Good

morning
INFANT ORAL HEALTH
Infant oral health
 Introduction
 Infants are born with their primary set of teeth formed underneath
the gums.

 Primary teeth usually start to come into the mouth at the age of six
to eight months old. By three, all 20 primary teeth should be
formed.

 It is important to develop good oral health habits at an early age.

 Healthy habits can prevent or reduce tooth decay in infants and

children.

 The American Academy of Pediatric Dentistry recommends that

infants have their first dental examination within 6 months of first
tooth development or their first birthday.
DEFINITION OF INFANT
ORAL HEALTH
 According to AAPD:

Professional intervention within 6 months after the

eruption of the first primary tooth or no later than

12 months of age directed at factors affecting the

oral cavity, counseling on oral disease risks and

delivery of anticipatory guidance.

GOALS OF INFANT ORAL HEALTH
PROGRAM
 To identify, intercept and modify the potentially harmful parenting practices that

may adversely affect the infant’s oral health.

 Parent education right from the prenatal period highlighting the importance of

their role in the prevention of dental disease for their child.

 Parent/ caregiver orientation to perceive dental services as an integral part of

infant’s overall health program.

 Periodic evaluation of the oro-facial development and oral health by the clinician.
NEED FOR INFANT ORAL CARE

• Nowak and Cassamassino (1995) quoted that ‘children are not born with a list of
Instructions written on their chest’

• Infectious diseases of oral cavity

• Pioneer bacteria and secondary invaders.

• Traumatic injuries

• Habits

• Child abuse and neglect

• Care of children with special health care needs

So…..ultimate goal

 According to Nowak(1997), the goal of first oral

supervision visit is to

 Assess the risk

 Initiate a preventive program
 Provide anticipatory guidance
 Decide periodicity of visits
Role of Dentist in providing
Infant oral health care
 As a valuable source of information
 Feeding practices
 Sucking and suckling
 Tips on bottle feeding
 Importance of weaning
 Use of Pacifiers
 Oral hygiene practices
 Anticipatory guidance
Oral Health Recomendations

Birth to 6 months of age:

 Always clean your infant's gums after feeding.

 Wrap a moistened washcloth around the index and gently massage the
gum tissues.

 Do not put your baby to bed with a bottle or prop it in their mouth.

 Teething begins between four and six months of age. Gums may be
red and swollen. To ease these symptoms, give your infant a clean
teething ring or cold wet washcloth.

 Dental decay is an infectious transmissible disease. Avoid sharing

utensils, cleaning pacifiers or a bottle nipples by putting it in their
mouth.
 Teething

Teething may be defined as the process by which an infant

teeth’s erupt, or break through, the gums. Teething is also
referred to as “cutting” of the teeth. Teething is medically
also termed as Odontiasis.
The appearance of the first tooth is most eagerly awaited,
significant
developmental landmarks by most parents. Teething Latin term
“Dentitio difficili” was coined, literally meaning difficult
dentition.
Signs and symptoms of teething

•intermittent localized discomfort in the area of erupting primary

teeth
•inflammation of the mucous membrane overlying the tooth
• pain
• general irritability/malaise
•Disturbed sleep
•facial flushing
•circumoral rash
•drooling
•Gum rubbing/biting/sucking
•bowel upset (ranging from constipation to loose stools and
diarrhea)
• loss of appetite
•alteration in volume of fluid intake
• ear rubbing on the same side as the erupting tooth
 Treatment:-

 Teething rings (chilled)

• Hard sugar‑free teething rusks/bread‑sticks/oven‑hardened
bread
• Cucumber peeled
• Pacifier (even frozen)
• Frozen items (anything from ice cubes to frozen banana, sliced
fruits, vegetables)
• Rub gums with clean finger, cool spoon, wet gauze
• Reassurance
• Analgesics/antipyretics
• Topical anesthetics.
6-12 months of age:
 Start to use a child's soft bristled toothbrush, with no
toothpaste, in addition to massaging the gum tissues.

 Begin to wean your baby from the bottle.

