This Policy Statement was retired January 2015.
Early childhood dental caries has been reported by the Centers for Disease Control and Prevention to be perhaps the most prevalent infectious disease of our nation’s children. Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in low-income children, in whom it occurs in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant’s dental flora is the mother or another intimate care provider, through shared utensils, etc. Decreasing the level of cariogenic organisms in the mother’s dental flora at the time of colonization can significantly impact the child’s predisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.
Comments
Oral Health Risk and The Dental Home
January 22, 2004
Jerold F. Lucey, MD, Editor, Pediatrics Editorial Office University of Vermont College Of Medicine 89 Beaumont Ave., Given Bldg., Room D201 Burlington, Vermont 05405-0068
Oral Health Risk and The Dental Home
I found the policy statement from the Section on Pediatric Dentistry informative, but have a number of practical questions. Other than advising Xylitol/chewing gum, how does the dentist lower the level of mother’s cariogenic organisms? I find it inexplicable why mouth to mouth kissing is not a risk factor, while maternal cleaning of a pacifier and sharing a spoon is not, please clarify. Are general dentists aware of the appropriate counseling for moms or should the parent see a pedodontist? What advice helps to avoid digits in the oral cavity, and at what age can it be instituted? Does it matter if oral hygiene is accomplished with a tooth brush, gauze or wash cloth, or before or after breakfast? Cleaning the teeth of a toddler can be a real challenge. Hence, how can flossing be reasonably performed? The statement recommends avoidance of carbonated beverages. Does carbonation itself adversely effect teeth or is it the sugar in sodas? If carbonation is the culprit though what age is it harmful?
Fluoride toothpaste is recommended without reference to age. Shouldn’t fluoridated toothpaste be deferred until after a child learns to spit out (at about 2 to 3 years old?) Before then is it appropriate and advantageous to use a non-fluoridated toothpaste compared to mechanical cleaning? At what age should a fluoride rinse be recommended? No age is specified. Our local pedodontist discourages fluoride tablets/drops when the water source has insufficient fluoride except for at risk patients, because of the frequency of fluorosis due to the high prevalence in edible sources. Do you concur? If indeed his advice is correct, that too much fluoride is available, are we doing more harm with fluoridated toothpaste and rinse?
Irwin J. Kash, M.D. Associates In Pediatrics 1555 Matthew Drive Ft. Myers, Florida 33907 (239) 939-1000
1. American Academy of Pediatrics, Policy Statement, Section on Pediatric Dentistry. Oral Health Risk Assessment Timing and Establishment of the Dental Home. Pediatrics. 2003; Vol. III: 1113-1116