counter teething products containing benzocaine shouldn’t be used in children younger than 2 years of age.

Oral hygiene — Parents must be encouraged to clean their children’s teeth at least daily when the youngster is between six months and 2 years of age, and twice per day thereafter. Their teeth should be cleaned using a small, soft toothbrush. To prevent fluorosis, toothpaste that contains fluoride should be used in small quantities, working toward a ‘pea-sized’ amount of toothpaste in the later preschool years. Parents should be prepared to supervise toothbrushing until the child is 5 - 6 years of age or can tie his or her own shoelaces. Flossing can be initiated as the space in between the teeth gets too small to adequately clean using a toothbrush.

Dietary patterns — Guidance in regard to dietary habits may play a huge part in caries prevention. Saliva has the ability to buffer acid until the pH in the mouth is less than 5.5; during this pH, dental enamel demineralization will occur. With continuous exposure to pH over 5.5, surface enamel will develop a chalky texture, well-known as a white spot lesion. During this phase, without intervention such as plaque removal, teeth cleaning, and the topical fluoride used to promote remineralization, cavitation will result.

Human breast milk, formula, and other beverages in vitro, vary in their capability to support bacterial growth, dissolve enamel mineral, reduce plaque pH, buffer acid, and decalcify dentin and enamel. As compared to water, breast milk and many infant formulas decrease plaque pH, possess variable buffering ability, and might support growth of bacteria and dissolve enamel mineral as exposure is extended. Beverages like juices which are commonly provided to toddlers and infants in training cups or bottles, possess increased cariogenic potential. Those beverages should not be ingested in bed, should only be provided in a training cup, and shouldn’t be sipped throughout the whole day. Cariogenic potential will be higher in foods which have increased carbohydrate content, reduce the pH of the mouth, and are gradually cleared from the oral cavity. Avoiding these types of foods altogether may not be necessary, provided teeth are appropriately cleaned following their ingestion. Moderation is the key, followed by frequency, and lastly duration. It is suggested that if children are going to consume sugary foods, it should be with meals as desserts, instead of being permitted to snack on these types of food throughout the whole day.

It is recommended that infants are breast-fed exclusively for the first 6 months of life, that breastfeeding continues until the child is one year old, and that solid food sources be introduced at around 6 months. The use of training cups for juice and other beverages may start as soon as the child is able to use one, and bottles should be discontinued as soon as possible following the child reaching one year in age. Fruit juice should be ingested solely at meal times, and carbonated beverages, especially the ones sweetened with corn syrup or sugar, should be avoided for at least the initial three years of life.

Breast-feeding has been implied to decrease the risk of malocclusion. However, few reports have assessed the effects of infant feeding technique upon dental arch development. The ones which were conducted are inconclusive due to them relying upon cursory assessment or parental report of malocclusion, instead of actual measurements. Therefore, the effects of bottle or breast-feeding upon dental arch development are not known.

Fluoride — In order to prevent the risk of dental caries from too little fluoride, or fluorosis from an overabundance, an accurate evaluation of the youngster's fluoride consumption should be made. It’s especially vital that you observe the youngster's fluoride consumption within the crucial months of enamel maturation, as the anterior permanent teeth that are developing are most vulnerable to excess fluoride causing fluorosis.

If indicated based on fluoride consumption and caries risk, fluoride supplementation should start at 6 months old. Fluoride supplementation is only necessary if the youngster is at increased risk for caries, if additional fluoride vehicles have shown to be inadequate, and if family members are using nonfluoridated water, processed or bottled waters, or water from rural wells.

Fluorosis — Excessive fluoride intake may lead to hypomineralization or fluorosis of the dental enamel. Fluorosis is primarily a cosmetic problem, yet it may make your teeth more susceptible to breakage and wear. Mild fluorosis will be indicated by a lacy appearance or white flecks in the enamel; serious fluorosis will be indicated with a brown discoloration. Fluorosis may be avoided by restriction of excess fluoride intake early in life and suitable fluoride supplementation.

Trauma — Almost 50% of youngsters experience some kind of dental injury during their childhood. Most of those injuries are preventable with anticipatory guidance in regard to preventing falls, especially as the youngster is starting to walk. As the child starts to participate in recreation activities and sports which are related to dental trauma risk, children and parents must be educated on the use of protective gear. Parents should also be made aware of the correct management of avulsed permanent and primary teeth, and the importance of routine dental maintenance and care.

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