 Be familiar with the normal appearance of your child's gums

and teeth and schedule the child's first dental appointment.
 4-6 months
Weaning:
 Process of expanding the diet to include foods and drinks
other than breast milk and infant formulae.
 It is a gradual process– the age at which it is started and the
rate at which it progresses vary between babies.

Babies should not be weaned at an earlier age,

 They don’t have the neuromuscular coordination needed to
move food from tip of tongue to the back of the mouth.
 Their gastrointestinal tract is too immature to digest and
absorb the food as the enzymes are not fully developed.
 They kidneys cannot regulate the high solute load.
Stages of Weaning
3 stages:
stage 1: 4-6 months
stage 2: 6-9 months
stage 3: 9-12 months

Stage 1:
 Usual for solid food to be introduced before the first feed of the day.
 If a cereal is used, it should be reconstituted with breast milk, infant
formula or boiled water.
 As the baby becomes used to taking food from a spoon, the consistency of
the food should become thicker.
 At this stage, all food must be sieved, pureed or finely minced.
 Iron rich, fortified cereals and green vegetables are introduced to prevent
iron deficiency.
Stage 2:
 Child is now able to chew and consequently minced and
mashed food that includes small soft lumps can be given.
 At this stage, the child must never be left alone while feeding
because of the risk of choking.

Stage 3:
 Food no longer needs to be mashed, it can now be chopped
and the infant should be encouraged to feed themselves, with
supervision.
 Early morning milk feed is replaced by a drink of water or
diluted fruit juice.
12 to 18 months of age:
 By the age of one, child should have an oral examination by a
dentist.

 Brush your child's teeth twice a day with plain water.

 Continue to take steps to avoid passing decay causing germs to

your child.

 If your drinking water is not fluoridated, talk to your PCP about

18 months to age 5:

 By 30 months of age, all of the primary teeth should have

come into the mouth.

 At age 2, begin brushing with a fluoridated toothpaste. Teach

child to spit out the toothpaste.

 Bring child to dentist for a regular checkup.

Recommendations
Recommendations for parent oral health:-
 ORAL HEALTH EDUCATION:-

All primary health care professionals who serves parent and

infants should provide education on the etiology and
prevention of ECC. Educating the parents on avoiding saliva
sharing behaviours (eg: sharing spoons and other utensils,
sharing cups,cleaning a droped pacifier or toy with their
mouth) can help prevent early colonization of MS in infants.

 COMPREHENSIVE ORAL EXAMINATION:-

Referral for a comprehensive oral examination and treatment

during pregnancy is especially important for the mother.
 Professional oral health:-

Removal of active caries, with subsequent restoration of

remaining tooth structure, in the parents suppresses the MS
reservoir and minimize the transfer of MS to the infant, there
by decreasing the risk of infant developing ECC.

 Oral hygiene :-
Brushing with fluoridated tooth paste and flossing by the
parent are important to help dislodge food and reduce
bacterial plaque level.

 Diet:-

Dietary education for the parents includes the carcinogenicity

of certain foods and beverages, role of frequencyof
consumption of these substances, and the
demineralization/remineralization process.
 Fluoride :-

Using a fluoridated tooth paste and rinsing with an alcohol

free containing 0.05% NaF once a day or 0.02% NaF twice a
day helps to reduce plaque levels and promote enamel
remineralization.

 Xylitol chewing gum:-

Use of xylitol chewing gum (at least 2 or 3 times a day by the

mother) has a significant impact on mother child transmission
of MS and decreasing the child’s caries rate.
Recommendations for infant’s oral health:-
 Oral health risk assessment:-

Every infant should receive an oral health risk assessment from

the primary health care provider by six months of age which
should evaluate the patient risk of developing of oral diseases
of soft and hard tissues, including caries risk assessment,
provide education on infant oral health, and evaluate and
optimize fluoride exposure.
 Establishment of a dental home:-

 Parents should establish a dental home for infants by 12

months of age.

 The initial visit should include thorough medical and dental

histories, a thorough oral examination, performance of an age
appropriate tooth brushing demonstration and prophylaxis
and fluoride varnish treatment if indicated.

