Description

• Dental health and prevention is the practice of maintaining proper oral health to prevent the initiation or progression of oral disease. It is composed of effective oral hygiene, appropriate dietary practices, fluoride exposure, and the establishment of a dental home.
• Dental caries is a disease that is generally preventable. Early risk assessment allows for identification of parent–infant groups who are at risk for early childhood caries (ECC) and would benefit from early preventive intervention.
• The ultimate goal of early assessment is the timely delivery of educational information to populations at high risk for developing caries in order to prevent the need for later surgical intervention.

Epidemiology

• 42% of children 2 to 11 years old have had dental caries in their primary teeth.
• 23% of children 2 to 11 years old have untreated dental caries.
• Children 2 to 11 years old have an average of 1.6 decayed primary teeth and 3.6 decayed primary surfaces.
• 21% of children 6 to 11 years old have had dental caries in their permanent teeth.
• Tooth decay is 5 times more common than asthma and 7 times more common than hay fever.
• >51 million school hours are lost due to dental-related illness each year.

Risk Factors

• Poor oral hygiene
• Poor dietary practices
  • Frequent nighttime bottlefeeding with milk or juice
  • Breastfeeding >7 times daily after 12 months of age
  • Ad libitum breastfeeding after introduction of other dietary carbohydrates
  • A diet high in natural or added sugars
  • Frequent sugar-containing snacking between meals
• Delayed establishment of dental home
• Previous caries
• Lack of exposure to fluoride
• Low socioeconomic status
• Immigrant status
• Poor salivary flow
• Special health care needs or chronic conditions

General Prevention

• Caries risk assessment is the determination of the likelihood of the incidence of caries (i.e., the number of new cavitated or incipient lesions) during a certain time period or the likelihood that there will be a change in the size or activity of lesions already present.
• Establishment of a dental home no later than the child’s first birthday allows the dental practitioner to educate and promote the use of caries-preventing strategies such as dietary recommendations and appropriate oral hygiene.
• Anticipatory guidance is the process of providing practical, developmentally-appropriate information about children’s health to prepare parents for the significant physical, emotional, and psychological milestones.
• Dietary guidelines include the following:
  • Eating a variety of nutrient-dense foods and beverages
  • Balancing foods eaten with physical activity to maintain a healthy body mass index
  • Maintaining a caloric intake adequate to support normal growth and development
  • Choosing a diet with plenty of vegetables, fruits, and whole grains and low in fat
  • Using sugars and salt (sodium) in moderation
  • The American Academy of Pediatrics (AAP) recommends children 1 to 6 years of age consume no more than 4 to 6 oz of fruit juice per day from a cup (i.e., not a bottle or covered cup) and as part of a meal or snack.
• Oral hygiene measures should be implemented no later than the time of eruption of the first primary tooth.
  • Brushing the infant’s teeth after eruption with a toothbrush will help reduce bacterial concentrations.
  • Brushing should be performed for children by a parent twice daily.
  • Flossing should be initiated when adjacent tooth surfaces touch.
  • Parents and caregivers should help or watch over their kids’ tooth brushing abilities until they’re at least 8 years old.
• Optimal exposure to fluoride is an important preventive measure for children. The use of fluoride for the prevention and control of caries is documented to be both safe and effective.
  • When determining the risk–benefit ratio of fluoride, the key issue is mild fluorosis versus preventing devastating dental disease.
  • In children considered at moderate or high caries risk of age <2 years, a “smear” of fluoridated toothpaste should be used.
  • In all children ages 2 to 5 years, a “pea-size” amount should be used.
  • Professionally applied topical fluoride, such as fluoride varnish, should be considered for children at risk for caries.
  • Systemically administered fluoride should be considered for all children at caries risk who drink fluoride-deficient water (<0.6 ppm) after determining all other dietary sources of fluoride exposure.

• To motivate children to consume vitamins, numerous companies have made “gummy” vitamin supplements.
  • Cases of vitamin A toxicity have been reported as a result of excessive consumption.
  • The AAP recommends that the optimal way to obtain adequate amounts of vitamins is to consume a healthy and well-balanced diet.

Pathophysiology

• The oral cavity contains a diverse microbiota that is essential for maintaining normal physiology in the oral cavity.
  • Oral bacteria metabolize sugar and produce lactic acid. Lactic acid is responsible for the demineralization of tooth structure and may lead to cavitation and the advancement of caries through the various dental structures.
  • Furthermore, lactic acid alters the oral environment to a more acidic one and thus disrupts the balance of the oral microbiota, causing the appearance of more pathogenic organisms, thereby enhancing the process.
• Dental caries is a common chronic infectious and transmissible disease resulting from primarily mutans streptococci (MS) that metabolize sugars to produce acid which, over time, demineralizes and cavitates tooth structure (enamel).
  • MS colonization of an infant may occur from the time of birth by “vertical transmission” from mother to infant. The higher the levels of maternal salivary MS, the greater the risk of the infant being colonized, the greater risk for caries.
  • Along with salivary levels of MS, mother’s oral hygiene, periodontal disease, snack frequency, and socioeconomic status also are associated with infant colonization.
• The initial acquisition of MS occurs at the median age of 26 months during the “window of infectivity.”
  • Mothers are recommended to minimize or eliminate saliva-sharing habits such as sharing spoons.