 Providing anticipatory guidance regarding dental and oral

development, fluoride status, non nutritive suckling habits,
teething , injury prevention, oral hygiene instruction and the
effect of diet on dentition are also important for the initial
visit.
Oral hygiene:-

 Oral hygiene measures should be implemented no later than

the time of eruption of the first primary tooth. Cleansing the
infant’s teeth as soon as they erupt with a soft toothbrush will
help reduce bacterial colonization. Tooth brushing should be
performed for children by a parent twice daily, using a soft
toothbrush of age‑appropriate size.
Diet:-
(i) Infants - breastfed during first 6 months of life in addition of
iron‑enriched solid food between 6 and 12 months of age.

(ii) Parents should be counseled about not to put their children

to sleep with the bottle. They should also be made aware of
the deleterious effects of inappropriate bottle usage and the
need for good oral hygiene practice upon the first primary
teeth eruption
iii)Breastfeeding for over 1 year and at night beyond eruption of
teeth may be associated with ECC. Hence, AAPD suggests that
children should be weaned from breast or bottle by 12–14
months of age and should drink from cup as they approach
their first birthday

(iv) Infants older than 6 months and with exposure to <0.3 ppm
fluoride in their drinking water need dietary fluoride
supplement of 0.25 mg fluoride per day.
(v) Parents should be counseled to reduce their child sugar
consumption frequency.
AAP suggests that infants should consume only 4–6 oz of
fruit juice per day.
Mashed/pureed whole fruit consumption should be
encouraged rather than fruit juice.
They should not be given powdered beverages or soda
pop as these drinks pose increased risk for dental caries.
Only iron‑fortified infant cereals along with breast milk
or infant formula should be given to infants who are older
than 6 months of age.
Cow’s milk should be completely avoided in the 1st year
of life and restricted to 24 oz per day in the 2nd year of life
 Fluoride:-

 safe and effective

 The correct amount of fluoridated tooth paste should be used
twice daily.
 No more than a smear or rice sized –under age of 3yrs
 No more than a pea sized – 3-6yrs

 Professionally applied topical fluoride such as fluoride varnish,

should be considered for children at risk of caries.
 Systemically administrated should be considered for all
children at caries risk who drink fluoride deficient water (less
than 0.6 ppm) after determining all the dietary sources of
fluoride.
 Injury prevention:-
Practitioners should provide age appropriate injury
prevention counseling for oro facial trauma including play
objects, pacifiers, car seats and electric cords.

 Non nutritive habits:-

Non nutritive oral habits such as digit or pacifier sucking ,
bruxism abnormal tongue thrust may apply forces to teeth
and dentoaleveolar structures.
Anticipatory Guidance
For
Children’s Dental Health
 DEFINATION
 Definition by AAPD:
“The process to provide practical, developmentally
appropriate information about the children’s health to
prepare parents for the significant physical, emotional
and psychological milestones.”

 Aims:
 Delivery of appropriate information.
 Discussion based counselling.
AAPD has identified three developmental age ranges associated
with specific milestones.

 Each age range has six specific entities called ‘ content areas’.
 Content areas:
 Oral development
 Fluoride adequacy
 Oral hygiene
 Diet and nutrition
 Habits
 Injury prevention
AAPD’s Age Ranges

6-12 month age

range

12-24 month
age range

2-6 years age

range
Child’s developmental age range : 6-
12 months
Milestone
The eruption of the first primary tooth
Oral Fluoride Oral Content
Abnormal areas Nutrition Injury
developmen exposure hygiene/ oral habits and Diet prevention
t health

Review Assess Review oral Review Encourage Review

pattern of fluoride hygiene pacifier use weaning at what to do
eruption. status. techniques Discuss the proper if the child
with the effects of age. has
Determine caregiver. thumb- Discuss the traumatic
Review supplement sucking. role of injury.
teething s if needed. Plan for Discuss sugar in
facts. next visit effects of dental Provide an
based on breastfeedi caries emergency
risk ng on the initiation. number
assessment mouth.
Child’s development age range:
1-2years
Milestones
Completion of primary dentition, occlusal relationships
established, arch length determined

Oral development
Completion of primary dentition Discuss importance of space maintainer
Concept of occlusion Discuss bruxing
Concept of arch length and spacing Review molar canine, and incisal position
with parents during examination
Formation of permanent teeth

Fluoride
Fluoride in food source in and outside Reassure fluoride status and determine
home appropriate type of toxicity
Toxicity and safety Discuss toxicity and how to manage
accidental ingestion
Habits

Thumb sucking Review non nutritive sucking and safe

Pacifier use use of pacifier if not covered previously

Oral hygiene
Type of brush Review home oral care procedures and
Role of dentifrice compliance
Role of child and parents in brushing Work with patient to solve problems of
Frequency of and setting for oral hygiene oral hygiene
Periodicity of dental visits Plan for baby’s next dental visit based on
risk assesment

Nutrition and diet

Plaque Discuss CHO’S and their role in plaque
development
Role of frequency of sugar intake in •Review diet outside of home
dental caries •Discuss frequency of CHO intake as a
caries factor
•Discuss caries control as a framework of
a heartful diet
Injury prevention

Electric cord injury Discuss electric cord safety

Review normal dental and oral anatomy

Primary tooth trauma and its sequelae with parents during examination
Reinforce home and use of car seats

Home child proofing Develop plans for oral trauma

management for preschool and child care
 Child's Developmental Age
Range:
Milestones
2 to 6 Years
Loss of first primary tooth, eruption of first permanent molar or
incisor
Oral Development
Exfoliation of primary teeth Review patterns of eruption
Eruption of first permanent teeth Cover permanent molar occlusion with
parents during examination
Molar occlusion Point out permanent molar occlusal
anatomy
Healthy gums
Describe healthy periodontal tissue

Fluoride
Fluoride sources in water outside Reassess fluoride status at periodic visit
the home and determine both supplement and age-
appropriate vehicle
Oral Hygiene/Health
Child's participation in oral hygiene Review home oral care procedures and
compliance
Recommend that the child begin brushing
with parent supervision and assistance

Role of dental sealants in prevention Discuss dental sealants

Explain dental radiographs
Plan child's next dental visit based on risk
assessment
Discuss parental separation or presence
at dental visits and normal child anxiety

Habits
Nonnutritive habits if child still sucking thumb, discuss with
parent how to help the child discontinue
the habit
Nutrition and Diet

Snacking and sugar intake at home Review diet outside the home and its
and at school caries potential
Use of food to reinforce behavior Discourage use of food as a behavioral
Relationship of a healthy diet to oral tool
health

Injury Prevention
Safety during sports activities such as Encourage use of helmets, pads, and
bicycling and skating mouthguards when appropriate
Permanent tooth injury Review differences between primary and
permanent teeth with parents during
examination
Prepare plan for home and school for oral
injury and treatment options
Car safety Encourage car seat use
Conclusion
 As our society for pediatric dentistry strives to achieve the

goal that “every child has a fundamental right to his or her

total oral health, it is the responsibility of the health‑care

professional involved with children to provide comprehensive

care for the child.

 Preventive dental assessment and treatment program can be

incorporated into the well‑baby visits provided by pediatricians.

 By examining the infant for oral problems and by providing early

preventive counseling, it is possible to prevent many forms of

dental
 References

 American Academy of Pediatrics. (2011). A pediatric guide to children’s oral health.

 American Academy of Pediatrics. (2008). Promoting oral health. Bright futures guidelines for health
supervision of infants, children, and adolescents.

 Infant Oral Health Care: An Invaluable Clinical Intervention. Indian Journal of Dental
Sciences.2017 ;16(7):11-77

 IOSR Journal of Dental and Medical Sciences Volume 13,Issue 12(Dec-2014)

 Pediatric dentistry infancy through adolescence fourth edition :Pinkham

 Textbook of pediatric dentistry 3rd edition Nikhil Marwah.

 Guidelines of American academy of Pediatric Dentistry revised in

1989,1994,2001,2004,2009,2011,2012,2014.